Neurointensive care

Neurocritical care (or neurointensive care) is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents/treats secondary brain injury. Neurocritical care (or neurointensive care) is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents/treats secondary brain injury. There have been many attempts to manage head injuries throughout history including trepanned skulls found from ancient Egypt and descriptions of treatments to decrease brain swelling in ancient Greek text. Intensive care begin with centers to treat the poliomyelitis outbreak during the mid-twentieth century. These early respiratory care units utilized a negative and positive pressure unit called the “Iron Lung” to aid patients in respiration and greatly decreased the mortality rate of Polio. Dr. Bjørn Aage Ibsen, a physician in Denmark, 'birthed the intensive care unit”, when he used tracheostomy and positive pressure manual ventilation to keep polio patients alive in the setting of an influx of patients and limited resources (only one iron Lung). The first neurological intensive care unit was created by Dr. Dandy Walker at Johns Hopkins in 1929. Dr. Walker realized that some surgical patient could use specialized postoperative neurosurgical monitoring and treatment. The unit Dr. Walker created showed a benefit to postoperative patients, than neurologic patients came to the unit. Dr. Safar created the first intensive care unit in the United States in Baltimore in the 1950s. In the 1970s, the benefit of specialized care in respiratory and cardiac ICUs led to the Society of Critical Care medicine being formed. This body created standards for extensive, difficult medical problems and treatments. Over time the need for specialized monitoring and treatments led to neurologic intensive care units. Modern neurocritical care began to develop in the 1980s. The Neurocritical care society was founded in 2002. In 2005, Neurocritical care was recognized as a neurological subspecialty. The doctors who practice this type of medicine are called neurointensivists, and can have medical training in many fields, including neurology, anesthesiology, emergency medicine, internal medicine, or neurosurgery. Common diseases treated in neurointensive care units include strokes, ruptured aneurysms, brain and spinal cord injury from trauma, seizures (especially those that last for a long period of time- status epilepticus, and/or involve trauma to the patient, i.e., due to a stroke or a fall), swelling of the brain (Cerebral edema), infections of the brain (encephalitis) and the brain's or spine's meninges (meningitis), brain tumors (especially malignant cases; with neurological oncology), and weakness of the muscles required to breathe (such as the diaphragm). Besides dealing with critical illness of the nervous system, neurointensivists also treat the medical complications that may occur in their patients, including those of the heart, lung, kidneys, or any other body system, including treatment of infections. Neurological Intensive care units are specialized units in select tertiary care centers that specialized in the care of critical ill neurological and post neurological surgical patients. The goal of NICUs are to provide early and aggressive medical interventions including managing pain, airways, ventilation, anticoagulation, elevated ICP, cardiovascular stability and secondary brain injury. Admission criteria includes: Impaired consciousness, impaired ability to protect airway, progressive respiratory weakness, need for mechanical ventilation, seizure, Radiologic evidence of elevated ICP, monitoring of neurologic function in patients that are critically ill. Neuro-ICU have been seeing increasing use at Tertiary referral hospital. One of the main reasons why Neuro-ICUs have seen increased use is the use of therapeutic hypothermia which has been shown to improve long-term neurological outcomes following cardiac arrest. Most neurocritical care units are a collaborative effort between neurointensivists, neurosurgeons, neurologists, radiologists, pharmacists, physician extenders (such as nurse practitioners or physician assistants), critical care nurses, respiratory therapists, rehabilitation therapists, and social workers who all work together in order to provide coordinated care for the critically ill neurologic patient. Hypothermia:One third to half of people with coronary artery disease will have an episode where their heart stops. Of the patients who have their heart stopped seven to thirty percent leave the hospital with good neurological outcome (conscious, normal brain function, alert, capable of normal life). Lowering patients body temperature between 32 -34 degrees within six hours of arriving at the hospital doubles the patients with no significant brain damage compared to no cooling and increases survival of patients. Basic life support monitoring:Electrocardiography, pulse oximetry, blood pressure, assessment of comatose patients.