Category: Domain 1

Resuscitation and initial management of the acutely ill patient

Neuroprognostication after Cardiac Arrest

Neuroprognostication after Cardiac Arrest

ICM Case SummariesLeave a comment

A 30 year old man suffered a 30 minute cardiorespiratory arrest secondary to an asthma attack. He was resuscitated, had his severe bronchospasm managed and he was treated with therapeutic hypothermia at 33 degrees. Once rewarmed, his neurology was assessed over several days. He was ventilated on a spontaneous mode, but his pupils remained fixed and dilated and there was no higher motor function seen. A CT brain was consistent with severe hypoxic ischaemic injury. After discussion with the family, treatment was withdrawn.

How reliable is neuroprognostication after cardiac arrest? What modalities are tested? Is there a difference in patients treated with therapeutic hypothermia?

Read More »

Therapeutic Hypothermia after Cardiac Arrest (Peri-TTM)

Therapeutic Hypothermia Post-Cardiac Arrest (Peri-TTM)

ICM Case SummariesLeave a comment

An elderly man was resuscitated from out-of-hospital VF cardiac arrest. He remained deeply comatose post ROSC and was ventilated on the intensive care. His temperature control was not actively managed unless hyperthermia developed. 24 hours post admission he started to have myoclonic jerks and his pupils were fixed and dilated. CT brain showed evidence of severe hypoxic ischaemic injury. Treatment was withdrawn at 72 hours after discussion with family.

What is the rationale for the use of therapeutic hypothermia after cardiac arrest?Read More »

Organ Donation After Cardiac Death

DCD Organ Donation: Eligibility and Contra-indications

ICM Case SummariesLeave a comment

A 35 year old man sustained a severe penetrating traumatic brain injury. His injuries were deemed to be unsurvivable, but he was not brainstem dead. He was on the organ donor register, and his family were keen to proceed with donation. He was admitted to the ICU to manage his end of life care and facilitate organ donation after circulatory death.

What are the eligibility criteria and contra-indications to organ donation after circulatory death?Read More »