Neuroprognostication Post Cardiac Arrest (Post TTM Era)

Neuroprognostication Post Cardiac Arrest (Post TTM Era)

A  young adult female with known diagnosis of poorly controlled type 1 diabetes mellitus was admitted with out-of-hospital cardiac arrest. She had only recently been discharged from hospital after an admission with diabetic ketoacidosis. On arrival she had a GCS 3 with minimal respiratory effort. She was in profound DKA. Her temperature was 34.7°C on admission to ICU and she had targeted temperature management aiming for 36°C which was achieved within 2 hours. Her pH had normalised to 7.35 within 8 hours. 48 hours later one pupil became fixed and dilated. CT brain was consistent with global hypoxic ischaemic injury. EEG and SSEP on day 3 revealed severe lack of normal cortical activity. After discussion with family, treatment was withdrawn on day 4.

How do we undertake neuroprognostication after cardiac arrest in the post-TTM era?

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Dexamethasone in Bacterial Meningitis

Dexamethasone in Bacterial Meningitis

A previously healthy 25 year old female was admitted with low GCS and a fever. She had a 24 history of viral symptoms including sore throat and a headache. On admission she had a GCS of 3, temperature of 38.9°C and raised inflammatory markers. She was intubated but did not require vasopressor support. A CT brain showed diffuse cerebral swelling, effacement of the sulci, sylvian fissures, basal cisterns and 3rd/4th ventricles, and early cerebellar tonsillar herniation. Lumbar puncture was not performed due to CT appearances. She was commenced on intravenous (IV) ceftriaxone 2g twice daily, IV acyclovir 800mg three times daily, and IV dexamethasone 10mg four times daily. Unfortunately, her pupils remained fixed and dilated on sedation hold 36 hours later, and she was making no respiratory efforts. She subsequently became a DBD organ donor.

What is the evidence for dexamethasone in bacterial meningitis?

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Meet the team

ICM Case Summaries is brought to you by:


Administrators and Lead Editors


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Prad Shanmugasundaram

Consultant ICM and Anaesthesia

Buckinghamshire Healthcare NHS Trust

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Steve Mathieu

Consultant ICM and Anaesthesia

Portsmouth Hospitals NHS Trust

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Jamie Strachan

ICM and Anaesthesia Specialty Registrar

Oxford University Hospitals NHS Trust

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Editor



Dr F RiccioFran Riccio

ICM Clinical Fellow

Portsmouth Hospitals NHS Trust

 

 


Contributors


ICM Case Summaries would like to thank:

Adrian Wong  twitter icon copy

Consultant ICM & Anaesthesia. Oxford University Hospitals NHS Trust

David Garry twitter icon copy

Consultant ICM & Anaesthesia. Oxford University Hospitals NHS Trust

Dave Slessor twitter icon copy

Specialty Registrar in Intensive Care and Emergency Medicine. Health Education Wessex

Sam Clark

Critical Care Echocardiography Fellow. Oxford University Hospitals NHS Trust

Helen Vollmer twitter icon copy

Specialty Registrar in Intensive Care Medicine and Anaesthesia. Royal Berkshire Hospital NHS Foundation Trust

Duncan Chambler twitter icon copy

Specialty Registrar in Intensive Care Medicine and Anaesthesia. Health Education Wessex

Tahir Ali

Specialty Registrar in Intensive Care Medicine and Anaesthesia. Health Education North East (ICM), Health Eduction Thames Valley (Anaesthesia)

Akshay Shah twitter icon copy

Academic Clinical Fellow in Intensive Care Medicine, Specialty Registrar in Anaesthesia. Oxford University Hospitals NHS Trust

Mirae Shin twitter icon copy

Academic Clinical Fellow in Intensive Care Medicine. Oxford University Hospitals NHS Trust

Stuart McKechnie

Consultant ICM and Anaesthesia, Oxford University Hospitals NHS Trust

Craig Walker twitter icon copy

Consultant ICM, St John’s Hospital, Livingston. Consultant EM, Royal Infirmary of Edinburgh

Katherine Francis

Specialty Registrar in Anaesthesia, Oxford University Hospitals NHS Trust

Stephen Shepherd twitter

Specialty Registrar in ICM and Anaesthesia, Barts Healthcare NHS Trust

Ben Harris twitter

Specialty Registrar in Intensive Care Medicine and Anaesthesia. Health Education Wessex

Emma Fitzgerald twitter

Consultant ICM and Anaesthesia. Queen Alexandra Hospital, Portsmouth

David Hepburn twitter

Locum Consultant ICM. Royal Gwent Hospital, Newport