ICH with intraventricular bleeding and midline shift
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General Critical Care
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This secondary analysis of a randomized clinical trial involving 566 ICU patients with delirium and baseline QTc intervals less than 550 ms investigated the effects of antipsychotics on QTc intervals and the risk of fatal arrhythmias. The study found that neither haloperidol nor ziprasidone significantly increased the QTc intervals compared to placebo. Furthermore, there were no fatal cardiac arrhythmias related to the study drugs. These findings suggest that in ICU patients with delirium and a QTc interval under 550 ms, the use of these antipsychotics may not lead to clinically significant cardiac arrhythmias.
The findings of this trial suggest that daily QTc interval monitoring during antipsychotic use may have limited value in patients in the ICU with normal baseline QTc and few risk factors for QTc prolongation.
Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke
https://jamanetwork.com/journals/jama/fullarticle/2815005
The study in question investigates the efficacy and time sensitivity of combining intravenous thrombolysis (IVT) with thrombectomy versus thrombectomy alone in treating acute ischemic stroke. Here's a breakdown according to the PICO format:
Population: The study focused on 2,313 participants presenting with anterior circulation large-vessel occlusion at thrombectomy-capable stroke centers across 15 countries. These participants were part of a larger pool from 6 randomized clinical trials. The median age was 71 years, with 44.3% female representation.
Intervention: The intervention group received IVT followed by thrombectomy.
Comparison: The comparison group underwent thrombectomy alone.
Electroencephalography (EEG) reveals suppressed background with triphasic waves demonstrating diffuse cerebral disease.
Cerebral ultrasound is a developing point of care tool for intensivists and emergency physicians, with an important role in the diagnosis of acute intracranial pathology, such as the assessment of cerebrovascular diseases and in the noninvasive
intracranial pressure measurement both in the acute clinical settings and in intensive care unit (ICU).
This paper is very good on how to use cerebral ultrasound in the icu:
In a multi-center, double-blind randomized trial across eight Dutch ICUs, 132 critically ill adults with delirium were administered intravenous haloperidol or placebo, resulting in no significant difference in delirium- and coma-free days. The study, which was terminated early for futility, also found haloperidol might decrease the need for benzodiazepines and reduce agitation-related behaviors, although these secondary outcomes were not statistically conclusive.
Individualized Blood Pressure Management During Endovascular Treatment of Acute Ischemic Stroke Under Procedural Sedation"
The INDIVIDUATE study, conducted at a tertiary care university hospital, investigated whether a personalized blood pressure approach during endovascular stroke treatment offers better outcomes than standardized systolic blood pressure (SBP) targets. Patients with acute ischemic stroke were either assigned to individualized blood pressure management, targeting pre-intervention baseline SBP, or a standard protocol maintaining SBP between 140 and 180 mmHg. The primary outcome was the proportion of patients with favorable functional outcomes at 90 days post-stroke (measured as a modified Rankin Scale score of 0 to 2).
Of the 250 patients studied, the mean intraprocedural SBP showed no significant difference between the individualized and standard groups (P=0.16). Likewise, the proportion of patients with favorable functional outcomes at 90 days post-stroke was comparable: 25% in the individualized group and 24% in the standard group (P=0.56). Consequently, individualized SBPโฆ
In a recent trial published at the Revista Espaรฑola de Cardiologรญa (English Edition), the researchers aimed to determine whether emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest (OHCA) in patients without ST-segment elevation myocardial infarction (STEMI) would improve survival with good neurological outcome. In this open-label, randomized trial, 69 OHCA survivors without STEMI were randomly assigned to undergo immediate CAG or deferred CAG. The primary efficacy endpoint was in-hospital survival without severe dependence. The results showed no significant difference in the primary endpoint between the two groups, with in-hospital survival being 62.5% in the immediate CAG group and 58.8% in the delayed CAG group.
There were some differences in secondary endpoints, such as the incidence of acute kidney failure, which was more frequent in the immediate CAG group and infections, which were higher in the delayed CAG group. However, these differences were not enough toโฆ
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- Hussain Al-shabib
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Findings:
Intracerebral Hemorrhage (ICH) with extension to the lateral ventricules: The hyperdense area is indicative of acute blood, and the size suggests a significant hemorrhage
2. Surrounding Edema: There appears to be hypodense areas around the hemorrhage, indicating cerebral edema.
3. Possible Midline Shift: There may be some degree of midline shift, suggesting raised intracranial pressure.