RT Book, Section
A1 Seder, David B.
A1 Yahwak, Jason A.
A2 Lee, Kiwon
SR Print(0)
ID 1101645279
T1 Percutaneous Tracheostomy
T2 The NeuroICU Book
YR 2012
FD 2012
PB McGraw-Hill Education
PP New York, NY
SN 9780071636353
LK neurology.mhmedical.com/content.aspx?aid=1101645279
RD 2024/04/16
AB A  30-year-old  man  is  admitted  after  an  unhelmeted  bicycling  accident  in  which  he  suffered  a  skull  fracture,  traumatic  subarachnoid  and  subdural  hemorrhages,  bifrontal  contusions,  and  diffuse  axonal  injury.  He  was  intubated  without  medications  in  the  field,  and  on  presentation,  the  Glasgow  Coma  Scale  (GCS)  score  is  4.  Computed  tomography  (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  score  is  5,  ICP  is  18  mm  Hg,  CPP  is  70  mm  Hg,  and  Pbto2  in  the  right  frontal  lobe  near  a  contusion  is  24  mm  Hg.  His  cardiopulmonary  status  is  stable.  A  rigid  cervical  collar  is  in  place,  and  he  is  maintained  on  the  controlled  mechanical  ventilation  (CMV)  mode  at  a  set  rate  of  14  ×  550  mL  (actual  respiratory  rate  [RR]  is  21  beaths/min),  fraction  of  inspired  oxygen  (Fio2)  of  0.35,  and  positive  end-expiratory  pressure  (PEEP)  of  5.