Chapter 18 - Cerebral Resusc

Question 1

How can brain death be assessed?

Answer 1

Failure to withdraw to noxious stimuli 72h after an arrest.

Question 2

What are the indications for therapeutic hypothermia?

Answer 2

GCS <9.

ROCS < 60 min

MAP > 60

Contraindications include sepsis, trauma, dementia, bleeding, malignancy with brain mets, DNR

Question 3

What is the rationale/physiologic basis for cooling post arrest?

Answer 3

Decrease in free radicals, decrease stimulatory amino acids, limit toxic cascades, reduce MPT opening and apoptosis, benefits multiple organs.

Question 4

What are the goals/targets of induced hypothermia?

Answer 4

Temperature 33C, EtCO2 35-40, avoidance of hyperglycemia, maintaining cooling for 24h.

Question 5

Describe the post arrest syndrome as it pertains to the brain.

Answer 5

Lack of brain perfusion followed by 5-10 minutes of hyperemia and then global or regional hypoperfusion.

Autoregulation disrupted (uncouple perfusion/metabolism, endothelial damage, NO imbalance)

Gap junction dysfunction (results in edema and increased ICP)

Depletion of ATP stores (apoptosis)