EMCrit 275 – NeuroCritical Care with Neha Dangayach

[featimage]

Today on the podcast, we discuss Neuro-Emergencies and NeuroCritical Care with Neha Dangayach. This is a wide-ranging conversation that you will truly enjoy.

Neha Dangayach

Neha is joining the EMCrit team!!!!!!

Neha S. Dangayach MD, MSCR is an Assistant Professor of Neurology and Neurosurgery. Dr. Dangayach serves as the Director of Neuroemergencies Management and Transfers (NEMAT) for the Mount Sinai Health System, Neurocritical Care Fellowship Director and Research Co-Director for the Institute for Critical Care Medicine (ICCM). She is also a Co-Director of the Mount Sinai Hospital’s busy NSICU and collaborates with a compassionate team to provide world-class patient-centered Neurocritical Care. She leads the Mount Sinai Critical Care Resilience Program (MSCCRP), a multidisciplinary program including intensivists, nursing, social workers, physical, occupation and speech therapists, chaplains, nutritionists among others. Several projects under this program seek to help patients and families cope with ICU recovery. Her research focuses on resilience, spirituality and recovery in critical care; inter-hospital transfers for neuroemergencies and social media in medicine.

Topics of Discussion with Time Stamps

Neha's Slides

* Neurocrit Care Stony Brook Grand Rounds

Neuro-Emergency Management and Transfer (NEMAT) Service

Tele-Stroke

Video the CT with phone

2 person job

scroll through every image of axial head ct q 2 seconds

Scroll through CTA MIPs, axial and coronal (sag is a bonus)

ICH

Blood Pressure

Specify how often to cycle BP cuff

Ischemic Stroke

Who to Intubate and Neuroprotective Intubation

* LAMW: The Neurocritical Care Intubation

Which Osmotic Agent for ICP

* Recently Published Guidelines

Platelet Reversal

Recent paper shows no benefit from PLTs or dDAVP in non-neurosurg bleeds [10.1097/CCM.0000000000004348]

Status Epilepticus

Choice of 2nd Line Agent

Keppra 60mg/kg (1/2 the dose in ESRD)

General Anesthetic of Choice is Midazolam

0.2 mg/kg bolus

start infusion 0.2 mg/kg/hr

titrate up every 5 minutes

max 2.9 mg/kg/hr

when getting close to 1mg/kg/hr, give ketamine 1mg/kg followed by 1 mg/kg/hr

Cirrhotics, get propofol

Now on to the Podcast...