Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 1994
ReviewThe neurosurgical intensive care unit in an era of health care reform.
Health care reform, public concern, and managed care will create an environment that demands highly creative strategies to deliver quality care while reducing costs. Patient satisfaction and outcomes will take on a high priority. To meet this challenge, the neurosurgical ICU of the future will be designed with a patient-focused theme wherein the physical environment embodies healing and humanism. ⋯ Patient outcomes will be a result of a highly organized collaborative model that includes primary nursing, critical paths, and case management. Partnerships between nurses and unit support staff will create skill-mix changes that allow the nurse to spend less time on nonclinical unit maintenance-type functions and more time with the patient and family. This will have a positive fiscal impact as well as enhance patient satisfaction and outcomes.
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Critical care of a patient with SAH should focus on the prevention or immediate treatment of the common sequelae of this disorder that adversely affect outcome: vasospasm, rebleeding, hydrocephalus, seizures, and associated medical problems. The frequency of rebleeding can be lessened by early surgical or endovascular intervention. The extent of SAH on the CT scan can identify those patients at highest risk for vasospasm, and all patients must be closely monitored in the ICU with serial neurological examinations and transcranial Doppler studies. ⋯ Seizures, which can cause intracranial and systemic hypertension, high cerebral metabolic demand, and delayed neurological injury, should be prevented with prophylactic use of anticonvulsants. In addition, early recognition and treatment of associated medical complications are critical. Novel endovascular approaches, meticulous surgical technique, and aggressive ICU care will undoubtedly lead to improved outcome following aneurysmal SAH.
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Neurosurg. Clin. N. Am. · Oct 1994
ReviewFluid and electrolyte disorders in neurosurgical intensive care.
The management of fluid and electrolytes is an important aspect of the intensive care of patients with intracranial disease and injury because the central nervous system has a critical role in fluid and electrolyte and acid-base homeostasis. This article reviews fluids and electrolytes and acid-base balance, their common disturbances in neurosurgical disorders, and their practical management.
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The subject of spinal cord pathology can be addressed in several ways. This article tackles spinal cord pathology by examining the topic according to purely nosologic criteria. Topics discussed include malformations, traumatic injuries, vascular and circulatory diseases, tumors, infections and inflammatory diseases, demyelinating diseases, toxic-metabolic and nutritional diseases, degenerative diseases, and miscellaneous other disorders.
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Neurosurg. Clin. N. Am. · Jul 1993
ReviewPrimary pontine hemorrhagic events. Hemorrhage or hematoma? Surgical or conservative management?
The pathophysiology of primary pontine hemorrhagic events is unclear, but the traditional classification of hemorrhage or hematoma does not have either pathologic or clinical support. Reported cases of brain stem hemorrhage suggest that patients who suffer progressive deterioration from hemorrhagic pontine lesions may benefit from surgery even if they eventually become comatose, whereas those who suddenly lose consciousness and have profound neurologic deficit probably will not survive.