Open AccessOver the years, some surgical therapies have shown clear benefit over medical management. For instance, now we have the possibility of embolectomy for proximal artery occlusions [8], the use of coiling or clipping to secure aneurysms [9,10], and open and minimally invasive surgical techniques for clot evacuation [11]. In other diagnoses, there is equipoisebetween medical and surgical intervention. However, in some conditions such as cerebral edema, the treatment remains primarily conservative. From a Neurocritical care perspective, there is much to be done to mitigate the intracranial hypertension related tocerebral edema from various etiologies, including stroke: for example, reduction in cerebral blood flow with anesthetics, increased venous drainage, hyperosmolar and hypertonic medications, and normo-or hypothermia [12].At our institution, we have taken maximal medical management of cytotoxic and vasogenic edema one step further and implemented a hospital-wide "Brain Code" system. This system was adopted in 2012, and is modeled after the now-familiar but once-revolutionary "Stroke Code" [13]. When clinical, neuro monitoring, or radiographic signs of intracranial hypertension or herniation are apparent, a healthcare provider pages a "Brain Code" through the operator, which brings the pharmacist, Neurocritical care physician, and "Brain Code" box to the bedside. Within the first two years of implementation, more than 75 brain codes were called at our institution. The average time to administration of potentially life-saving medication has improved from greater than 40minutes to 11 minutes in the era of the Brain Code-a highly significant improvement both in terms of statistics and the quality of patient care. When it comes to the brain, time matters [14]. We need to be able to give these medications in the most timesensitive manner possible, and we are using the 'code' model to push the envelope and achieve faster administration. This system was suggested by the Emergency Neurological Life Support course [12] and called for by neurological academicians [15, 16], but we are one of the first academic medical centers to have implemented a formalized brain code process. Using the Brain Code system, we can more effectively manage intracranial crises. We hope other institutions will implement a similar system; without it, medical managementof neurological emergencies simply are not maximized. References
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