Neurotrauma

Part 1 - Resuscitation 1) Does it matter how head-injured or spinal cord-injured patients are resuscitated? Initial Evaluation/Assessment 2) What's the best way to assess & classify head-injured patients? 3) What's the best way to assess & classify spinal-cord injured patients? 4) When are CT scans & skull x-rays indicated for patients with minor head injury? 5) What's the best way to rule out spine or spinal cord injury in a trauma patient, especially wjen head injury is present? 6) How can I decide that a heaf-injured patient can't be salvaged? Basic ICU Management 7) Can special beds reduce the incidence of complication in head-injured and spinal cord-injured patients? 8) How soon should patients receive nutrition? How much & by which route? 9) What's the safest way to prevent DTV and PE after head or spinal-cord injury? How soon after surgery can I anticoagulate my patients who develop DTV? Part 2 - Head Injury Monitoring 10) When & how should I monitor ICP? 11) Should I monitor jugular venous oxygen saturation? 12) Should I monitor PO2 brain tissue? 13) Should I monitor cerebral blood flow? General Management 14) Does raising cerebral perfusion pressuer help head-injured patients? 15) What is the optimal hematocrit & hemoglobin for head-injured patients? 16) Should I restrict fluids or use hypertonic saline to treat low sodiu? Is there a safe upper & lower limit for serum sodium & serum osmolarity in head-injured patients? 17) When should follow-up CT scans be obtained? 18) Do patients with ventriculostomies need prophylactic antibioyics? 19) Do head-injured patients need prophylactic anticonvulsants? For how long? 20) Are steroids indicated in treatment of head injury? 21) Does following the recommendations in the "Guidelines for the Management of Severe Head Injury" make a difference in patient outcomes? 22) Can I say "no" if a family wants to support a vegetative patient forever? 23) Why have therapeutic trials in head injury been unable to demonstrate benefits? Treatment of Elevated Intracranial Pressure 24) Do paralysis & sedation really help head-injured patients? 25) Is there a "best" way to give mannitol? 26) Should I use hypertonic saline to treat high intracranial pressure? 27) Does barbiturate coma help improve outcome from head injury? 28) Does hypothermia help improve outcome? 29) Does decompressive craniectomy help improve outcome for head injury? 30) What are the best ventilator settings for head-injured patients? What is the role of hyperventilation? 31) Is a "good CPP" better than a "controlled ICP?" 32) What's the best algorithm for treating intracranial hypertension? Polytrauma Patient 33) Simultaneous head injury and abdominal injury: Which gets operatedon first, and which has higher treatment priority? 34) When is it safe to let the orthopedic surgeons operate on long-bone fractures in head-injured patients, and when should these patients be monitored? Pediatric Head Injury 35) When should I suspect child abuse in head-injured children? 36) Is pediatric head injury really different than adult head injury? Part 3 - Spinal Cord Injury General Management 37) Does methylprednisolone really help patients with spinal cord injury? 38) Are there new therapies that improve outcome in spinal cord-injured patients? 39) How do I decide it's safe to extubate a newly quadriplegic patient? 40) How do I diagnose & manage SCIWORA? Surgical Treatment 41) Do I need to decompress patients with spinal cord injury? 42) When is surgery indicated for patients with gunshot wounds to the spine? Part IV - Postacute Care 43) What is the outcome of patients with mild, moderate & severe head injury? 44) How well can patients be expected to recover after spinal cord injury? 45) Does rehabilitation really help head-injured patients? 46) Does rehabilitation facilitate neurological recovery after spinal cord injury? Part V - Sports Medicine 47) When should I refuse to let an athlete return to the game after a concussion, and when is it safe to let him/her return? Is there a cummulative effect of repeated concussions? 48) How soon after a head injury (with or without craniotomy) can patients resume contact sports? 49) How important are stingers? 50) Do recommendations differ for high school, collegiate and professional athletes? Part VI - Trauma systems 51) Who should be in charge of neurotrauma patients? Do patients with head or spinal cord injury require a specialized neurosurgical intensive care unit? 52) Should head-injured patients be brought to the nearest hospital, or to a hospital with neurosurgical capability that is further away?