Traumatic Brain Injury with Dr. Kristen Smith and Dr. Carly Schmidt (Part 2)

54 snips

Sep 30, 2024

In this riveting discussion, Dr. Kristen Smith, the 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 cover crucial neuroprotective measures and how to adeptly handle increased intracranial pressure. Key insights include strategies for cerebral edema management, the challenges of existing treatments, and the importance of clear communication with families during recovery. Their expertise sheds light on hope, collaboration, and the evolving landscape of pediatric TBI care.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

ADVICE

Acute ICP Management

When ICP acutely rises, assess what changed and revert if possible.
Give 5 ml/kg of 3% saline, re-sedate, check vitals, and consider neuromuscular blockade.

ADVICE

Initial Sodium Targets

Aim for sodium targets of 145-155 mEq/L in TBI patients initially.
Avoid higher initial targets as they limit rescue options later.

INSIGHT

Mannitol's Drawbacks

Mannitol is less favored for TBI due to practical drawbacks and risks.
It's difficult to administer, can crystallize, and may worsen outcomes with a disrupted blood-brain barrier.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

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.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

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.