NROS

Question 1

Decrease ICP measures

Answer 1

1. Avoid CBF
   - normocapnia - IPPV
   (30-35mmhg)
   - normoxia - good O2
   - normal BP - analgesia
   - warm
2. Avoid venous pressure
   - no cough/strain
   - no head down
   - no ETT ties
3. Prevent cerebral oedema
   - maintain IV volume and CPP
   - CPP>65
   - mannitol 20% 1mg/ml
   (0.25g/kg)
   - NS 5% 100ml
   - steroids for tumor and abscess ONLY - DO NOT GIVE for head injury
4. CSF
   - ventricular/lumbar drain
5. CVP
   - head up 30 deg
6. MAP
   - pressor

Question 2

VP Shunt

Answer 2

Indication:
1. Hydrocephalus

Options:
1. Ventriculoartial
2. Ventriculopleural

Surgical:
1. Occipital burr hole –> LV
2. Tunnel SC down to nec and trunk
3. Peritonal cavity via abdo cut

System:
1. Flushing device - keep system clear
2. Valve - prevent CSF draining too quickly

PRE:
1. assume raised ICP
2. paeds consideration
3. emerg = RSI

PERI:
M: routine +/- IAL
A:
D: IV or IT abx; trocar stimulating - relax/analgesia
E: FAW

POST:
D - ALOC –> CT excl. shunt mal or SDH

Considerations x3
- ICH risk if drained too quick
- shunt - block/infection = resite
- trocar - risk of PTX

oxford

Question 3

WFNS

Answer 3

Prognostication!

GCS and motor deficit

Motor deficit grade 3+

GCS
15 = 1
13-14 no def = 2
13-14 def = 3
7-12 =4
3-6 = 5

secure aneurysm <48 hrs post ictus of 1-3
- coil / clip

Question 4

mFS

Answer 4

Risk of vasospasm!

SAH IVH spasm%

0 = none = 0%
1 = thin/ none = 24%
2 = thin/yes = 33%
3 = thick/no = 33%
4 = thick/yes = 40%

Question 5

Intracranial aneurysms

Answer 5

Location - junction

Common
1. AComm 40%
2. MCA bifur 34%
3. PCA 20%

RF
1. HTN
2. Smoke
3. FHx
4. PCKD
5. Cocaine
6. CTD

Question 6

VAE

Answer 6

sx:
1. dec EtCO2!
- inc dead space
2. bronchoconstriction
3. hypoxia
4. arrhythmias
5. MI
6. hypotension
7. cardiac arrest