Traumatic Brain Injury with Dr. Kristen Smith and Dr. Carly Schmidt (Part 1)
Sep 23, 2024
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In this engaging discussion, Dr. Kristen Smith, PICU medical director at the University of Michigan, and Dr. Carly Schmidt, a critical care fellow, delve into managing traumatic brain injuries in children. They share insights on neuroprotective measures essential for severe TBIs and the complexity of critical care management. Topics include optimizing oxygen delivery and personalized sedation strategies, emphasizing the importance of monitoring and adapting treatment to improve outcomes for young patients.
Neuroprotective measures must be prioritized in pediatric traumatic brain injury management to prevent secondary injuries and optimize recovery.
Collaborative effort among medical professionals is crucial for effective management and patient safety in cases of traumatic brain injury.
Flexible sedation protocols tailored to individual patient needs are essential for effective pain management and neurological stability in TBI patients.
Deep dives
Understanding Traumatic Brain Injury Management
Traumatic brain injury (TBI) management involves a comprehensive approach aimed at preventing further injury while optimizing recovery. Key considerations include maintaining normal physiological parameters such as CO2 levels, blood pressure, and oxygenation to mitigate secondary injuries. The podcast emphasizes the significance of monitoring and interventions immediately following the injury, such as placing an intracranial pressure monitor to gauge levels and guide therapy. The importance of collaboration among medical professionals in ensuring patient safety and effective management is also highlighted, demonstrating the multidimensional nature of TBI care.
Clinical Protocols and Monitoring Techniques
Clinical protocols for managing pediatric TBI patients include using age-related estimates for cerebral perfusion pressure (CPP) and actively monitoring invasive parameters like intracranial pressure. Practitioners aim to maintain a target CPP range specific to the patient's age, actively adjusting treatment based on continuous monitoring. The use of near-infrared spectroscopy (NIRS) is stressed as a valuable tool for assessing cerebral oxygenation, providing real-time feedback on brain health. The podcast points out that achieving optimal monitoring practices can facilitate timely interventions and improve patient outcomes.
Sedation Strategies in TBI Management
Choosing appropriate sedation for TBI patients involves careful consideration of the patient's clinical status and response to interventions. Propofol is often utilized for its rapid onset, but longer-acting agents like dexmedetomidine may also be employed based on individual needs. Additionally, managing pain control is crucial, with options like fentanyl recommended for its short-acting characteristics. The discussion highlights the necessity for flexibility and tailored approaches in sedation protocols, emphasizing the need for continuous assessment to ensure effective pain management and neurological stability.
Temperature and Hemodynamics Management
Maintaining a controlled temperature range for TBI patients is critical in preventing fever-related complications and promoting better neurological recovery. Medical professionals typically aim to keep patients in the range of 35 to 36.5 degrees Celsius to avoid adverse effects of hypothermia on coagulation. The discussion surrounding hemodynamic monitoring introduces the use of tools like Rotem to assess coagulation status, particularly in trauma patients. Proper management ensures that patients are not only warm but also adequately perfused, which is essential for healing and recovery in pediatric TBI cases.
Seizure Prevention and Management in TBI
Seizures are a potential complication following TBIs, necessitating proactive monitoring and management strategies to minimize their impact. The practice of conducting EEG monitoring soon after the injury is emphasized as a way to detect seizure activity in a timely manner. Furthermore, the podcast discusses the use of preventative medications, like Keppra, to reduce the risk of post-traumatic seizures during the first week post-injury. This approach underscores the importance of early detection and preventative care in enhancing long-term outcomes for pediatric TBI patients.
Dr. Kristen Smith is the PICU medical director, critical care fellowship program director, and director of the nurse practitioner program at the University of Michigan C.S. Mott Children’s Hospital. She received her medical degree from the University of Toledo and completed her pediatric residency at Akron Children’s Hospital, followed by a critical care fellowship at Johns Hopkins. Dr. Smith’s research is focused on the long-term outcome of Pediatric Intensive Care Unit (PICU) survivors.
Dr. Carly Schmidt is a critical care fellow at the University of Michigan C.S. Mott Children’s Hospital. She received her medical degree from Case Western University and completed her pediatric residency at Brown University, where she also served as chief resident. Carly is interested in the intersection of the PICU and the community via transport medicine, advocacy, and outcomes.
Learning Objectives:
By the end of this podcast, listeners should be able to describe:
Neuroprotective measures that should be provided to all pediatric patients with severe traumatic brain injury (TBI).
An expert, guideline-directed approach to managing a child with increased intracranial pressure due to severe TBI.
Reference: Kochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, Selden NR, Bratton SL, Grant GA, Kissoon N, Reuter-Rice KE, Wainwright MS. Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies. Pediatr Crit Care Med. 2019 Mar;20(3):269-279.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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