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The Neuro Patient

The Neuro Patient. A Case Study. Case Study. A 19-year-old female presents to the ED with a severe headache. Onset was 2 hours ago. History is negligible. Vital signs are as follows: BP 88/46 Pulse 130 Respirations 24 Temperature 98.2 SpO2 98%

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The Neuro Patient

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  1. The Neuro Patient A Case Study

  2. Case Study A 19-year-old female presents to the ED with a severe headache. Onset was 2 hours ago. History is negligible. Vital signs are as follows: • BP 88/46 • Pulse 130 • Respirations 24 • Temperature 98.2 • SpO2 98% What are your list of differential diagnoses? What else do you want to know?

  3. Tests & Procedures? • CAM-ICU • CT Scan • NIH Stroke Scale

  4. Laboratory Tests? • CBC • CMP • PT/INR • Ammonia • ABG

  5. Results The results are coming in. The CT scan indicates a large hemorrhage in the right frontal lobe. The coagulation studies indicate a high INR. The ABG indicates trending acidosis. Your patient is obtunded at this point and vital signs are plummeting. Current BP is 76/30, Pulse 145 and irregular, Respirations are 30 and agonal. What medications and procedures do you anticipate?

  6. Medication • Mannitol: decrease intracranial pressure • Vasopressors: increase blood pressure and constrict cranial vasculature to reduce bleeding • Vitamin K: lower coagulation levels and reduce intracranial bleeding

  7. Procedures • Prepare for intubation and ventilator support • Possible cranial bolt to monitor ICP • Neuro checks q 15 minutes • EEG • Possible surgery for hematoma evacuation and/or Burr’s holes • Frequent vital signs, strict I&O, and preparation for impending code blue

  8. Conclusion The outcome for these patients is generally poor unless the bleed is quickly identified and interventions are immediate. A widening pulse pressure, fixed pinpoint pupils, and decerabate posturing are all indications of brain death. Unfortunately, many of these patients are young and/or do not have a previous history.

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