Traumatic Brain Injury with Dr. Kristen Smith and Dr. Carly Schmidt (Part 1)

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Sep 23, 2024

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.

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ADVICE

Normalizing Physiology

Prioritize normalizing the patient's physiological parameters (CO2, blood pressure, SPO2).
This helps prevent secondary injury by reducing inflammation and ischemia around the primary injury site.

INSIGHT

Secondary Injury

Secondary brain injury occurs due to a complex cascade of inflammation and ischemia, not a single pathway.
Treat the whole patient, preventing further injury by maintaining normal physiology (blood pressure, glucose, temperature).

ADVICE

CPP Management

Maintain age-appropriate cerebral perfusion pressure (CPP) using guidelines.
Aim for CPP of 40 in 0-5 years, above 50 in 6-17 years, and 50-60 in adults, adjusting MAP as needed.

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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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.