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The Jefferson Manual for Neurocritical Care.

By: Contributor(s): Material type: TextTextPublisher: New York : Thieme Medical Publishers, Incorporated, 2020Copyright date: ©2021Edition: 1st edDescription: 1 online resource (328 pages)Content type:
  • text
Media type:
  • computer
Carrier type:
  • online resource
ISBN:
  • 9781626234956
Subject(s): Genre/Form: Additional physical formats: Print version:: The Jefferson Manual for Neurocritical CareDDC classification:
  • 616.80428
LOC classification:
  • RC350.N49 .J355 2021
Online resources:
Contents:
The Jefferson Manual for Neurocritical Care -- Title Page -- Copyright -- Contents -- Preface -- Contributors -- 1. Encephalopathy and Delirium -- 1.1 Encephalopathy -- 1.1.1 Definition -- 1.1.2 Causes of Encephalopathy -- 1.1.3 Diagnosis of Encephalopathy -- 1.1.4 Treatment of Encephalopathy -- 1.1.5 Relationship to Delirium -- 1.2 Delirium -- 1.2.1 Definition -- 1.2.2 Duration of Symptoms -- 1.2.3 Level of Activity -- 1.2.4 Risk Factors for Delirium -- 1.2.5 Clinical Assessment -- 1.3 Treatment -- 1.3.1 Medications for Agitation -- 1.3.2 Pharmacologic Management of Hyperactive Delirium and Agitation -- 1.3.3 Nonpharmacologic Treatments for Delirium -- 2. Cerebrovascular Emergency: Acute Stroke Diagnosis and Management -- 2.1 Epidemiology -- 2.2 Etiology -- 2.2.1 Nonmodifiable Risk Factors -- 2.2.2 Modifiable Risk Factors -- 2.2.3 Stroke Subtypes -- 2.3 Common Clinical Presentations -- 2.4 Differential Diagnosis for Acute Ischemic Stroke -- 2.5 Acute Stroke Diagnosis, Treatment, and Management -- 2.5.1 Stroke Activation -- 2.6 Criteria for Endovascular Therapy -- 2.6.1 Neurocritical Care Management of Ischemic Stroke -- 2.7 Stroke Workup and Management -- 2.7.1 Post Stroke Complication -- 3. Cerebrovascular Emergency: Spontaneous Intracerebral Hemorrhage (ICH) -- 3.1 Epidemiology -- 3.2 Etiologies/Differential Diagnosis -- 3.3 Common Clinical Presentations -- 3.4 Neuroimaging -- 3.5 Treatment -- 3.5.1 Aggressive Reduction in SBP to Goal of 140 -- 3.5.2 Seizures -- 3.5.3 Intracranial Pressure -- 3.5.4 Medical Issues -- 3.5.5 Coagulopathies -- 3.5.6 Surgical Options -- 3.5.7 Craniotomy -- 3.5.8 Craniectomy -- 3.5.9 Minimally Invasive Surgical Evacuation -- 3.6 Prognosis -- 4. Cerebrovascular Emergencies: Aneurysmal Subarachnoid Hemorrhage (SAH) -- 4.1 Epidemiology -- 4.2 Risk Factors -- 4.3 Diagnosis -- 4.4 Grading System.
4.4.1 Hunt and Hess Grade -- 4.4.2 World Federation of Neurological Surgeons Grade -- 4.4.3 Modified Fischer Scores -- 4.5 Management of Subarachnoid Hemorrhage -- 4.5.1 Early Phase -- 4.5.2 Late Phase -- 4.6 Vasospasm, Delayed Neurologic Deterioration (DND), and Delayed Cerebral Ischemia (DCI) -- 4.6.1 Detection and Management of Vasospasm and DCI -- 4.7 Hyponatremia and Endocrine Dysfunction -- 4.7.1 Hyponatremia -- 4.7.2 Endocrine Dysfunction -- 5. Transfusion Medicine and Anticoagulation -- 5.1 Introduction -- 5.2 Anemia in the ICU -- 5.3 Red Cell Transfusion -- 5.3.1 Leukocyte Reduction Indications -- 5.3.2 Washed RBC -- 5.3.3 Irradiation -- 5.3.4 Complications of Red Blood Cell Transfusion -- 5.3.5 Benefits to Transfusion -- 5.4 Hemoglobin "Triggers" -- 5.5 Thrombocytopenia -- 5.6 Prophylaxis Thresholds -- 5.6.1 Treatment of Bleeding -- 5.7 Antiplatelet Reversal in Intracranial Hemorrhage -- 5.8 Coagulation Cascade and Anticoagulants -- 5.9 Anticoagulants -- 5.9.1 Warfarin -- 5.10 Oral Factor Xa Inhibitors -- 5.10.1 Apixaban, Rivaroxaban, Edoxaban -- 5.11 Thrombin Inhibitors -- 5.11.1 Oral -- 5.11.2 Intravenous -- 5.12 The Heparins -- 5.12.1 Unfractionated Heparin -- 5.12.2 Low-Molecular-Weight Heparin (LMWH) -- 5.12.3 Fondaparinux -- 5.13 Deep Vein Thrombosis (DVT) Prophylaxis -- 6. Cerebral Edema and Elevated Intracranial Pressure -- 6.1 The Basics -- 6.1.1 Monro-Kellie Doctrine -- 6.1.2 ICP and Cerebral Perfusion Pressure (CPP) -- 6.1.3 Intracranial Compliance -- 6.1.4 ICP Waveforms and Herniation Syndromes -- 6.2 Cerebral Edema -- 6.3 Stepwise Approach to the Management of Elevated ICP -- 6.4 Management of Increased Intracranial Pressure -- 6.4.1 Tier 1 -- 6.4.2 Tier 2 -- 6.4.3 Tier 3 -- 7. Fevers and Infections in the Neuro-ICU -- 7.1 Brain -- 7.1.1 Meningitis -- 7.1.2 Acute Bacterial Meningitis -- 7.1.3 Aseptic Meningitis.
7.1.4 Viral Meningitis -- 7.1.5 Fungal Meningitis -- 7.1.6 Ventriculitis -- 7.1.7 HIV-Related Infections -- 7.1.8 Empyema -- 7.2 Spine -- 7.2.1 Epidural Abscess -- 7.2.2 Osteomyelitis -- 7.3 Central Fever -- 8. Treatment of Status Epilepticus in Adults -- 8.1 Overview and Definitions -- 8.2 Convulsive Status Epilepticus Management -- 8.3 Nonconvulsive Status Epilepticus (NCSE) -- 8.4 Refractory Status Epilepticus (RSE) -- 8.5 Super Refractory Status Epilepticus (SRSE) -- 9. Trauma -- 9.1 Acute Spinal Cord Injury -- 9.1.1 Introduction -- 9.1.2 Medical Treatment of Acute SCI -- 9.1.3 Surgical Management of Acute SCI -- 9.2 Traumatic Brain Injury -- 9.2.1 Introduction -- 9.2.2 Management of Elevated ICP -- 9.2.3 Other Post-TBI Considerations -- 9.3 Paroxysmal Sympathetic Hyperactivity (PSH) -- 10. Neuromuscular and Other Neurologic Emergencies -- 10.1 Guillain-Barré Syndrome (GBS)/Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) -- 10.1.1 Definition -- 10.1.2 Epidemiology -- 10.1.3 Differential Diagnosis -- 10.1.4 Common Clinical Presentation -- 10.1.5 Diagnosis -- 10.1.6 GBS Variants -- 10.1.7 Ancillary Testing -- 10.1.8 Complications of GBS -- 10.1.9 Management -- 10.1.10 Prognosis -- 10.2 Myasthenia Gravis -- 10.2.1 Definition -- 10.2.2 Epidemiology -- 10.2.3 Differential Diagnosis -- 10.2.4 Clinical Presentation of Generalized Myasthenia Gravis -- 10.2.5 Diagnosis -- 10.2.6 Management of Myasthenic Crisis -- 10.2.7 Prognosis -- 10.3 Botulism -- 10.3.1 Definition -- 10.3.2 Epidemiology -- 10.3.3 Pathophysiology -- 10.3.4 Differential Diagnosis -- 10.3.5 Clinical Presentation -- 10.3.6 Diagnosis -- 10.3.7 Management -- 10.3.8 Prognosis -- 10.4 Organophosphate Toxicity -- 10.4.1 Definition -- 10.4.2 Epidemiology -- 10.4.3 Pathophysiology -- 10.4.4 Differential Diagnosis -- 10.4.5 Clinical Presentation -- 10.4.6 Diagnosis.
10.4.7 Management -- 10.4.8 Prognosis -- 10.5 Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) -- 10.5.1 Definition -- 10.5.2 Epidemiology -- 10.5.3 Pathogenesis -- 10.5.4 Differential Diagnosis -- 10.5.5 Clinical Presentation -- 10.5.6 Diagnosis -- 10.5.7 Management -- 10.5.8 Complications -- 10.5.9 Prognosis -- 11. Brain Tumor Postoperative Management -- 11.1 Introduction -- 11.1.1 Clinical Presentation -- 11.1.2 Tumor Classification -- 11.2 Postoperative Care and Complications -- 11.2.1 Airway Management -- 11.2.2 Blood Pressure Control and Postoperative Hemorrhage -- 11.2.3 Seizure Prophylaxis -- 11.2.4 Venous Thromboembolism Prophylaxis -- 11.2.5 Antibiotic Prophylaxis and Postoperative Infection -- 11.2.6 Cerebral Edema -- 11.2.7 CSF Leak -- 11.3 Specific Concerns for Sellar and Parasellar Tumors -- 11.3.1 Hormonal Dysregulation -- 11.3.2 Pituitary Apoplexy -- 11.4 Conclusion -- 12. Brain Death in Adults -- 12.1 Definition of Brain Death -- 12.2 Clinical Evaluation -- 12.2.1 Establishing the Proximate Cause of Coma -- 12.2.2 Clinical Examination to Establish Irreversibility -- 12.3 Ancillary Tests -- 12.4 Legal -- 12.5 Management of the Brain-Dead Patient for Organ Donation -- 13. Sodium Dysregulation -- 13.1 Terminology -- 13.2 Hyponatremia Classification -- 13.2.1 Causes of Hyponatremia -- 13.2.2 Symptomatic Hyponatremia -- 13.3 SIADH versus CSW -- 13.3.1 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) -- 13.3.2 Cerebral Salt Wasting (CSW) -- 13.3.3 SIADH and CSW Diagnosis -- 13.4 Diagnostic Approach to Hyponatremia -- 13.4.1 Hyponatremia Treatment: General Principles -- 13.4.2 Acute Symptomatic Moderate to Severe Hyponatremia -- 13.4.3 Acute Asymptomatic Moderate Hyponatremia -- 13.4.4 Severe Chronic Mild-Moderate Hyponatremia -- 13.4.5 SIADH Treatment -- 13.4.6 CSW Treatment.
13.4.7 Treatment of Hyponatremia in Patients with Subarachnoid Hemorrhage -- 13.4.8 Treatment of Hyponatremia in Patients with Heart Failure -- 13.5 Hypernatremia -- 13.5.1 Central (Neurogenic) Diabetes Insipidus -- 13.5.2 Nephrogenic Diabetes Insipidus -- 13.6 Diagnostic Approach to Hypernatremia -- 13.6.1 Treatment -- 13.6.2 Central DI Treatment -- 13.6.3 Nephrogenic DI Treatment -- 14. Nutrition -- 14.1 Glucose Utilization -- 14.2 Nutrition in Critical Care -- 14.3 Nutrition Status -- 14.3.1 Malnutrition -- 14.3.2 Refeeding Syndrome -- 14.3.3 Nutrition-Related Laboratory Tests -- 14.4 Nutrition Assessment -- 14.4.1 Calorie Needs -- 14.4.2 Protein Needs -- 14.4.3 Nutrition Support -- 14.4.4 Enteral Nutrition -- 14.5 Specific EN Considerations -- 14.5.1 Parenteral Nutrition -- 14.6 Therapy-Specific Considerations -- 14.7 Conclusion -- 15. Sedation -- 15.1 Introduction -- 15.2 Indications for Sedation -- 15.3 Complications of Sedation -- 15.4 Assessment of Sedation -- 15.5 Choice of Sedative -- 15.5.1 Propofol (Diprivan) -- 15.5.2 Midazolam (Versed) -- 15.5.3 Dexmedetomidine (Precedex) -- 15.5.4 Fentanyl (Sublimaze) -- 15.5.5 Ketamine (Ketalar) -- 16. Pain Management in the Neuro-Intensive Care Unit (ICU) -- 16.1 Introduction -- 16.2 Modern Strategy of Pain Management in ICU Liberation -- 16.3 Challenges of Pain Management in Neuro-ICU -- 16.4 Individualizing Therapy in NICU -- 16.4.1 Pharmacologic Interventions of Pain -- 16.4.2 Nonpharmacologic Approach -- 16.5 Neuro-specific Diseases at Risk for Pain -- 16.5.1 Pain with SAH -- 16.5.2 Spondylosis and Disk Herniation -- 16.5.3 Spasticity -- 16.6 Ongoing Continuous Pain Monitoring in NICU -- 16.6.1 Pain Scales -- 17. Advanced Hemodynamic and Neurological Monitoring in the Neuro-ICU -- 17.1 Hemodynamic Monitoring -- 17.1.1 Invasive Monitoring: Pulmonary Thermodilution.
17.1.2 Less Invasive: Transpulmonary Thermodilution.
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The Jefferson Manual for Neurocritical Care -- Title Page -- Copyright -- Contents -- Preface -- Contributors -- 1. Encephalopathy and Delirium -- 1.1 Encephalopathy -- 1.1.1 Definition -- 1.1.2 Causes of Encephalopathy -- 1.1.3 Diagnosis of Encephalopathy -- 1.1.4 Treatment of Encephalopathy -- 1.1.5 Relationship to Delirium -- 1.2 Delirium -- 1.2.1 Definition -- 1.2.2 Duration of Symptoms -- 1.2.3 Level of Activity -- 1.2.4 Risk Factors for Delirium -- 1.2.5 Clinical Assessment -- 1.3 Treatment -- 1.3.1 Medications for Agitation -- 1.3.2 Pharmacologic Management of Hyperactive Delirium and Agitation -- 1.3.3 Nonpharmacologic Treatments for Delirium -- 2. Cerebrovascular Emergency: Acute Stroke Diagnosis and Management -- 2.1 Epidemiology -- 2.2 Etiology -- 2.2.1 Nonmodifiable Risk Factors -- 2.2.2 Modifiable Risk Factors -- 2.2.3 Stroke Subtypes -- 2.3 Common Clinical Presentations -- 2.4 Differential Diagnosis for Acute Ischemic Stroke -- 2.5 Acute Stroke Diagnosis, Treatment, and Management -- 2.5.1 Stroke Activation -- 2.6 Criteria for Endovascular Therapy -- 2.6.1 Neurocritical Care Management of Ischemic Stroke -- 2.7 Stroke Workup and Management -- 2.7.1 Post Stroke Complication -- 3. Cerebrovascular Emergency: Spontaneous Intracerebral Hemorrhage (ICH) -- 3.1 Epidemiology -- 3.2 Etiologies/Differential Diagnosis -- 3.3 Common Clinical Presentations -- 3.4 Neuroimaging -- 3.5 Treatment -- 3.5.1 Aggressive Reduction in SBP to Goal of 140 -- 3.5.2 Seizures -- 3.5.3 Intracranial Pressure -- 3.5.4 Medical Issues -- 3.5.5 Coagulopathies -- 3.5.6 Surgical Options -- 3.5.7 Craniotomy -- 3.5.8 Craniectomy -- 3.5.9 Minimally Invasive Surgical Evacuation -- 3.6 Prognosis -- 4. Cerebrovascular Emergencies: Aneurysmal Subarachnoid Hemorrhage (SAH) -- 4.1 Epidemiology -- 4.2 Risk Factors -- 4.3 Diagnosis -- 4.4 Grading System.

4.4.1 Hunt and Hess Grade -- 4.4.2 World Federation of Neurological Surgeons Grade -- 4.4.3 Modified Fischer Scores -- 4.5 Management of Subarachnoid Hemorrhage -- 4.5.1 Early Phase -- 4.5.2 Late Phase -- 4.6 Vasospasm, Delayed Neurologic Deterioration (DND), and Delayed Cerebral Ischemia (DCI) -- 4.6.1 Detection and Management of Vasospasm and DCI -- 4.7 Hyponatremia and Endocrine Dysfunction -- 4.7.1 Hyponatremia -- 4.7.2 Endocrine Dysfunction -- 5. Transfusion Medicine and Anticoagulation -- 5.1 Introduction -- 5.2 Anemia in the ICU -- 5.3 Red Cell Transfusion -- 5.3.1 Leukocyte Reduction Indications -- 5.3.2 Washed RBC -- 5.3.3 Irradiation -- 5.3.4 Complications of Red Blood Cell Transfusion -- 5.3.5 Benefits to Transfusion -- 5.4 Hemoglobin "Triggers" -- 5.5 Thrombocytopenia -- 5.6 Prophylaxis Thresholds -- 5.6.1 Treatment of Bleeding -- 5.7 Antiplatelet Reversal in Intracranial Hemorrhage -- 5.8 Coagulation Cascade and Anticoagulants -- 5.9 Anticoagulants -- 5.9.1 Warfarin -- 5.10 Oral Factor Xa Inhibitors -- 5.10.1 Apixaban, Rivaroxaban, Edoxaban -- 5.11 Thrombin Inhibitors -- 5.11.1 Oral -- 5.11.2 Intravenous -- 5.12 The Heparins -- 5.12.1 Unfractionated Heparin -- 5.12.2 Low-Molecular-Weight Heparin (LMWH) -- 5.12.3 Fondaparinux -- 5.13 Deep Vein Thrombosis (DVT) Prophylaxis -- 6. Cerebral Edema and Elevated Intracranial Pressure -- 6.1 The Basics -- 6.1.1 Monro-Kellie Doctrine -- 6.1.2 ICP and Cerebral Perfusion Pressure (CPP) -- 6.1.3 Intracranial Compliance -- 6.1.4 ICP Waveforms and Herniation Syndromes -- 6.2 Cerebral Edema -- 6.3 Stepwise Approach to the Management of Elevated ICP -- 6.4 Management of Increased Intracranial Pressure -- 6.4.1 Tier 1 -- 6.4.2 Tier 2 -- 6.4.3 Tier 3 -- 7. Fevers and Infections in the Neuro-ICU -- 7.1 Brain -- 7.1.1 Meningitis -- 7.1.2 Acute Bacterial Meningitis -- 7.1.3 Aseptic Meningitis.

7.1.4 Viral Meningitis -- 7.1.5 Fungal Meningitis -- 7.1.6 Ventriculitis -- 7.1.7 HIV-Related Infections -- 7.1.8 Empyema -- 7.2 Spine -- 7.2.1 Epidural Abscess -- 7.2.2 Osteomyelitis -- 7.3 Central Fever -- 8. Treatment of Status Epilepticus in Adults -- 8.1 Overview and Definitions -- 8.2 Convulsive Status Epilepticus Management -- 8.3 Nonconvulsive Status Epilepticus (NCSE) -- 8.4 Refractory Status Epilepticus (RSE) -- 8.5 Super Refractory Status Epilepticus (SRSE) -- 9. Trauma -- 9.1 Acute Spinal Cord Injury -- 9.1.1 Introduction -- 9.1.2 Medical Treatment of Acute SCI -- 9.1.3 Surgical Management of Acute SCI -- 9.2 Traumatic Brain Injury -- 9.2.1 Introduction -- 9.2.2 Management of Elevated ICP -- 9.2.3 Other Post-TBI Considerations -- 9.3 Paroxysmal Sympathetic Hyperactivity (PSH) -- 10. Neuromuscular and Other Neurologic Emergencies -- 10.1 Guillain-Barré Syndrome (GBS)/Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) -- 10.1.1 Definition -- 10.1.2 Epidemiology -- 10.1.3 Differential Diagnosis -- 10.1.4 Common Clinical Presentation -- 10.1.5 Diagnosis -- 10.1.6 GBS Variants -- 10.1.7 Ancillary Testing -- 10.1.8 Complications of GBS -- 10.1.9 Management -- 10.1.10 Prognosis -- 10.2 Myasthenia Gravis -- 10.2.1 Definition -- 10.2.2 Epidemiology -- 10.2.3 Differential Diagnosis -- 10.2.4 Clinical Presentation of Generalized Myasthenia Gravis -- 10.2.5 Diagnosis -- 10.2.6 Management of Myasthenic Crisis -- 10.2.7 Prognosis -- 10.3 Botulism -- 10.3.1 Definition -- 10.3.2 Epidemiology -- 10.3.3 Pathophysiology -- 10.3.4 Differential Diagnosis -- 10.3.5 Clinical Presentation -- 10.3.6 Diagnosis -- 10.3.7 Management -- 10.3.8 Prognosis -- 10.4 Organophosphate Toxicity -- 10.4.1 Definition -- 10.4.2 Epidemiology -- 10.4.3 Pathophysiology -- 10.4.4 Differential Diagnosis -- 10.4.5 Clinical Presentation -- 10.4.6 Diagnosis.

10.4.7 Management -- 10.4.8 Prognosis -- 10.5 Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) -- 10.5.1 Definition -- 10.5.2 Epidemiology -- 10.5.3 Pathogenesis -- 10.5.4 Differential Diagnosis -- 10.5.5 Clinical Presentation -- 10.5.6 Diagnosis -- 10.5.7 Management -- 10.5.8 Complications -- 10.5.9 Prognosis -- 11. Brain Tumor Postoperative Management -- 11.1 Introduction -- 11.1.1 Clinical Presentation -- 11.1.2 Tumor Classification -- 11.2 Postoperative Care and Complications -- 11.2.1 Airway Management -- 11.2.2 Blood Pressure Control and Postoperative Hemorrhage -- 11.2.3 Seizure Prophylaxis -- 11.2.4 Venous Thromboembolism Prophylaxis -- 11.2.5 Antibiotic Prophylaxis and Postoperative Infection -- 11.2.6 Cerebral Edema -- 11.2.7 CSF Leak -- 11.3 Specific Concerns for Sellar and Parasellar Tumors -- 11.3.1 Hormonal Dysregulation -- 11.3.2 Pituitary Apoplexy -- 11.4 Conclusion -- 12. Brain Death in Adults -- 12.1 Definition of Brain Death -- 12.2 Clinical Evaluation -- 12.2.1 Establishing the Proximate Cause of Coma -- 12.2.2 Clinical Examination to Establish Irreversibility -- 12.3 Ancillary Tests -- 12.4 Legal -- 12.5 Management of the Brain-Dead Patient for Organ Donation -- 13. Sodium Dysregulation -- 13.1 Terminology -- 13.2 Hyponatremia Classification -- 13.2.1 Causes of Hyponatremia -- 13.2.2 Symptomatic Hyponatremia -- 13.3 SIADH versus CSW -- 13.3.1 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) -- 13.3.2 Cerebral Salt Wasting (CSW) -- 13.3.3 SIADH and CSW Diagnosis -- 13.4 Diagnostic Approach to Hyponatremia -- 13.4.1 Hyponatremia Treatment: General Principles -- 13.4.2 Acute Symptomatic Moderate to Severe Hyponatremia -- 13.4.3 Acute Asymptomatic Moderate Hyponatremia -- 13.4.4 Severe Chronic Mild-Moderate Hyponatremia -- 13.4.5 SIADH Treatment -- 13.4.6 CSW Treatment.

13.4.7 Treatment of Hyponatremia in Patients with Subarachnoid Hemorrhage -- 13.4.8 Treatment of Hyponatremia in Patients with Heart Failure -- 13.5 Hypernatremia -- 13.5.1 Central (Neurogenic) Diabetes Insipidus -- 13.5.2 Nephrogenic Diabetes Insipidus -- 13.6 Diagnostic Approach to Hypernatremia -- 13.6.1 Treatment -- 13.6.2 Central DI Treatment -- 13.6.3 Nephrogenic DI Treatment -- 14. Nutrition -- 14.1 Glucose Utilization -- 14.2 Nutrition in Critical Care -- 14.3 Nutrition Status -- 14.3.1 Malnutrition -- 14.3.2 Refeeding Syndrome -- 14.3.3 Nutrition-Related Laboratory Tests -- 14.4 Nutrition Assessment -- 14.4.1 Calorie Needs -- 14.4.2 Protein Needs -- 14.4.3 Nutrition Support -- 14.4.4 Enteral Nutrition -- 14.5 Specific EN Considerations -- 14.5.1 Parenteral Nutrition -- 14.6 Therapy-Specific Considerations -- 14.7 Conclusion -- 15. Sedation -- 15.1 Introduction -- 15.2 Indications for Sedation -- 15.3 Complications of Sedation -- 15.4 Assessment of Sedation -- 15.5 Choice of Sedative -- 15.5.1 Propofol (Diprivan) -- 15.5.2 Midazolam (Versed) -- 15.5.3 Dexmedetomidine (Precedex) -- 15.5.4 Fentanyl (Sublimaze) -- 15.5.5 Ketamine (Ketalar) -- 16. Pain Management in the Neuro-Intensive Care Unit (ICU) -- 16.1 Introduction -- 16.2 Modern Strategy of Pain Management in ICU Liberation -- 16.3 Challenges of Pain Management in Neuro-ICU -- 16.4 Individualizing Therapy in NICU -- 16.4.1 Pharmacologic Interventions of Pain -- 16.4.2 Nonpharmacologic Approach -- 16.5 Neuro-specific Diseases at Risk for Pain -- 16.5.1 Pain with SAH -- 16.5.2 Spondylosis and Disk Herniation -- 16.5.3 Spasticity -- 16.6 Ongoing Continuous Pain Monitoring in NICU -- 16.6.1 Pain Scales -- 17. Advanced Hemodynamic and Neurological Monitoring in the Neuro-ICU -- 17.1 Hemodynamic Monitoring -- 17.1.1 Invasive Monitoring: Pulmonary Thermodilution.

17.1.2 Less Invasive: Transpulmonary Thermodilution.

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