1. Traumatic Brain Injury Management- What Really Happened to the Scarecrow Glenn Carlson APRN, MSN, CCRN Critical Care Clinical Nurse Specialist Bronson Methodist Hospital Kalamazoo, MI

2. TBI case review I have no conflict of interest with any of the information presented in this review. Glenn Carlson APRN, MSN, CCRN I am on the AACN speaker’s bureau

3. Dorothy and tornado http://www. youtube .com/watch?v=5xNA8seaqGQ&feature=related

4. Dorothy meets scarecrow http://www. youtube .com/watch?v= wKrJoih _ uCQ

5. Case 1

6. Case 2

10. Australian doctor uses household drill to save boy- May 20, 2009 MELBOURNE, Australia – A doctor in rural Australia used a handyman's power drill to bore a hole into the skull of a boy with a severe head injury, saving his life. Nicholas Rossi fell off his bike on Friday in the small Victoria state city of Maryborough, hitting his head on the pavement, his father, Michael, said Wednesday. By the time Rossi got to the hospital, he was slipping in and out of consciousness. The doctor on duty, Rob Carson, quickly recognized the boy was experiencing potentially fatal bleeding on the brain and knew he had only minutes to make a hole in the boy's skull to relieve the pressure. But the small hospital was not equipped with neurological drills — so Carson sent for a household drill from the maintenance room. "Dr. Carson came over to us and said, 'I am going to have to drill into (Nicholas) to relieve the pressure on the brain — we've got one shot at this and one shot only,'" Michael Rossi told The Australian newspaper. Carson called a neurosurgeon in the state capital of Melbourne for help, who talked Carson through the procedure — which he had never before attempted — by telling him where to aim the drill and how deep to go. "All of a sudden the emergency ward was turned into an operating theater," Michael Rossi told Fairfax Radio on Wednesday. "We didn't see anything, but we heard the noises, heard the drill. It was just one of those surreal experiences."

18. Brain monitoring early

20. Cerebral oxygenation via Licox

23. July TBI case review Case review

33. Case 1

34. Case 1- video play

35. Case 2

36. Case 2 More Pics

37. Case 2 Videos

41. ICP management- something new CRRT and Intracranial hypertension

42. Fletcher JJ, Bergman K, Feucht EC, Blostein P. Neurocrit Care. 2009 Mar 7. [Epub ahead of print]

44. Fletcher JJ, Bergman K, Feucht EC, Blostein P. Neurocrit Care. 2009 Mar 7. INTRODUCTION: Little is known about the effects of hemodialysis on the injured brain, however; concern exists over the use of intermittent hemodialysis in patients with acute brain injury (ABI) due to its hemodynamic effects and increased intracranial pressure (ICP) associated with therapy. Continuous renal replacement therapy (CRRT) has become the preferred method of renal support in these patients though there is limited data to support its safety. Furthermore, exacerbations of cerebral edema have been reported. CRRT is an option for the treatment of hypervolemia and in theory may improve intracranial compliance. We report the case of a poly-trauma patient with severe traumatic brain injury (TBI) in which CRRT was implemented solely for refractory intracranial hypertension. METHODS: A 28-year-old male was involved in a high-speed motor vehicle collision suffering a severe TBI and polytrauma. He required significant volume resuscitation. Intensive care unit course was complicated by shock, acute respiratory distress syndrome, ventilator associated pneumonia, and development of intracranial hypertension (IH). Data were collected by retrospective chart review. RESULTS: Continuous hemofiltration was initiated for IH refractory to medical therapy. Within hours of initiation increase, ICP improved and normalized. Hemofiltration was safely discontinued after 48 h. Modified Rankin Score was 2 at 90 days. CONCLUSION: Though unproven, CRRT may be beneficial in patients with IH due to gentle removal of fluid, solutes, and inflammatory cytokines. Given the limited data on safety of CRRT in patients with ABI, we encourage further reports.

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54. Resource for families

55. Questions