颅脑挫伤
脑水肿 大脑中动脉卒中
脑积水
Glasgow Coma Score (GCS) 3-15 格拉斯哥昏迷评分
• Eye opening (1 - 4) 睁眼反应 Opens eyes spontaneously (4) 自然睁眼（spontaneous）4分 Opens eyes to verbal (3) 呼唤会睁眼（to speech）3分 Opens eyes to pain (2) 有刺激或痛楚会睁眼（to pain）2分 No eye opening (1) 对于刺激无反应（none）1分
An example of a typical Camino Setup
ICP Catheter ICP导管
Catheter Cable 导管导线
Camino Monitor Camino监护 仪
Bedside Cable w/ ICP, ICT Cables 床边 监护仪导线
Bedside Monitor 床边监护仪
Why monitor ICP? 为什么要监测颅内压
Monroe Kellie doctrine Monroe Kellie原理 • The skull is a closed, fixed volume containing the following incompressible fluids: 颅腔是个封闭的有着固定的体积的腔，里面容纳着体 积不能压缩的液体 • Brain 大脑 • Blood 血液 • CSF 脑脊液
• Best verbal (1 - 5) 语言反应 （1-5） Oriented (5) 说话有条理（oriented）5分 Confused(disoriented) (4) 可应答，但有答非所问的情形（confused）4分 Inappropriate (swearing, yelling) (3)
Who shall we monitor？ 哪些患者需要监测
• Guidelines for the Management of Severe Head Injury
Bullock, Chesnut et al (2007)
重症颅脑创伤管理指南 • All patients with GCS <8 所有格拉斯哥评分<8
可说出单字（inappropriate words）3分
Incomprehensible sounds (2) 可发出声音（unintelligible sounds）2分 None (1) 无任何反应（none）1分
Glasgow Coma Score (GCS) 3-15 格拉斯哥昏迷评分
Motor response 肢体运动 • obey commands （6）可依指令动作 6分 • Localize （5） 施以刺激时，可定位出疼痛位置 5分 • Withdrawal （4） 对疼痛刺激有反应，肢体会回缩 4分 • decorticate flexion （3） 对疼痛刺激有反应，肢体会弯曲 3分 • decerebrate extension （2） 对疼痛刺激有反应，肢体会伸直 2分 • no response （1） 无任何反应 1分
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Presentation Outline 培训大纲
• • • • Clinical Review 临床基础 Camino System Overview Camino产品一览 Product History 产品发展史 Product Walkthrough • Monitor 监护仪 • Catheters 导管
Skull 颅骨
Traumatic injuries 颅脑创伤 • Basal skull fractures 颅骨骨折 • Cerebrospinal fluid (CSF) leaks 脑脊液渗漏 • Treated by placement of lumbar or ventricular catheters to drain CSF 植入分流管 • Connected to an EVD 连接外引流管
Concepts of Intracranial Pressure (ICP) 颅内压监测的概念 Disease State / Patient Type 疾病情况/患者类型
- Traumatic Brain Injury (TBI) 颅脑创伤
- Subarachnoid Hemorrhage (SAH) 蛛网膜下腔出血 - Hydrocephalus 脑积水
Who shall we monitor？ 哪些患者需要监测
• Who are these patients? • Trauma, edema, tumors, aneurysms 创伤，水肿，肿瘤，脑动脉瘤 • Stroke 中风 • Sometimes hydrocephalus 脑积水 • Infectious diseases 传染性疾病
• Normal ICP ~ 0 – 15 mmHg 颅内压正常值 0-15 mmHg • Moderate elevation > 20 mmHg 中度升高> 20 mmHg • Cerebral Perfusion Pressure (CPP) 颅内灌注压 • Cerebral perfusion calculated 颅内灌注压计算 • CPP = MAP (mean arterial pressure) – ICP CPP=MAP(平均动脉压）-ICP（颅内压） • CPP 50 - 70 mmHg • Cerebral perfusion is necessary for carrying oxygen to brain to prevent ischemia 颅内灌注对于大脑供氧防止大脑缺血非常必要
® Integra
Camino ICP Monitoring System
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Presentation Objectives 培训目标
• At the end of the presentation you will: • Be familiar with the history of the Integra Camino ICP Monitoring System as well as its technology 熟悉Integra Camino颅内压监护仪的发展历史和技术 • Be able to in-service the Camino monitor, and help an account start using the device 能够提供Camino监护仪现场支持 的使用，培训客户 • Understand the different placement techniques, monitoring locations, and catheters Integra offers for intracranial pressure 了解不同的放置技术、监护位置和Integra的导管产品
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Camino Intracranial Pressure Monitoring Camino颅内压监护
Disposable
Capital
History of Camino Camino的发展历史
• Developed in 1983 • Designed as fiber optic cardiac catheters 被研发用于intracranial pressure (approved by FDA) 被发现可以被用于检测颅内压 • Bolted system at launch(110-4B~Parenchymal) 螺栓系统上市 • Developed first catheters with 3 doctors in San Diego (OLM)与三位医生首次研发导管 • Acquired by Integra in March 1999 1999年被Integra收购
Causes of Increased ICP 引起颅内压升高的原因
• Brain 大脑 • trauma, tumor, infection, edema 创伤、肿瘤、感染、水肿 • Blood 血液 • vasodilatation, cerebrovascular disease, intracerebral bleeding 血管扩张、脑血管病、 颅内出血 • CSF • Hydrocephalus 脑积水
Where are these patients？ 患者在哪里
• ICU (Intensive Care Unit) (know which units may treat the Neuro patients) 重症监护室，了解哪些科室治疗神外患者 • Neuro ICU 神外ICU • Trauma ICU 创伤科ICU • Surgical ICU 外科ICU
Where are these patients?
CAMINO SYSTEM OVERVIEW
- Product History 产品历史 - Monitoring Platform 监护平台 - Catheters Family 导管产品线
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Where are these patients?
Where are these patients？ 患者在哪里
• • • • • • Operating Room 手术室 Pediatrics Units 儿科 Post-anesthesia Recovery Unit (PACU) 麻醉恢复室 Cardiovascular ICU 心血管ICU Epilepsy Monitoring Unit（EMU) Emergency department 急诊