Neurocritical Care Case: Intubation and Hemodynamic Management

In this neurocritical care case, a 30-year-old patient is brought in unresponsive due to a drug overdose. The team discusses the importance of a neuroprotective intubation and the choice of medications used. They highlight the need for pretreatment to manage the patient's blood pressure and intracranial pressure (ICP). The team opts for a combination of propofol and fentanyl, maintaining sedation with intermittent boluses of propofol. The use of succinylcholine is debated, with the suggestion of using rocuronium instead. The need for an arterial line to monitor blood pressure accurately is emphasized. Hemodynamic management using hypertonic saline is discussed, with the importance of careful administration to avoid hypotension. The imaging findings reveal a large intracranial hemorrhage impacting the basal ganglia and ventricular spaces. The team highlights the differentiation between traumatic and non-traumatic bleeds and the importance of involving neurosurgery in such cases. They discuss the neuroprotective intubation approach for traumatic brain injury patients and stress the need for maintaining adequate oxygenation and avoiding hypoxemia during intubation. Lastly, the team touches on the choice of videolaryngoscopy versus direct laryngoscopy and the potential impact on ICP.