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Jeffrey Siegler
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Jeffrey Siegler

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Has anyone heard of anything that states that giving a dose of mannitol in an ICH with increased ICP and decreasing mental status is as effective as a decompressive craniotomy as far as reversing the brainstem herniation?

The neurosurgery residents were not thrilled at our decision to intubate the patient semi-electively and were trying to get us to give mannitol to act like a reversal agent. My attending and I weren't buying it. The patient was successfully intubated without hypoxia or hypotension. 
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Oliver Hawksley's profile photoSteve Carroll's profile photo
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Jeff

I was meaning to comment this for a while.  My 0.02- prevention of hypoxia and hypotension >>>> mannitol.  The evidence for mannitol is not that great but we do know that hypotenstion and hypoxia definitely increase mortality.  It's much more important to secure that airway than delay it to get mannitol on board.  I have never seen anyone get mannitol and then start dancing a jig ala a narcan resurrection.  Take the airway early with maximal attention to prevention of hypotension and desaturation and that will get the best outcomes.

Scott has a page on his crashingpatient.com website that reviews the literature for all of things around head injury (and resuscitation medicine in general).  There is one article that suggest rapid loading with a large amount of mannitol (> 1.4 grams/kg) may prevent death in crashing head injury patients who may have been previously unsalvageable.  I haven't read the study myself (bad EBM person!  bad!) but I still contend that airway trumps mannitol.

Here's the link:

http://crashingpatient.com/trauma/severe-traumatic-brain-injury.htm/

Hope that helps

Steve
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Jeffrey Siegler

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Any chance the ENLS protocols will be made into a mobile app? 
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EMCrit
 
We are considering it!
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Jeffrey Siegler

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Hello all. I am preparing a grand rounds on damage control resuscitation. I would like to include the latest literature on RSI/damage control anesthesia. I have already watched Scott's lecture from SMACC and have the Dutton paper from 2005. Any other papers/FOAMed lectures anyone can recommend?

Thanks,

Jeff
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Søren Steemann Rudolph's profile photoMinh Le Cong's profile photo
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Update in Trauma Anesthesiology: Perioperative
Resuscitation Management
Joshua M. Tobin, MD* and Albert J. Varon, MD, MHPE
Anasthesia & ANALGESIA

December 2012

Volume 115

Number 6

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Jeffrey Siegler

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Just listened to your tubing the shocked patient talk. Pure gold. Definitely practice changing. 
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EMCrit's profile photoMinh Le Cong's profile photo
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am saving the podcast for a long flight tomorrow! cant wait!
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Jeffrey Siegler

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Scott,

Any updates on the status of the online ENLS course? The protocols on the website are great, btw! 
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EMCrit's profile photoJonathan Downham's profile photoJeffrey Siegler's profile photo
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Www.Enlscourse.org
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Google Wave 2.0???
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Alan Scott Droutsas's profile photoChristopher Sponaugle's profile photoNash Mendlinger's profile photo
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Hi Jeffery! Hows Jacque doing?

Jeffrey Siegler

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First post....
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