Neuro ICU Procedure Atlas

Cover
Title Page
Copyright
Contents
Preface
Contributors
1 External Ventricular Drain
	1.1 Introduction
	1.2 Relevant Anatomy and Physiology
	1.3 Indications
		1.3.1 ICP Monitoring
		1.3.2 CSF Diversion
		1.3.3 Intrathecal Access
	1.4 Contraindications
	1.4.1 Special Situations
	1.5 Equipment
	1.6 Technique
		1.6.1 Preparation
		1.6.2 Medications
		1.6.3 Positioning/Equipment Setup
		1.6.4 Procedure
		1.6.5 Alternative Approaches
	1.7 Complications
		1.7.1 Infection
		1.7.2 Hemorrhage
		1.7.3 Upward Herniation
		1.7.4 Aneurysm Re-rupture
		1.7.5 Motor Cortex Injury
		1.7.6 Superior Sagittal Sinus Injury
	1.8 Expert Suggestions/Troubleshooting
		1.8.1 Scalp Bleeding
		1.8.2 Entry Site
		1.8.3 Tunneling Direction
		1.8.4 Fracture Lines/Cranial Defects
		1.8.5 Ventricular Collapse
2 Shunt Tap and Shunt Externalization
	2.1 Introduction
	2.2 Relevant Anatomy and Physiology
	2.3 Indications—Shunt Tap
	2.4 Contraindications—Shunt Tap
	2.5 Equipment—Shunt Tap
	2.6 Technique—Shunt Tap
		2.6.1 Preparation
		2.6.2 Medications
		2.6.3 Positioning/Equipment Setup
		2.6.4 Procedure
	2.7 Indications—Shunt Externalization
	2.8 Contraindications—Shunt Externalization
	2.9 Equipment—Shunt Externalization
	2.10 Technique—Shunt Externalization
		2.10.1 Preparation
		2.10.2 Medications
		2.10.3 Positioning/Equipment Setup
		2.10.4 Procedure
	2.11 Complications
		2.11.1 Infection
		2.11.2 Catheter Retraction
		2.11.3 Air Lock of Shunt System
	2.12 Expert Suggestions/Troubleshooting
		2.12.1 Inability to Tap Shunt Valve
		2.12.2 Distal Catheter Resistance
		2.12.3 Partial Retraction of the Shunt Catheter
3 Lumbar Puncture
	3.1 Introduction
	3.2 Relevant Anatomy
		3.2.1 Cerebrospinal Fluid
		3.2.2 Lumbar Spine
	3.3 Indications
		3.3.1 Obtain a CSF Sample
		3.3.2 Measure Pressure
		3.3.3 Therapeutic Drainage
	3.4 Contraindications
		3.4.1 Intracranial Space-Occupying Lesion or Existing Brain Shift
		3.4.2 Obstructive Hydrocephalus
		3.4.3 Coagulopathy/Clotting Dysfunction/Bleeding Disorder
		3.4.4 Insertion Site Infection
	3.5 Equipment
	3.6 Technique
		3.6.1 Patient Positioning
		3.6.2 Preparation
		3.6.3 Needle Insertion
		3.6.4 Pressure Measurement
		3.6.5 CSF Collection
		3.6.6 Closure
	3.7 Complications
	3.8 Expert Suggestions/Troubleshooting
4 Lumbar Drain
	4.1 Introduction
	4.2 Relevant Anatomy/Physiology
	4.3 Indications
		4.3.1 Craniotomy
		4.3.2 Endoscopic Skull Base Surgery
		4.3.3 CSF Leak
		4.3.4 Normal Pressure Hydrocephalus
		4.3.5 Thoracoabdominal Aortic Surgery
		4.3.6 Miscellaneous
	4.4 Contraindications
		4.4.1 Intracranial Mass Lesion
		4.4.2 Obstructive Hydrocephalus
		4.4.3 Skin Infection/Spinal Epidural Abscess
		4.4.4 Coagulopathy/Thrombocytopenia/Anticoagulant Therapy
	4.5 Equipment
	4.6 Technique
		4.6.1 Positioning and Equipment Setup
		4.6.2 Procedure
	4.7 Complications
		4.7.1 Headache
		4.7.2 Cerebral Herniation
		4.7.3 Infection
		4.7.4 Retained Catheter
		4.7.5 Spinal Cord Injury/Parethesia
	4.8 Expert Suggestions/Troubleshooting
		4.8.1 Overdrainage
		4.8.2 Catheter Shearing
		4.8.3 No CSF Egress
		4.8.4 Severe Pre-existing CSF Leak
	4.9 Conclusion
5 Parenchymal Intracranial Pressure Monitor
	5.1 Introduction
	5.2 Relevant Anatomy and Physiology
	5.3 Indications
		5.3.1 Recommendations from the 4th Edition Brain Trauma Foundation Guidelines
		5.3.2 Recommendations from the Prior (3rd) Edition Not Supported by Evidence Meeting Current Standards
	5.4 Contraindications
	5.5 Equipment
	5.6 Technique
		5.6.1 Preparation
		5.6.2 Medications
		5.6.3 Positioning/Equipment Setup
		5.6.4 Procedure
		5.6.5 Postprocedure
	5.7 Complications
		5.7.1 Infection
		5.7.2 Hemorrhage
		5.7.3 Motor Cortex Injury
		5.7.4 Superior Sagittal Sinus Injury
	5.8 Expert Suggestions/Troubleshooting
		5.8.1 Scalp Bleeding
		5.8.2 Entry Site
		5.8.3 Aberrant ICP Measurement
6 Brain Tissue Oxygenation: Procedural Steps and Clinical Utility
	6.1 Introduction
	6.2 Relevant Anatomy and Physiology
		6.2.1 Anatomic Considerations
		6.2.2 Physiologic Principles
		6.2.3 Devices
	6.3 Indications
	6.4 Contraindications
	6.5 Equipment
		6.5.1 Pre-Op Checklist and Equipment/Supplies
		6.5.2 Sedation
	6.6 Technique
		6.6.1 Positioning
		6.6.2 Incision Planning
		6.6.3 Prep and Drape
		6.6.4 Incision and Twist Drill
		6.6.5 Dural Opening
		6.6.6 Probe Placement and Securement
		6.6.7 Connection to Monitoring System
		6.6.8 Closure and Dressing
		6.6.9 Postprocedure Imaging
	6.7 Complications
		6.7.1 Hemorrhage
		6.7.2 CSF Leak
		6.7.3 Skull Fracture
		6.7.4 Infection
	6.8 Expert Suggestions/Troubleshooting
		6.8.1 Sedation Issues
		6.8.2 Positioning Issues and Tips
		6.8.3 Scalp Bleeding and Avoidance
		6.8.4 Craniotomy Angulation and Tips
		6.8.5 Dural Opening
		6.8.6 Probe Pull-Out and Avoidance
	6.9 Conclusion
7 Jugular Bulb Oxygen Monitor
	7.1 Introduction
	7.2 Relevant Anatomy and Physiology
	7.3 Indications
	7.4 Contraindications
	7.5 Equipment
	7.6 Technique
	7.7 Complications
	7.8 Expert Suggestions/Troubleshooting
8 Central Line
	8.1 Introduction
	8.2 Anatomy/Physiology
		8.2.1 Subclavian Vein Anatomy
		8.2.2 Internal Jugular Vein Anatomy
		8.2.3 Femoral Vein Anatomy
	8.3 Indications
	8.4 Contraindications
	8.5 Equipment
		8.5.1 Catheter Types
	8.6 Technique
		8.6.1 Subclavian Vein Technique
		8.6.2 Femoral Vein Technique
		8.6.3 Internal Jugular Vein Technique
	8.7 Complications
	8.8 Expert Suggestions/Troubleshooting
9 Arterial Line
	9.1 Introduction
	9.2 Anatomy/Physiology
	9.3 Indications
		9.3.1 Measurement of Intra-arterial Blood Pressure
		9.3.2 Arterial Access for Frequent Blood Sampling
	9.4 Contraindications
	9.5 Equipment
	9.6 Technique
	9.7 Complications
	9.8 Expert Suggestions/Troubleshooting
10 Cervical Traction
	10.1 Introduction
	10.2 Relevant Anatomy and Physiology
		10.2.1 Cervical Spine Anatomy
		10.2.2 Pathophysiology of Cervical Traction
	10.3 Indications
		10.3.1 Facet Dislocations
		10.3.2 Displaced or Angulated Hangman’s Fractures
		10.3.3 Displaced or Angulated Type II Odontoid Fractures
		10.3.4 Rotary Atlantoaxial Subluxations
		10.3.5 Subaxial Burst Fractures
	10.4 Contraindications
	10.5 Equipment
		10.5.1 Gardner-Wells Tongs
		10.5.2 Halo Ring
		10.5.3 Modified Hospital Bed
		10.5.4 Weight
		10.5.5 Halo Vest
	10.6 Technique
		10.6.1 Patient Assessment
		10.6.2 Tong Placement
		10.6.3 Patient Positioning
		10.6.4 Weight Application
		10.6.5 Neurological Monitoring
		10.6.6 Radiographic Assessment
	10.7 Complications
	10.8 Expert Suggestions/Troubleshooting
		10.8.1 Resource Management
		10.8.2 Halo Vest
		10.8.3 Force Vector
		10.8.4 Converting to Open Reduction and Internal Fixation
	10.9 Conclusion
11 Intubation
	11.1 Introduction
	11.2 Relevant Anatomy/Physiology
	11.3 Indications
		11.3.1 Airway
		11.3.2 Lung
		11.3.3 Tissue
	11.4 Contraindications (and Precautions)
		11.4.1 General Assessment for Difficult Airway
	11.5 Equipment
	11.6 Technique
		11.6.1 Using Direct Laryngoscope (the Curved Macintosh Blade or the Straight Miller Blade)
		11.6.2 Using Video Laryngoscope (Glidescope)—“Down, Up, Down, Up”
		11.6.3 Complications/Precautions
		11.6.4 Difficult Airway Algorithm
		11.6.5 Supraglottic Assist Devices
	11.7 Expert Suggestions/Troubleshooting
	11.8 Special Circumstances
		11.8.1 Intubation of Patients with Maxillofacial Injury
		11.8.2 Intubation of Patients with Cervical Spine Trauma
		11.8.3 Intubation of Patients with Dislodged Tracheostomy Tube
		11.8.4 Intubation of Patients Post Carotid Endarterectomy or Cervical Spine Surgery
		11.8.5 Intubation of Patients Post Transphenoidal Surgery
		11.8.6 Intubation of Patients with Moya-Moya
		11.8.7 Intubation of Morbidly Obese Patients
12 Cricothyrotomy
	12.1 Introduction
	12.2 Relevant Anatomy and Physiology
	12.3 Indications
	12.4 Contraindications
	12.5 Equipment
	12.6 Technique
		12.6.1 Preparation
		12.6.2 Medications
		12.6.3 Positioning/Equipment Set-up
		12.6.4 Procedure
	12.7 Complications
		12.7.1 Acute Complications
		12.7.2 Delayed Complications
	12.8 Expert Suggestions/Troubleshooting
		12.8.1 Controlled Chaos
		12.8.2 Time Management
		12.8.3 Don’t Lose the Airway
13 Chest Tube Insertion
	13.1 Introduction
	13.2 Relevant Anatomy/Physiology
	13.3 Indications
		13.3.1 Emergency Indications
		13.3.2 Nonemergent Indications
	13.4 Contraindications
	13.5 Equipment
	13.6 Technique
		13.6.1 Preparation
		13.6.2 Seldinger Technique
		13.6.3 Standard Technique
	13.7 Removal
		13.7.1 Technique for Removal
	13.8 Complications
	13.9 Expert Suggestions/Troubleshooting
Index