RT Book, Section
A1 Balwan, Akshu
A1 Seder, David B.
A2 Lee, Kiwon
SR Print(0)
ID 1143957447
T1 Percutaneous Tracheostomy
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143957447
RD 2021/01/20
AB A  30-year-old  man  is  admitted  after  an  unhelmeted  bicycling  accident  in  which  he  suffers  skull  fracture,  traumatic  subarachnoid  and  subdural  hemorrhages,  bifrontal  contusions,  and  diffuse  axonal  injury.  He  is  intubated  without  medications  in  the  field,  and  on  presentation,  the  Glasgow  Coma  Scale  (GCS)  score  is  4.  CT  scan  of  the  neck  does  not  reveal  bony  injury  to  the  cervical  spine.  A  fiberoptic  intracranial  pressure  (ICP)  device  is  placed,  and  ICP,  cerebral  perfusion  pressure  (CPP),  and  brain  tissue  oxygen  tension  (Pbto2)  are  monitored.  On  hospital  day  5,  the  GCS  is  5,  ICP,  18  mm  Hg;  CPP,  70  mmHg;  and  Pbto2  in  the  right  frontal  lobe  near  a  contusion,  24  mm  Hg.  His  cardiopulmonary  status  is  stable.  A  rigid  cervical  collar  is  in  place,  and  he  is  maintained  on  CMV  mode  ventilation  at  a  set  rate  of  14  ×  550  cc  (actual  RR  is  21),  Fio2,  0.35;  and  PEEP,  5.