RT Book, Section
A1 Kurtz, Pedro
A1 Lee, Kiwon
A2 Lee, Kiwon
SR Print(0)
ID 1143955139
T1 Advanced Hemodynamic Monitoring
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143955139
RD 2024/09/18
AB A  57-year-old  man  with  history  of  hypertension  and  gastric  ulcer  presents  after  a  sudden  onset  of  severe  headache  followed  by  nausea  and  vomiting.  The  patient  arrived  in  the  emergency  department  (ED)  after  becoming  stuporous  in  the  ambulance.  On  arrival  to  the  ED,  he  is  hemodynamically  unstable,with  blood  pressure  (BP)  80/40  mm  Hg  and  is  promptly  intubated.  He  is  given  fluid  resuscitation  with  the  infusion  of  2  L  of  crystalloids,  and  blood  pressure  recovers  to  140/80  mm  Hg.  Computed  tomography  (CT)  of  the  head  reveals  acute  subarachnoid  hemorrhage  (SAH)  filling  the  basal  cistern  and  bilateral  sylvian  fissures  with  thick  hemorrhages  (modified  Fisher  grade  3)  and  early  evidence  of  hydrocephalus  (Figure  17-1).  The  patient  is  transferred  to  the  neurologic  intensive  care  unit  (NeuroICU)  where  an  external  ventricular  drainage  (EVD)  is  urgently  placed  and  urgent  angiography  planned.  After  EVD  placement  the  patient  was  comatose,  with  intact  brainstem  reflexes,  and  pupils  were  symmetric  and  reactive  to  light  bilaterally.  Vital  signs  were  as  follows:  BP,  150/70  mm  Hg;  heart  rate,  120/minute;  respiration  rate,  22/minute  (mechanical  ventilation  at  assist-control  pressure-controlled  mode),  and  temperature,  37°C.