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non-biased, and of acceptable quality. This datasheet and an online
questionnaire were then emailed to 384 patients with chronic trau-
matic SCI. The chi-square test was used to analyze responses.
Results:
77 patients completed our questionnaire (20.1%). 65 of the
77 patients (84.4%) report arriving to the hospital within the 8 hour
MPSS treatment window. Only 6 patients (7.8%) reported that they
were given the chance to decide whether they would receive MPSS or
not. Only 11 patients (15.3%) know whether they received MPSS or
not.
59.4% of respondents rated the small neurological benefits associ-
ated with MPSS as being very important to them (10 on a 10 point
Likert scale, p
<
0.0001). Patients had little concern for potential side-
effects of MPSS (49.3% chose 1–3 on a 10 point Likert scale,
p
<
0.0001). The majority of patients (53.2% or 41/77) ‘‘felt strongly’’
that MPSS should be a treatment option for SCI patients (p
<
0.0001).
Only 1.4% of respondents felt that MPSS should not be given to SCI
patients (p
<
0.0001).
Conclusion:
Communication surrounding MPSS administration
was poor. Patients with SCI favor the administration of MPSS for
acute SCI, however very few had input into whether or not it was
administered. Conscious patients should be given greater opportunity
to decide how they are treated; the results of this study provide some
guidance regarding MPSS administration in patients who are unable to
communicate.
Keywords: methylprednisolone, spinal cord injury, patient prefer-
ence, communication
C3-09
IMPLEMENTATION OF UNIQUE PROCESS FOR CERE-
BRAL MICRODIALYSIS AT A LEVEL I TRAUMA CENTER
Kathryn D’Aquila
, Kathy Cosimano, Lori Csenscics, Terry Rattigan-
Davis, Linda McGinnis, Patricia Wrobbel
Westchester Medical Center, Neuroscience/ Trauma, Valhalla, USA
Objectives:
To create an efficient and reliable process for cerebral
microdialysis (CMD) promoting rapid speciment turnaround and op-
timal utilization of multidisciplinary organizational roles.
Background:
Industry implementation of cerebral microdialysis
includes point of care bedside analysis of hourly microdialysis spec-
imens. Establishing a unique process using a collaborative multidis-
ciplinary team approach at our level I trauma hospital, microdialysis
specimen analysis is processed in the clinical laboratory. This unique
process promotes nurses’ role to focus on vigilant patient assessment,
monitoring, and implementation of therapies to prevent secondary
brain injury.
Methods:
Planning initiated in the third quarter 2012 with im-
plementation in April 2013. Specific roles and process steps were
established for team members. Handoff of microdialysis specimens in
the trauma intensive care unit reflects time of patient specimen re-
moval to courier handoff for hand delivery to the STAT clinical
laboratory for immediate analysis. Handoff tools provide quality im-
provement data for monitoring and team communication.
Results:
The process improved teamwork, communication and
resource utilization. The mean delivery to lab time
=
5.5 minutes for
98 CMD patients since initiation of the process. Successful process
eliminated need for nurses to perform point of care lab analysis on
microdialysis specimens. Process demonstrates effective communi-
cation and matches team member roles according to training and
expertise.
Conclusions:
Creating a process with specific roles matched to
organizational roles improved specific process, efficiency, and com-
munication. Clarifying roles and responsibilities can reduce time to
interventions and improve outcomes.
Keywords: Microdialysis, Specimen processing, Multidisciplinary
implementation
C4 Poster Session V - Group C: Neurotoxicity/
Neuroexcitation
C4-01
NEUROLOGICAL COMPLICATIONS DUE TO A SUB-
ARACHNOID INJECTION OF HYPERTONIC CONTRAST
MEDIA IN RAT
Kazuhiko Kibayashi
, Ryo Shimada, Jiro Ezaki
School of Medicine, Tokyo Women’s Medical University, Department
of Legal Medicine, Tokyo, Japan
Myelography is routinely performed using a non-ionic contrast media.
However, the inadvertent administration of ionic hypertonic contrast
media into the subarachnoid space results in convulsions and acute
respiratory failure, and can lead to death if not treated immediately.
The mechanisms underlying the adverse effects of hypertonic contrast
media on the central nervous system are unclear. We examined the
effects of a subarachnoid injection of hypertonic contrast media (60%
Urografin ; osmotic pressure 6) on the central nervous system in the
rat. Under general anesthesia, rats were administered a subarachnoid
injection of 20.0, 10.0, 7.5, or 5.0
l
L of Urografin or saline. The rats
that received 20.0 or 10.0
l
L of Urografin immediately developed
severe convulsions and died within 42 minutes of the injection. The
rats that received 7.5 or 5.0
l
L of Urografin exhibited delayed-onset
convulsions that subsided within 240 minutes. Immunohistological
examinations of the brain and spinal cord two days after the 7.5
l
L
Urografin injection revealed microglial activation and decreased
expression of transient receptor potential vanilloid 4 (TRPV4), a
protein related to osmoregulation, in the brain stem. Neither convul-
sions nor histological changes were observed in rats that received the
saline injection. These findings indicate that the extent and duration of
convulsions and fatality depend on the volume of hypertonic contrast
media. Furthermore, brain stem injury is the mechanism underlying
the acute respiratory failure that occurs following the subarachnoid
injection of hypertonic contrast media. This study also suggests that
high cerebrospinal fluid osmolality affects the central nervous system.
Keywords: cerebrospinal fluid, osmotic pressure, microglia, tran-
sient receptor potential vanilloid 4 (TRPV4), contrast media, myelo-
graphy
C4-02
ALTERED TRYPTOPHAN METABOLISM IN BLAST-
INDUCED TRAUMATIC BRAIN INJURY
Peethambaran Arun
, Donna Wilder, William Rittase, Meghan
Mccuistion, Samuel Oguntayo, Ying Wang, Irene Gist, Joseph Long
Walter Reed Army Institute of Research, Blast-Induced Neurotrauma/
Center for Military Psychiatry & Neurosciences, Silver Spring, USA
Blast-induced traumatic brain injury (bTBI) is one of the major dis-
abilities in service members returning from recent military operations.
The neurobiological underpinnings of bTBI, which is associated with
acute and chronic neuropathological and neurobehavioral deficits, are
uncertain. The role of the essential amino acid, tryptophan, in the
A-83