The Adam Williams initiative: collaborating with community resources to improve care for traumatic brain injury.

BACKGROUND: The Brain Trauma Foundation has developed treatment guidelines for the care of patients with acute traumatic brain injury. However, a method to provide broad acceptance and application of these guidelines has not been published. OBJECTIVE: To describe methods for the development, funding, and continued educational efforts of the Adam Williams Initiative; the experiences from the first 10 years may serve as a template for hospitals and nurses that seek to engage in long-term quality improvement collaborations with foundations and/or industry. METHODS: In 2004, the nonprofit Adam Williams Initiative was established with the goal of providing education and resources that would encourage hospitals across the United States to incorporate the Brain Trauma Foundation's guidelines into practice. RESULTS: Between 2004 and 2014, 37 hospitals have been funded by the Adam Williams Initiative and have had staff members participate in an immersion experience at Mission Hospital (Mission Viejo, California) during which team members received both didactic and hands-on education in the care of traumatic brain injury. CONCLUSIONS: Carefully cultivated relationships and relentless teamwork have contributed to successful implementation of the Brain Trauma Foundation's guidelines in US hospitals.

Intra-arterial verapamil-induced seizures: case report and review of the literature.

BACKGROUND: Intra-arterial verapamil infusion with or without balloon angioplasty is a common therapy for patients with hypertensive, hypervolemic, and nimodipine-refractory vasospasm following aSAH. Seizures occurring from IA infusion of verapamil are rare. CASE DESCRIPTION: A 24-year-old Korean-American woman presented with aSAH from the rupture of a 5-mm ICA bifurcation aneurysm. The aneurysm was secured with clip ligation through a craniotomy, and the patient was treated with HHH therapy in the neurosurgical ICU. Routine postoperative cerebral angiography was performed to confirm occlusion of the treated aneurysm and assess for vasospasm. In the first angiogram, vasospasm was detected in the supraclinoid portion of the ICA. Intra-arterial verapamil was started; during this treatment, the patient developed right-sided focal motor seizures. The infusion was terminated and the seizures were halted with midazolam. The patient's course was unremarkable until postoperative day 7, when she developed expressive aphasia, for which she was taken for emergent cerebral angiography under anesthesia. Marked focal spasm was identified in the distal supraclinoid ICA and the left A1. The patient was treated with 25 mg of superselective verapamil infusion. Upon emerging from anesthesia, her aphasia had resolved; however, 90 minutes after angiography, she experienced generalized seizures while she was in the ICU. CONCLUSIONS: Seizures are a rare complication during cerebral angiographic procedures. Intra-arterial verapamil-induced seizures are infrequently reported. Cognizance for the potential of seizures to occur is advised during verapamil infusion for the treatment of refractory vasospasm in certain individuals.

Early propofol infusion syndrome following cerebral angiographic embolization for giant aneurysm repair. Case report.

The authors report a case of short-term high-dose propofol-related metabolic acidosis in a 3-year-old girl. The patient initially presented at another institution with left fourth cranial nerve palsy, and examination revealed a large, wide-necked 19 x 22 x 17-mm aneurysm in the left internal carotid artery. She had undergone three previous unsuccessful attempts at endovascular coil embolization, which were complicated by repeated coil protrusions into the parent vessel. During angiography and a balloon occlusion test (BOT) 80 mg propofol was given for 3 hours followed by 200 microg/kg/min for another 4 hours. The 20-minute BOT was well tolerated, and the aneurysm was occluded with stent-assisted coil embolization. Following the procedure the patient developed severe acidosis, hypotension, tachycardia, and signs of cardiac failure. On postoperative Day 3 her metabolic acidosis resolved, and she was weaned off sedatives. She continued to improve and was discharged from the hospital on postoperative Day 7. The metabolic acidosis and hypotension were thought to be due to propofol-related infusion syndrome.