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Transcript

Escape NSICU Room

ChaoticBRAIN

start

HPI: DA is a 56yo F who was speaking with her family on the phone, yelled out in pain and stopped responding. Family came to check on her and found her minimally responsive and covered in vomit. When EMS arrived, DA was hypertensive with a BP of 230/115 and bradycardic with a HR in the 20-30s. They brought her to the ED where she was intubated and taken for a head CT. CT scan demonstrates diffuse subarachnoid hemorrhage (SAH) with intraventricular extension (IVH). .

Look at the note on the fridge

Patient Info

Ht: 160 cm

Wt: 99kg

PMH: Migraine headaches, Hypertension, GERDSocial: Patient is a Jehovah witness

Is this hypertensive urgency vs emergency?Reminder BP was 230/115

Urgency

Emergency

Blood pressure goals?

Drop MAP by 20% over nect hour; then to 160 over next 6 hours

Drop to <160 SBP ASAP

How do we attain the goal blood pressure?

Nicardipine gtt, clevidipine gtt, hydralazine IV push

Labetalol IV push; esmolol, oral medications

What other concerns do you have given some of her vitals and symptoms

May continue once at least 3 people provide educated guesses

Click here if wrong answer provided

Patient management

HTN emergency

Patient Course Cont.

Neurosurgery arrives to assess the patient. DA was intubated, bradycardic, did not withdraw to pain in any extremities, though she did have a cough and gag. Her SAH is graded as a Hung and Hess grade V and Fisher grade IV. Neurosurgery needs pharmacy help while they prepare to place an IRRAFlow device (similar to an external ventricular drain).

What can be done acutely in the ED? (That a pharmacist can assist with)

May continue once at least 2 interventions are provided

Click here if wrong answer provided

Click here if answered correctly

Click here if wrong answer provided

Patient management

HTN emergency

ED tx requirements

Patient course cont.

IRRAflow is successfully placed and DA is taken to the angio suite. It is found that she has a large bilobed anterior communicating artery aneurysm and they place a WEB device.

What complications is DA at risk for and how should we monitor for them?

May continue once at least four people provide educated guesses

Click here if wrong answer provided

Post-angio what medications should the patient be started on and why?

May continue once at least four people provide educated guesses

Click here if wrong answer provided

Patient Management

HTN emergency

ED tx requirements

Post-angio monitoring and complications

Patient Course Cont.

Day 4: Patient is following simple commands (ie. squeezing hand)Day 7: Patient neuro exam starts to decline per discussion with APP during rounds

Patient lab data

Based on the above laba data, what do you think is going on? At least 2 people must take an educated guess to move on.

Click here if wrong answer provided

What are treatment options for her at this time?

May continue once at least three people provide educated guesses

Click here if wrong answer provided

What other treatment(s) should continue during her stay?

May continue once at least four people provide educated guesses

Click here if wrong answer provided

Patient management

HTN emergency

ED tx requirements

Post-angio monitoring and complications

Identifying and tx pt complications w standard ICU care

starT over?

Congrats!

You have made it out of the NSICU!!!

Wrong!

Please try again, in order to escape the NSICU