Thread by @gretchemaben

Next up for tweet-ucation is “Fundamentals of Neurocritical Care for the Medical ICU”! #CHEST2020

First up is "Acute Ischemic Stroke" with @drdangayach #CHEST2020

Every 4 minutes someone dies of a stroke! #CHEST2020

Make sure you know how to activate the stroke system at your hospital! ABCs always come first! #CHEST2020

Classic signs of strokes by distribution. #CHEST2020

If you see perfusion mismatch it indicates brain at risk! #CHEST2020

Know your TPA contraindications and remember to give it within the 4.5 hour window! #CHEST2020

The risk of hemorrhage with TPA is about 6%. #CHEST2020

This slide reviews the TPA approvals over the years. #CHEST2020

The ASPECTS score helps estimate the risk of bleeding. #CHEST2020

Evolution of thrombectomy trials #CHEST2020

There were early negative trials. #CHEST2020

Later trials required proven vessel occlusion, and those were positive. #CHEST2020

Faster reperfusion = Better outcomes. #CHEST2020

The DEFUSE and DAWN trials extended the thrombectomy window. #CHEST2020

The EXTEND study used perfusion imaging to determine whether TPA could be used later. #CHEST2020

Summary Points #CHEST2020

The next session is "Non-Convulsive Status Epilepticus in teh MICU" with @sshoskote! #CHEST2020

Definition and Classification #CHEST2020

Non-convulsive status epilepticus basics #CHEST2020

Etiologies of status epilepticus #CHEST2020

When to suspect NCSE in the ICU #CHEST2020

Negative and positive symptoms you can see in NCSE #CHEST2020

Basic initial diagnostics and management #CHEST2020

EEG is essential in diagnosing NCSE due to lack of specific clinical features. #CHEST2020

Situations where you should use continuous EEG include coma post-arrest, epileptiform discharged on 30-min EEG, ICH, and recent seizure without return to baseline within10 min. #CHEST2020

Continuous EEG in NCSE #CHEST2020

Other diagnostics in NCSE that can be helpful include MRI, LP, and toxicology. #CHEST2020

You can do an AED trial as a diagnostic test. #CHEST2020

How aggressive should we be in treating NCSE? #CHEST2020

Refractory NCSE (lack of response to 2 or more AEDs) is associated with a poor prognosis. #CHEST2020

Conclusions #CHEST2020

The next session is "Management of ICP Crisis in the MICU" with Dr. Joshua Botdorf! #CHEST2020

There are many different ways to approach ICP management. Some methods are step-wise, and others are more of a bundled type. #CHEST2020

One of the easiest things you can do is elevate the HOB. Keep the head midline to avoid jugular compression. #CHEST2020

After raising the HOB the next goal is hypervetilation to a PaCO2 of 25-34 mm Hg. This is a TEMPORARY measure. #CHEST2020

Complications of hyperventilation/hypocapnia #CHEST2020

The next step in ICP treatment is osmolar therapy. #CHEST2020

RCT of sodium bicarb showed it's as effective as sodium chloride #CHEST2020

Progression of therapies #CHEST2020

After you've temporized the patient's ICP the next step is to call neurosurgery. #CHEST2020

Decompressive hemicraniectomy has been shown to lead to improved survival, but many still have disability. Best done within 48 hours. Patients over 60 have worse outcomes. #CHEST2020

Thanks to our wonderful panel of speakers! #CHEST2020