Critical Care Scenarios Episode 46: Neurologic catastrophe and brain death with Casey Albin
Apr 24, 2022
This episode features Dr. Casey Albin, a neurologist and neurointensivist at Emory, who delves into the intricate world of brain death determination. He unpacks a challenging case of massive hemorrhage, highlighting the critical initial assessments and urgent interventions. Casey discusses effective strategies for managing intracranial pressure and the nuances of family communication regarding prognosis. Additionally, he outlines the meticulous process of brain death testing, from preparing families to interpreting test results, all while emphasizing the importance of clarity throughout.
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Image Early And Check Pupils Immediately
- Get a non-contrast head CT and CTA immediately for large acute neurologic decline to define hemorrhage and possible basilar or brainstem compromise.\n- Check pupils early to guide urgency and next steps like EVD or neurosurgical consult.
Optimize Medically And Consider Early EVD
- Start aggressive medical optimization (mannitol, hypertonic therapy, central access) while discussing goals with family.\n- Early EVD placement is reasonable in large parenchymal hemorrhage with IVH even if hydrocephalus is not yet obvious.
ICH Score Is Biased By Treatment Choices
- The ICH score is biased by withdrawal-of-care decisions and can overestimate poor outcome.\n- Use the ICH score cautiously and avoid self-fulfilling prognostic conclusions.