Episode 22: Aneurysmal subarachnoid hemorrhage with Thomas Lawson

In this episode of Critical Care Scenarios, Brandon Odo and Brian Bowling are joined by Tom Lawson, a nurse practitioner specializing in neurocritical care, to discuss the management of a patient with a subarachnoid hemorrhage. The discussion begins with an overview of initial assessments and diagnostic considerations upon receiving a call about a 56-year-old female presenting with a severe headache. The conversation progresses through the steps of managing the patient, including addressing hydrocephalus with an external ventricular drain, securing a detected aneurysm via coiling, and dealing with potential complications such as vasospasm and cerebral salt wasting. The panel also explores various treatment options, such as nimodipine, intra-arterial verapamil, and milrinone, while highlighting the complexities and challenges of neurocritical care.

Outlines

Part 1: Initial Assessment and Diagnosis

Part 2: Acute Management and Intervention

Part 3: Vasospasm and Long-Term Care

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Critical Care Scenarios

Part 1: Initial Assessment and Diagnosis

Introduction to Neurocritical Care Scenarios and Initial Case Overview

Initial Patient Assessment and Immediate Concerns

Differentiating Aneurysmal vs. Traumatic Subarachnoid Hemorrhage and CT Head Interpretation

Subarachnoid Hemorrhage Scoring Systems and Rapid Neurological Decline

Immediate Actions for Neurological Decline: Imaging and Intubation Considerations

Part 2: Acute Management and Intervention

Managing Hydrocephalus and Securing the Aneurysm

Post-Coiling Management: Neurological Assessment and Cardiac Considerations

Fluid Management, Blood Pressure Goals, and Sodium Balance

Differentiating Hyponatremia Causes and Prophylactic Measures

Part 3: Vasospasm and Long-Term Care

Recognizing and Investigating Delayed Neurological Decline

Initial Management of Suspected Vasospasm and Diagnostic Imaging

Endovascular Treatment of Vasospasm and Refractory Cases

EVD Weaning, Long-Term Management, and Concluding Remarks

Episode 22: Aneurysmal subarachnoid hemorrhage with Thomas Lawson

Critical Care Scenarios

Part 1: Initial Assessment and Diagnosis

00:05Introduction to Neurocritical Care Scenarios and Initial Case Overview

Introduction to Neurocritical Care Scenarios and Initial Case Overview

02:50Initial Patient Assessment and Immediate Concerns

Initial Patient Assessment and Immediate Concerns

05:14Differentiating Aneurysmal vs. Traumatic Subarachnoid Hemorrhage and CT Head Interpretation

Differentiating Aneurysmal vs. Traumatic Subarachnoid Hemorrhage and CT Head Interpretation

09:10Subarachnoid Hemorrhage Scoring Systems and Rapid Neurological Decline

Subarachnoid Hemorrhage Scoring Systems and Rapid Neurological Decline

12:27Immediate Actions for Neurological Decline: Imaging and Intubation Considerations

Immediate Actions for Neurological Decline: Imaging and Intubation Considerations

Part 2: Acute Management and Intervention

17:24Managing Hydrocephalus and Securing the Aneurysm

Managing Hydrocephalus and Securing the Aneurysm

20:57Post-Coiling Management: Neurological Assessment and Cardiac Considerations

Post-Coiling Management: Neurological Assessment and Cardiac Considerations

23:30Fluid Management, Blood Pressure Goals, and Sodium Balance

Fluid Management, Blood Pressure Goals, and Sodium Balance

27:32Differentiating Hyponatremia Causes and Prophylactic Measures

Differentiating Hyponatremia Causes and Prophylactic Measures

Part 3: Vasospasm and Long-Term Care

30:53Recognizing and Investigating Delayed Neurological Decline

Recognizing and Investigating Delayed Neurological Decline

33:52Initial Management of Suspected Vasospasm and Diagnostic Imaging

Initial Management of Suspected Vasospasm and Diagnostic Imaging

37:18Endovascular Treatment of Vasospasm and Refractory Cases

Endovascular Treatment of Vasospasm and Refractory Cases

41:41EVD Weaning, Long-Term Management, and Concluding Remarks

EVD Weaning, Long-Term Management, and Concluding Remarks