INTENSIVE CARE IN NEUROLOGY AND NEUROSURGERY - Pathophysiological Basis for the Management of Acute Cerebral Injury [Godoy - Seed]
- ISBN/EAN
- 9788897419396
- Editore
- Seed
- Formato
- Brossura
- Anno
- 2013
- Pagine
- 1791
Disponibile
170,00 €
200,00 €
This volume presents the work of a group of international experts in neurocritical care. This book provides the physician with a quick and practical tool for consultation and it’s dedicated to brain-injured and neurocritically ill patients and provides the physician with a quick and practical tool for consultation. The management of these patients constitutes a growing subspecialty that remains unrecognized by many international medical associations but has played a prominent role in intensive care over the last two decades. Neurocritical care as a subspecialty evolved from the need to provide highly specialized care to neurosurgical patients. Later, patients with severe traumatic brain injury (TBI), hemorrhagic stroke, and acute central nervous system disorders were included in this line of care. Each of these patients requires specialists who are knowledgeable of their particular clinical situations in addition to rapid and often complex management of intracranial hypertension, technical equipment, and skilled nurses.
This book arrives in an era of electronic information sharing, and in the field of neuroscience, one of the fastest moving. If completeness was the aim, the book will look as a library, and would become outdated tomorrow. But the aim is to be of practical use, and to assist the clinical practice of the busy physician. Then clarity and synthesis have been the priority, rather than academic perfection. The intelligent reader will find what is necessary for starting, rather than finishing, his approach to neurointensive care. If this book will reinforce interest and curiosity, suggesting further reading and research, it will have accomplished a valuable goal.
Maggiori Informazioni
| Autore | Godoy Daniel Agustín |
|---|---|
| Editore | Seed |
| Anno | 2013 |
| Tipologia | Libro |
| Lingua | Inglese |
| Indice | SECTION 1. Introduction to Neuroinjury 1 Neuroscience Critical Care: Two Experts’ Point of View................................................. 3 1.1 History, Organization, and Vision for the Future: Prof. Mirski’s Point of View....... 3 1.2 NICU Organization: Past, Present and Future: Prof. Robertson’s Point of View... 10 References........................................................................................................... 20 2 Basic Anatomy Applied to the Interpretation of Axial Tomography of the Brain in Emergency Medicine............................................................................. 27 2.1 Introduction......................................................................................................... 27 2.2 Development....................................................................................................... 27 2.3 Key Concepts........................................................................................................ 36 2.4 Appendix: Images................................................................................................. 36 References........................................................................................................... 51 General References.............................................................................................. 51 3 Physiological Basis for the Correct Interpretation of Different Situations in Acute Cerebral Injury...... 53 3.1 Functional and Structural Organization of the Nervous System.......................... 53 3.2 The Blood-Brain Barrier (BBB).............................................................................. 55 3.3 Cerebrospinal Fluid (CSF)..................................................................................... 56 3.4 Aquaporins (AQP)................................................................................................ 57 3.5 Intracranial Pressure............................................................................................ 58 3.6 Cerebral Volume/Pressure Curve (V/P). Cerebral Compliance............................. 59 3.7 Intracranial Pressure Curve.................................................................................. 60 3.8 Cerebral Oxygen Metabolism............................................................................... 61 3.9 Cerebral Blood Flow (CBF)................................................................................... 62 3.10 Oxygen Tissue Pressure (ptiO2)............................................................................ 64 3.11 Cerebral Glucose Metabolism.............................................................................. 65 3.12 Cerebral Temperature.......................................................................................... 65 3.13 Brain-systemic Temperature Gradient................................................................. 66 3.14 Concept of Primary and Secondary Injury........................................................... 68 General References.............................................................................................. 68 4 Examination of the Critically Ill Neurological Patient................................................... 71 4.1 Clinical Evaluation (or Examination) of the Critically Ill Neurological Patient...... 71 4.2 General Examination............................................................................................ 72 4.3 Comprehensive Neurological Examination.......................................................... 74 4.4 Routine Investigations of the Neurocritical Patient ............................................. 74 4.5 Focused Neurological Examination of Selected Topics ........................................ 75 References......................................................................................................... 101 General References............................................................................................ 102 5 Evaluation Scales in Neurocritically Ill Patients.......................................................... 105 5.1 Objectives.......................................................................................................... 105 5.2 Introduction....................................................................................................... 105 5.3 Evaluation in the Acute Phase............................................................................ 105 5.4 Imaging-based Assessment Scales..................................................................... 114 5.5 Scale of Evolution, Evaluation of Consciousness in Advanced Stages of Brain Injury Outcome Scales.......................................................................... 123 General References............................................................................................ 129 SECTION 2. Neuromonitoring 6 Neuroimage Monitoring in the Management of Neurocritical Care Patients............ 135 6.1 Introduction....................................................................................................... 135 6.2 CT in Head-injured Patients............................................................................... 137 6.3 CT in Patients With Cerebrovascular Hemorrhagic Disease............................... 145 6.4 CT in the Diagnosis of Acute Ischemic Cerebrovascular Diseases ..................... 152 6.5 Conclusions........................................................................................................ 156 References......................................................................................................... 156 7 Intracranial Pressure Monitoring. Acute Cerebral Injury: the First 48 Hours............ 159 7.1 Intracranial Pressure.......................................................................................... 159 7.2 Techniques for Monitoring Intracranial Pressure............................................... 160 7.3 The ICP Waveform.............................................................................................. 161 7.4 Elevated Intracranial Pressure and Pressure Waves........................................... 163 7.5 Cerebral Perfusion Pressure............................................................................... 165 7.6 Cerebral Autoregulation..................................................................................... 165 7.7 Indications for ICP Monitoring........................................................................... 166 7.8 Conclusions........................................................................................................ 166 References......................................................................................................... 166 8 Update on Brain Tissue Oxygen Monitoring in TBI and Other Acute Cerebral Disorders....................................................................................................... 169 8.1 Introduction....................................................................................................... 169 8.2 Approaches to Monitoring Cerebral Oxygenation............................................. 170 8.3 Hyperemia and Arterial pCO2 ............................................................................ 178 8.4 Approaches to Treatment.................................................................................. 181 8.5 Early Detection and Treatment of Ischemia....................................................... 206 8.6 Suggestions and Limitations............................................................................... 211 8.7 Conclusions........................................................................................................ 212 References......................................................................................................... 213 9 Monitoring Cerebral Blood Flow and Cerebral Autoregulation: Basic Principles, Techniques, Common Patterns and Interpretation of Results................................... 225 9.1 Introduction....................................................................................................... 225 9.2 Physiology of Cerebral Circulation..................................................................... 225 9.3 Techniques to Measure Cerebral Blood Flow..................................................... 227 9.4 CBF in Pathological Conditions........................................................................... 229 9.5 Key Concepts...................................................................................................... 230 References......................................................................................................... 231 10 The Current Role of Transcranial Doppler in the Intensive Care Unit. Indications, Bases for Its Correct Interpretation, Most Frequent Applications and Patterns....... 233 10.1 CBF Monitoring at the Bedside. Transcranial Doppler Ultrasound.................... 233 10.2 Flow Velocity and Pulsatility Index. Normal Range and its Variations ............... 235 10.3 Clinical Applications of Transcranial Doppler in Intensive Care Medicine.......... 235 10.4 Transcranial Ultrasonographic Abnormalities in Neurocritical Patients............. 237 10.5 Extreme Expression of Intracranial Hypertension: Cerebral Circulatory Arrest............................................................................................... 242 10.6 TCD as a Complementary (Auxiliary) Diagnostic Technique in Determining Brain Death............................................................................... 242 10.7 Summary of Changes in Cerebral Hemodynamics: Muñoz Chard...................... 243 10.8 Assessment of Cerebrovascular Reactivity......................................................... 244 10.9 Appendix............................................................................................................ 252 10.10 TCD in Evaluating Hemodynamics...................................................................... 256 10.11 Relationship Between CBF and CPP................................................................... 258 References......................................................................................................... 259 11 Neurophysiologic Monitoring in Neurointensive Care: EEG, EMG, and Evoked Potentials................................................................................................. 265 11.1 Introduction....................................................................................................... 265 11.2 Electroencephalography.................................................................................... 265 11.3 Evoked Potential................................................................................................ 266 11.4 Continuous Neurophysiological Monitoring (EEG-SEP) in the ICU..................... 275 11.5 EMG in the ICU................................................................................................... 279 References......................................................................................................... 281 12 Monitoring Brain Chemistry by Microdialysis During Neurointensive Care.............. 285 12.1 Introduction....................................................................................................... 285 12.2 The Microdialysis Technique.............................................................................. 285 12.3 Biochemical Markers of Ischemia and Cell Damage........................................... 287 12.4 Lactate/Pyruvate Ratio....................................................................................... 288 12.5 Glycerol.............................................................................................................. 288 12.6 Glutamate.......................................................................................................... 289 12.7 Glucose.............................................................................................................. 289 12.8 Implanting and Positioning of Microdialysis Catheters...................................... 290 12.9 Selecting Perfusion Flow.................................................................................... 293 12.10 Multimodal Monitoring..................................................................................... 293 12.11 Interpreting Microdialysis Data.......................................................................... 293 12.12 Clinical Studies................................................................................................... 294 12.13 Conclusions........................................................................................................ 298 References......................................................................................................... 299 SECTION 3. General Support 13 Fluid Therapy in Acute Brain Injury............................................................................. 305 13.1 Introduction....................................................................................................... 305 13.2 Fluids Commonly Used in Neurocritical Care..................................................... 306 13.3 Use of Fluids in Neurocritical Care..................................................................... 310 13.4 Conclusions........................................................................................................ 312 References......................................................................................................... 312 14 The Metabolism of Sodium and Its Effect on the Brain.............................................. 317 14.1 Introduction....................................................................................................... 317 14.2 Hyponatremia.................................................................................................... 318 14.3 Hypernatremia................................................................................................... 325 14.4 Clinical Management and Treatment................................................................. 326 General References............................................................................................ 326 15 Hemodynamic Monitoring.......................................................................................... 329 15.1 Introduction....................................................................................................... 329 15.2 Indications and Complexity of Hemodynamic Monitoring................................ 330 15.3 Definitions and Hemodynamic Parameters....................................................... 330 15.4 Pressure Monitoring.......................................................................................... 332 15.5 Pulmonary Artery Pressure and the Swan-Ganz Catheter................................. 334 References......................................................................................................... 345 16 Cardiac Arrhythmias in Nervous System Disorders.................................................... 347 16.1 Introduction....................................................................................................... 347 16.2 Stroke................................................................................................................. 347 16.3 Paroxysmal Essential Hyper- and Hypopothassemia (Periodic Paralysis)........... 348 16.4 Dystrophy........................................................................................................... 349 16.5 Myotonic Muscular Dystrophy........................................................................... 350 16.6 Steinert Myotonic Dystrophy............................................................................. 350 16.7 Emery-Dreyfuss Muscular Dystrophy................................................................. 351 16.8 Muscular Dystrophy of the Extremities and the Waist...................................... 351 16.9 Friederich’s Ataxia.............................................................................................. 351 16.10 Kearns-Sayre Syndrome..................................................................................... 352 16.11 Leber’s Hereditary Optical Neuropathy............................................................. 353 16.12 Guillain-Barré Syndrome.................................................................................... 353 16.13 Myasthenia Gravis.............................................................................................. 353 16.14 Epilepsy.............................................................................................................. 353 General References............................................................................................ 358 17 Mechanical Ventilation in the Neurologic Critically Ill Patient................................... 359 17.1 Introduction....................................................................................................... 359 17.2 Breathing Control and Respiratory Depression.................................................. 359 17.3 Sedation............................................................................................................. 363 17.4 Hyperventilation................................................................................................ 364 17.5 Lung Recruitability and Use of PEEP.................................................................. 367 17.6 ALI/ARDS and Ventilator-induced Lung Injury.................................................... 369 17.7 Weaning............................................................................................................. 370 17.8 Tracheostomy..................................................................................................... 372 17.9 Conclusions........................................................................................................ 372 General References............................................................................................ 372 18 Surgical Airway Management in the Neurocritically Ill Patient: Timing, Technique, and Complications....................................................................... 375 18.1 Introduction....................................................................................................... 375 18.2 Surgical Airway Management............................................................................ 375 18.3 Conclusions........................................................................................................ 379 References......................................................................................................... 380 19 Gastrointestinal Disorders in the Neurocritical Patient.............................................. 381 19.1 Gastrointestinal Motility Disorders in the Neurocritical Patient........................ 381 19.2 Common Gastroenterological Disorders in Severe Acute Neurological Illness..... 385 General References............................................................................................ 393 20 Nutritional Support in Critically Ill Patients................................................................ 395 20.1 Introduction....................................................................................................... 395 20.2 Metabolism During Injury.................................................................................. 395 20.3 Assessment of Nutritional Status....................................................................... 397 20.4 Anthropometric Measurement.......................................................................... 397 20.5 Biochemical Measures (Biological Indicators).................................................... 400 20.6 Nutritional Requirements.................................................................................. 405 20.7 Artificial Nutrition.............................................................................................. 408 20.8 Enteral Nutrition................................................................................................ 409 20.9 Parenteral Nutrition........................................................................................... 414 20.10 Assessment and Monitoring of Artificial Nutrition............................................ 420 20.11 Is There a Specific Nutritional Formulation for Patients with Brain Injury?....... 421 General References............................................................................................ 423 21 Acute Renal Injury in the Neurocritical Patient.......................................................... 425 21.1 Introduction....................................................................................................... 425 21.2 Epidemiology of Acute Kidney Injury................................................................. 425 21.3 Definition of AKI in Critically Ill Patients............................................................. 425 21.4 Diagnosis of AKI in Critically Ill Patients............................................................. 428 21.5 Common Causes of AKI in Critically Ill Patients.................................................. 431 21.6 Prevention and Management of AKI in Critically Ill Patients.............................. 432 21.7 Indications and Initiation of Renal Replacement Therapy in AKI....................... 437 21.8 Dose of Renal Replacement Therapy in Acute Kidney Injury............................. 440 21.9 Methods of Renal Replacement Therapy in Acute Kidney Injury....................... 442 21.10 Conclusions........................................................................................................ 444 General References............................................................................................ 445 22 The Brain and the Abdomen: Closer Than You Think................................................. 451 22.1 Introduction....................................................................................................... 451 22.2 The Relationship Between IAP and ICP.............................................................. 451 22.3 Clinical Importance of IAH in Patients at Risk for ICH........................................ 456 22.4 Treatment Options............................................................................................. 458 22.5 Clinical Recommendations................................................................................. 459 22.6 Conclusions........................................................................................................ 460 References......................................................................................................... 460 23 Endocrinology of Acute Brain Injury........................................................................... 465 23.1 Basic Anatomy, Physiology and Changes in Acute Brain Injuries....................... 465 23.2 Endocrinology of Acute Brain Injury Secondary to Traumatic Brain Injury (TBI) and Subarachnoid Hemorrhage (SAH)............................................. 477 General References............................................................................................ 483 24 Coagulation Disorders in the Neurocritical Patient.................................................... 485 24.1 Introduction....................................................................................................... 485 24.2 Pathophysiology................................................................................................. 485 24.3 Traumatic Brain Injury........................................................................................ 485 24.4 Spontaneous Intracranial Hemorrhage.............................................................. 487 24.5 Ischemic Stroke.................................................................................................. 489 24.6 Subarachnoid Hemorrhage................................................................................ 489 24.7 Prophylaxis of Pulmonary Thromboembolism in Neurocritical Patients............ 489 General References............................................................................................ 493 SECTION 4. Intracranial Hypertension 25 Pathophysiology of Intracranial Hypertension........................................................... 497 25.1 General Concepts............................................................................................... 497 25.2 Compliance........................................................................................................ 499 25.3 ICP Waves........................................................................................................... 500 25.4 Factors Which the ICP Depends on.................................................................... 501 25.5 Intracranial Hypertension Compensating Mechanisms..................................... 501 25.6 Effects of Intracranial Hypertension................................................................... 502 25.7 Intracranial Pressure Gradients.......................................................................... 503 25.8 Herniaton Syndrome.......................................................................................... 504 25.9 Elevated ICP....................................................................................................... 504 25.10 Hydrocephalus................................................................................................... 504 General References............................................................................................ 508 26 Cerebral Edema: State of the Art................................................................................ 511 26.1 Introduction....................................................................................................... 511 26.2 Causes of Edema................................................................................................ 512 26.3 Methods to Measure Edema............................................................................. 515 26.4 Treatment.......................................................................................................... 516 26.5 Conclusions........................................................................................................ 519 References......................................................................................................... 519 27 The Treatment of Intracranial Hypertension. Algorithm of Treatment and First Level Therapeutic Measures........................................................................ 521 27.1 Introduction....................................................................................................... 521 27.2 Neurotraumatic Patient Treatment in the Hospital............................................ 522 27.3 Multimodal Monitoring in Patients With Severe Traumatic Brain Injury........... 524 27.4 General Measures for Treating Brain Injured Patients....................................... 525 27.5 Specific Treatment of Intracranial Hypertension............................................... 526 27.6 Muscle Relaxation.............................................................................................. 527 27.7 Evacuation of Cerebrospinal Fluid...................................................................... 528 27.8 Hyperosmolar Solutions..................................................................................... 530 27.9 Hyperventilation................................................................................................ 532 27.10 Therapeutic Alternatives in the Treatment of Intracranial Hypertension. Second Level Measures: How Often do We Use Them?.................................... 535 27.11 Quantification of Intensity of Treatment Applied to Control Intracranial Pressure: The Extended Therapy Intensity Level Scale...................................... 536 27.12 The Withdrawal of Treatment: A Reverse Stepwise Process.............................. 537 27.13 Case Report........................................................................................................ 538 27.14 Key Concepts...................................................................................................... 541 27.15 Acknowledgements............................................................................................ 542 References......................................................................................................... 542 28 Second Level Measures for the Treatment of Intracranial Hypertension in Traumatic Brain Injury............................................................................................. 547 28.1 Introduction....................................................................................................... 547 28.2 Etiology of Intracranial Hypertension................................................................ 549 28.3 Intracranial Pressure Monitoring....................................................................... 549 28.4 Clinical Significance of the Pressure-Volume Curve........................................... 549 28.5 Where to Monitor ICP? The Problem of Intracranial Pressure Gradients.......... 551 28.6 Stepped Versus Individualized Treatment.......................................................... 552 28.7 Types of the Therapeutic Measures................................................................... 552 28.8 Barbiturates....................................................................................................... 554 28.9 Moderate Hypothermia..................................................................................... 557 28.10 Decompressive Craniectomy.............................................................................. 559 28.11 Acknowledgements............................................................................................ 562 References......................................................................................................... 562 29 Non-conventional Therapeutics for the Treatment of Elevated Intracranial Pressure: Indomethacin and THAM............................................................................ 567 29.1 Indomethacin..................................................................................................... 567 29.2 Tromethamine (THAM or TRIS).......................................................................... 569 29.3 References......................................................................................................... 572 30 A Different Point of View in Intracranial Hypertension Management: the Lund Therapy......................................................................................................... 573 30.1 Introduction....................................................................................................... 573 30.2 Pathophysiology After Brain Trauma.................................................................. 574 30.3 Measures to Reduce Vasogenic Brain Edema.................................................... 574 30.4 Decompressive Craniotomy and Other Surgical Measures................................ 576 30.5 Microcirculation Around Contusions................................................................. 576 30.6 Maintenance of Normovolemia to Improve Cerebral Microcirculation............. 576 30.7 Arterial Pressure and Plasma Volume Expanders.............................................. 577 30.8 Albumin and Erythrocytes as Blood Volume Expanders.................................... 578 30.9 How to Determine Whether Intravascular Volume is Adequate........................ 579 30.10 Other Measures to Improve Cerebral Microcirculation..................................... 579 30.11 Arterial, Plasma Oncotic and Cerebral Perfusion Pressure................................ 580 30.12 Body Temperature Control................................................................................. 581 30.13 Nutrition............................................................................................................. 582 30.14 Clinical Application............................................................................................. 582 References......................................................................................................... 584 31 A Critical Point of View in the Management of Intracranial Hypertension: Are All Therapeutic Tools Evidence Based?................................................................ 587 31.1 Introduction....................................................................................................... 587 31.2 Sedation as a Therapy........................................................................................ 588 31.3 Hyperventilation................................................................................................ 589 31.4 Drainage of Cerebrospinal Fluid......................................................................... 589 31.5 Osmotherapy..................................................................................................... 590 31.6 Cerebral Perfusion Pressure............................................................................... 590 31.7 Hypothermia...................................................................................................... 591 31.8 Steroids.............................................................................................................. 591 31.9 Albumin.............................................................................................................. 593 31.10 Conclusions........................................................................................................ 593 References......................................................................................................... 593 SECTION 5. Traumatic Injury 32 Mild Traumatic Brain Injury......................................................................................... 599 32.1 Introduction....................................................................................................... 599 32.2 Epidemiology..................................................................................................... 599 32.3 Classification...................................................................................................... 600 32.4 Radiological Diagnosis........................................................................................ 604 32.5 Timing of Hospital Discharge............................................................................. 605 32.6 Post-traumatic Sequelae.................................................................................... 606 32.7 Key Concepts...................................................................................................... 607 Acknowledgements............................................................................................ 607 General References............................................................................................ 607 33 Moderate Traumatic Brain Injury................................................................................ 609 33.1 Introduction....................................................................................................... 609 33.2 Epidemiology..................................................................................................... 609 33.3 Baseline Evaluation............................................................................................ 609 33.4 Management Issues........................................................................................... 610 33.5 Computerized Tomography................................................................................ 611 33.6 Intracranial Pressure Monitoring....................................................................... 611 33.7 Results................................................................................................................ 611 33.8 Final Considerations........................................................................................... 612 General References............................................................................................ 612 34 Medical Treatment of Severe Traumatic Brain Injury................................................. 615 34.1 Introduction....................................................................................................... 615 34.2 Epidemiology..................................................................................................... 615 34.3 Classification...................................................................................................... 616 34.4 Pathology of Brain Damage................................................................................ 617 34.5 Pathophysiology................................................................................................. 620 34.6 Diagnosis of TBI.................................................................................................. 622 34.7 Treatment of TBI................................................................................................ 624 34.8 Conclusions........................................................................................................ 635 General References............................................................................................ 636 35 Surgical Management of Severe Traumatic Brain Injury............................................ 639 35.1 Introduction ...................................................................................................... 639 35.2 Epidural Hematoma........................................................................................... 639 35.3 Subdural Hematomas ........................................................................................ 642 35.4 Intra-axial Lesions ............................................................................................. 645 35.5 Contusion and Cerebral Hemorrhage................................................................ 646 35.6 Delayed Intracerebral Hematoma...................................................................... 648 35.7 Lesions of the Posterior Fossa............................................................................ 648 35.8 Depressed Skull Fracture.................................................................................... 649 35.9 Surgical Treatment of Increased ICP: Decompressive Craniectomy................... 650 References......................................................................................................... 655 36 Severe Traumatic Brain Injury: Pathophysiology and Management Guided by Multi-modal Monitoring............................................................................ 659 36.1 Introduction....................................................................................................... 659 36.2 Clinical and Cellular Pathophysiology of Severe Traumatic Brain Injury............ 659 36.3 Clinical Pathophysiology..................................................................................... 661 36.4 Autoregulation................................................................................................... 661 36.5 Secondary Brain Injury....................................................................................... 663 36.6 Intracranial Pressure.......................................................................................... 663 36.7 Intracranial Hypertension, Monitoring Modalities, and Treatment Strategies....664 36.8 Conclusions........................................................................................................ 673 References......................................................................................................... 674 37 Prognosis in Traumatic Brain Injury............................................................................ 679 37.1 Introduction....................................................................................................... 679 37.2 Prognosis............................................................................................................ 681 37.3 Prognosis in Traumatic Brain Injury.................................................................... 683 37.4 Prognostic Models............................................................................................. 686 37.5 CRASH Prognostic Models.................................................................................. 687 37.6 Individual Predictors.......................................................................................... 688 37.7 Comparison With Previous Studies.................................................................... 691 37.8 Strengths and Weaknesses of This Study........................................................... 692 37.9 Implications........................................................................................................ 693 37.10 Future Research................................................................................................. 693 References......................................................................................................... 694 38 Surgical Treatment of Spinal Cord Injury.................................................................... 703 38.1 Introduction....................................................................................................... 703 38.2 Terminology....................................................................................................... 704 38.3 Initial Treatment................................................................................................. 708 38.4 Spine Immobilization......................................................................................... 708 38.5 Maintenance of Blood Pressure......................................................................... 709 38.6 Maintenance of Oxygenation............................................................................. 710 38.7 General Care of SCI Patients.............................................................................. 711 38.8 Laboratory Evaluations....................................................................................... 712 38.9 Surgical Treatment............................................................................................. 715 38.10 Functional Independence Measure (FIM).......................................................... 716 General References............................................................................................ 718 39 Acute Spinal Cord Injury: Pathophysiology and Intensive Care Management.......... 721 39.1 Introduction....................................................................................................... 721 39.2 Pathophysiology of Spinal Cord Injury............................................................... 721 39.3 Acute Management of the Patient With Spinal Cord Injury............................... 724 39.4 Conclusion.......................................................................................................... 728 References......................................................................................................... 729 |
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