NCCEd: Neurocritical Care Education for Residents

In the meanwhile, you elevate the head of bed (free and easy yet effective way of managing intracranial hypertension). Actually, we should've done this even before getting the 23.4%. (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.)

Suggested Reading:

• Posner JB, Saper CB, Schiff ND, Claassen J. Chapter 3: Structural Causes of Stupor and Coma. In: Posner JB, Saper CB, Schiff ND, Claassen J, eds. Plum and Posner's Diagnosis and Treatment of Stupor and Coma. Oxford University Press; 2019. doi:10.1093/med/9780190208875.003.0003