NCCEd: Neurocritical Care Education for Residents

In the meanwhile, you should elevate the head of bed (free and easy yet effective way of managing intracranial hypertension) and ask for hyperosmolar therapy. (Ideally you'd start with 30mL of 23.4% NaCl that you can even push peripherally, but that's unlikely to happen in most non-NCCU locations. If you have crash cart medications readily available, ask for 1 ampule of sodium bicarb to be pushed. This has equivalent osmolality to 6% NaCl! If you have 3% NaCl more easily available, then start with 250mL peripherally. The last option would be 1g/kg of 20% mannitol, which can be pushed peripherally but does require an in-line filter.)

You explain to the primary team and neurology that you want to place an EVD once his airway is secured. Plateau waves are not always known by neurologists and neurosurgeons alike, so understanding the phenomenon and being able to explain it can help ensure the appropriate treatment is pursued. Your neurosurgery attending agrees with your plan. You also quickly call the neurointensivist and NCCU charge nurse so that they can start preparing to receive the patient.

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