Subarachnoid Haemorrhage: Initial Management
SAH initial management includes: resuscitation; specific treatment; supportive care and monitoring; disposition
Month January 2019
Subarachnoid Haemorrhage: Prognostication
Subarachnoid Haemorrhage: Prognostication - some factors are modifiable; mortality rates currently ~35%; 15% die prior to reaching hospital; 8-20% long-term dependence
Subarachnoid Haemorrhage (SAH)
Subarachnoid Haemorrhage (SAH) potentially fatal bleeding into the subarachnoid space, usually due to a ruptured cerebral aneurysm
Vasospasm in Subarachnoid Haemorrhage
Vasospasm in SAH: vasospasm = dynamic narrowing of vessels due to a radiological diagnosis; delayed neurological deterioration (DND) is clinically detected neurological deterioration after stabilisation not due to re-bleeding, may be due to multiple other causes; delayed cerebral ischaemia (DCI) is any neurological deterioration >1 hour that presumed due to ischemia, and other causes excluded
Ventriculitis
Bacterial ventriculitis (BV) is inflammation of the ventricular drainage system, usually due to bacterial infection of the cerebrospinal fluid (CSF)
Cerebral Salt Wasting
Cerebral Salt Wasting: also now known as renal salt wasting; hyponatraemia not always required to make diagnosis, but often present; cerebral lesion + excess renal loss of Na+ and Cl-; cerebral lesions: SAH, TBI, tumour
SIADH vs Cerebral Salt Wasting
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) versus Cerebral Salt Wasting
Basal metabolic rate
Basal metabolic rate
Cachexia
Cachexia refers to weight loss and skeletal muscle wasting due to illness where the body does not reduce catabolism (unlike the adaptive reduction in protein metabolism that occurs in starvation). Mechanisms not clearly understood
Daily Nutritional Requirements
Daily Nutritional Requirements
Poor Nutrition in ICU
Poor Nutrition in ICU: the establishment of enteral feeding is considered an important goal
Scleroderma
Scleroderma = autoimmune mediated widespread collagenous deposition. Limited form: Calcinosis, Raynauds, Esophageal dysfunction, Sclerodacytaly and Telangiectasia (CREST syndrome)