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Neurocritical care (or neurointensive care) could be a medical field that treats serious diseases of the systema nervosum and identifies, prevents/treats secondary brain injury. Neuro Patient Care BD There have been many attempts to manage head injuries throughout history including trepanned skulls found from ancient Egypt and descriptions of treatments to decrease brain swelling in ancient Neuro Patient Care BD Greek text. Intensive care begin with centers to treat the poliomyelitis outbreak during the mid-twentieth century. These early respiratory care units utilized a negative and positive pressure unit called the “Iron Lung” to aid patients in respiration and greatly decreased the mortality rate of Polio.Dr. Bjørn Aage Ibsen, a physician in Denmark, “birthed the intensive care unit”, when he used tracheostomy and positive pressure manual ventilation to keep polio patients alive within the setting of Associate in Nursing flow of patients and restricted resources (only iron Lung).Walter Edward Dandy (April 6, 1886 – April 19, 1946) was an American neurosurgeon and scientist.Neuro Patient Care BD The first neurological intensive care unit was created by Dr. Dandy Walker at Johns Hopkins in 1929. 

Dr. Walker realized that some surgical patient could use specialized postoperative neurosurgical monitoring and treatment. The unit Dr. Walker created showed a benefit to postoperative patients, than neurologic patients came to the unit. Dr. Safar created the first intensive care unit in the United States in Baltimore in the 1950s. In the 1970s, the benefit of specialized care in respiratory and cardiac ICUs led to the Society of Critical Care medicine being formed. This body created standards for extensive, difficult medical problems and treatments. Over time the need for specialized monitoring and treatments led to neurologic intensive care units. Modern neurocritical care began to develop in the 1980s.The Neurocritical care society was founded in 2002. In 2005, Neurocritical care was recognized as a neurological subspecialty.Neuro Patient Care BD The doctors who practice this type of medicine are called neurointensivists, and can have medical training in many fields, including neurology, anesthesiology, emergency medicine, internal medicine, or neurosurgery. Common diseases treated in neurointensive care units include strokes, ruptured aneurysms, brain and spinal cord injury from trauma, seizures (especially those that last for a long period of time- status epilepticus, and/or involve trauma to the patient, i.e., due to a stroke or a fall), swelling of the brain (Cerebral edema), infections of the brain (encephalitis) and the brain’s or spine’s meninges (meningitis), brain tumors (especially malignant cases; with neurological oncology), and weakness of the muscles required to breathe (such as the diaphragm).

Besides dealing with critical illness of the nervous system, neurointensivists also treat the medical complications that may occur in their patients, including those of the heart, lung, kidneys, or any other body system, including treatment of infections. Neurological Intensive care units are specialized units in select tertiary care centers that specialized in the care of critical ill neurological and post neurological surgical patients.Neuro Patient Care BD The goal of NICUs are to provide early and aggressive medical interventions including managing pain, airways, ventilation, anticoagulation, elevated ICP, cardiovascular stability and secondary brain injury. Admission criteria includes: Impaired consciousness, impaired ability to protect airway, progressive respiratory weakness, need for mechanical ventilation, seizure, Radiologic evidence of elevated ICP, monitoring of neurologic function in patients that are critically ill.Neuro-ICU have been seeing increasing use at Tertiary referral hospital. One of the main reasons why Neuro-ICUs have seen increased use is the use of therapeutic hypothermia which has been shown to improve long-term neurological outcomes following cardiac arrest. Most neurocritical care units are a collaborative effort between neurointensivists, neurosurgeons, neurologists, radiologists,Neuro Patient Care BD pharmacists, physician extenders (such as nurse practitioners or physician assistants), critical care nurses, respiratory therapists, rehabilitation therapists, and social workers who all work together in order to provide coordinated care for the critically ill neurologic patient. Hypothermia: One third to half of people with coronary artery disease will have an episode where their heart stops.Of the patients who have their heart stopped seven to thirty percent leave the hospital with good neurological outcome (conscious, normal brain function, alert, capable of normal life). Lowering patients body temperature between 32 -34 degrees within six hours of arriving at the hospital doubles the patients with no significant brain damage compared to no cooling and increases survival of patients. 

ICU Monitor (front) Basic life support monitoring: Electrocardiography, pulse oximetry, blood pressure, assessment of comatose patients.Neuro Patient Care BD Neurological monitoring : Serial neurologic examination, assessment of comatose patients (Glasgow Coma Scale plus pupil or four score),Neuro Patient Care BD ICP (subarachnoid hemorrhages, TBI, Hydrocephalus, Stroke, CNS infection, Hepatic failure), multimodality monitoring to monitor disease and prevent secondary injury in states that are insensitive to neurological exam or conditions confounded by sedation, neuromuscular blockade and coma.Intracranial pressure (ICP) management: Ventricular catheter to monitor Brain oxygen and concentrations of glucose and PH. With treatment options of Hypertonic serum, barbiturates, hypothermia and decompressive hemi-craniotomy Traumatic brain injury: Sedation, ICP monitoring and management, Decompressive Craniectomy, Hyperosmolar therapy and maintain hemodynamic stability.Neuro Patient Care BD MCA-Stroke-Brain-Human-2 Stroke: Airway management, Maintenance of blood pressure and cerebral perfusion, intravenous fluid management, Temperature control, prophylaxis against seizures, nutrition,ICP management and treatment of medical complications. Subarachnoid hemorrhage: Find the cause of hemorrhage, treat aneurysm or arteriovenous malformation if necessary, monitor for clinical deterioration,Neuro Patient Care BD manage systemic complications and maintain cerebral perfusion pressure and prevent vasospasm and bridge patient to angiographic clipping. Status epilepticus: Termination of seizures, prevention of seizure recurrence, treatment of cause of seizure, management of complications, monitoring of hemodynamic stability and continuous Electroencephalography(EEG). Meningitis: Empirical treatment with antibiotics and maintain hemodynamic stability. Encephalitis: Airway protection, monitoring of ICP, treatment of seizures if necessary, and sedation if patient is agitated and virial testing hemodynamic stability.Neuro Patient Care BD Acute parainfectious inflammatory encephalopathy (Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis (AHL)) : high dose corticosteroids, monitoring of hemodynamic stability.Neuro Patient Care BD Multiple sclerosis, Autonomic neuropathy, spinal cord lesion and neuromuscular disease causing respiratory failure: Monitor respiration and respiratory assistance, if necessary to maintain hemodynamic stability.Neuro Patient Care BD Tissue plasminogen activator: Monitor patient who receive TPA for 24 hours for brain bleeds Neuroscience nursing is a distinctive area within the discipline of nursing.It focuses on the care of individuals with brain, spine and nervous system disorders. Neuroscience nurses work in a wide range of settings from academic medical centers to skilled nursing facilities, rehabilitation units to epilepsy monitoring units.

Neuroscience nurses can be found in virtually any setting that nurses practice. The first reports of nurses providing direct care to patients with neurological diseases came out of France and England in the late 19th century. Nurses observed Sir Victor Horsley’s first operation at the National Hospital for the Paralysed and Epileptic in London.To have the skills necessary to care for the complex patient population nurses at the time knew they needed specialized training. At the time training there was no formal training and to gain specialized knowledge nurses at the time only had informal training that was provided by physicians sharing their knowledge. Around the same time, neuroscience nursing started to emerge in the United States as a nursing specialty. The emergence of neuroscience nursing is due in part to Dr.Charles Karsner Mills,Neuro Patient Care BD a physician at Philadelphia General Hospital. He held lectures for nurses on the care of patients with neurological diseases. In 1889 the content of these lectures was collected and The Nursing and Care of the Nervous and the Insane was published, thought to be the first textbook on neuroscience nursing. In 1910, Amy Hilliard became the first superintendent of the nurses at the New York Neurological Institute. She went on to organize the first post-graduate courses that focused on neuroscience nursing. These courses continued to be led by physicians. It was not until the 1960s that neuroscience nursing courses were taught by specialty trained nurses, with the University of California School of Nursing in San Francisco and the New York Medical College in New York leading the way in training neuroscience nurses.American Association of Neuroscience Nursing In 1968 the American Association of Neurosurgical Nurses (AANN) was founded. The creation of AANN was a collaboration between Barbara Therrien, a nurse instructor at Barnes Hospital in St.Neuro Patient Care BD Louis Missouri and Dr. Henry Schwartz, the president of the American Association of Neuroscience Surgeons. A colleague of Dr. Henry presented the idea to Agnes M. Marshall. The inaugural AANN education conference was held in Chicago in 1968, with over 100 nurses in attendance.In 1970 AANN applied for membership into the World Federation of Neurosurgical Societies and was the first nursing organization accepted. Since the founding of AANN it has been the leading authority in neuroscience nursing. Today AANN has over 5,200 members worldwide.