NCCEd: Neurocritical Care Education for Residents

A 83 year-old woman with HFpEF and CAD s/p PCI to RCA (2010) initially presented to the ED with an acute onset of expressive aphasia, severe dysarthria, and right hemiparesis. She was found to have a proximal left MCA occlusion. She was treated with tPA and mechanical thrombectomy. Nicardipine gtt is needed to maintain her BP below the goal of 180/105.

On post-stroke day 2, an interval non-contrast head CT is obtained, and reveals a moderate-sized frank infarct. You are paged by her nurse that he suddenly became tachycardic. A 12-lead ECG is obtained.

You review the ECG print-out, and then the patient's monitor starts alarming. Her heart rate is variable, now bouncing around between the 150s and 170s. The patient is harder to rouse than this morning. You cycle the blood pressure cuff, and it reads 90/48. You stop the nicardipine.