Devastating Brain Injuries
The Resus Room
Simon Laing
4.9 • 708 Ratings
🗓️ 12 February 2018
⏱️ 14 minutes
🧾️ Download transcript
Summary
On a not infrequent basis we will come across patients in hospital who have a CT head scan that appears to show an unsurvivable event. Having sourced opinion from our neurosurgical and neurology colleagues we may well be given the advice to withdraw care for the patient.
It has become increasingly recognised that prognosticating in such patients at an early stage is extremely difficult with numerous cases surviving what was initially thought to be an unsurvivable event, with a good neurological outcome.
This joint document from the Intensive Care Society, Royal College of Emergency Medicine, Neuro Anaesthesia and Critical Care Society of Great Britain & Ireland and the Welsh Intensive Care Society gives new guidance for such perceived devastating brain injuries and will challenge many peoples thinking on the topic with additional questions being asked on resource utilisation.
In this podcast Caroline Leech, EM and PHEM Consultant in Coventry, discusses the guidelines and the implications they hold for our practice.
As always make sure you read the document yourself, we would love to hear your thoughts.
Enjoy!
Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement
Transcript
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| 0:00.0 | Welcome to the Recess Room podcast. |
| 0:03.9 | Five, four, three, two, one, fire. |
| 0:13.4 | So hi, and welcome back to the Recess Room podcast. I'm Simon Lang, and I'm joined by Caroline Leach, |
| 0:20.1 | an EM and Fem consultant based in Coventry. |
| 0:24.1 | And today we're going to be talking about devastating brain injuries. |
| 0:28.5 | Yeah, we're talking about the management of perceived devastating brain injury after hospital admission. |
| 0:33.9 | This is a consensus document which was published in January 2018 and endorsed by all the relevant organisations, so intensive care, emergency medicine and neurosurgical organisations. |
| 0:46.1 | It's really important, I think, for all of us who work in those three specialties in how we're going to manage this group of patients. |
| 0:53.0 | There has been a lot of talk about this online and about resource utilization, about making |
| 0:58.0 | end-of-life care decisions. |
| 1:00.2 | So yeah, it does really affect us, doesn't it? |
| 1:01.7 | There's also a fantastic blog out there that's on St Emlins, which we'll put a link to as well. |
| 1:05.8 | So definitely go and have a read of that as well. |
| 1:10.2 | So let's just start off by defining what we mean by devastating |
| 1:14.0 | brain injury. I don't think it's a term that we've used commonly in the past. And for the purpose of |
| 1:19.9 | this statement, it's defined as any neurological condition that is assessed at the time of hospital |
| 1:25.6 | admission as an immediate threat to life or incompatible |
| 1:28.9 | with good functional recovery and where you're considering withdrawal of therapy. And so we're not |
| 1:34.8 | just talking about traumatic brain injury with a horrific CT scan. We're also talking about those patients |
| 1:40.6 | who have spontaneous aneurysmal subarachnoid hemorrhages, patients who've had |
| 1:44.9 | stroke, and also hypoxic brain injuries. So think about the cardiac arrest where they have a |
| 1:49.8 | rask but have a GCS of three, patients who've had hanging, they're all in the same sort of group |
... |
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