You are called to review a 55-year-old female following difficult prolonged surgery for emergency clipping of a ruptured left middle cerebral artery (MCA) aneurysm. She had returned to the ICU three hours earlier, intubated, ventilated and with an external ventricular drain (EVD) in situ.
She has developed frank blood in the EVD, and her ICP has increased to 57 cmH2O. Outline your approach to her initial management.
This question is almost identical to Question 6 from the second paper of 2015, except this time some of the punctuation has been revised and some of the words rearranged. Also, this time, the patient is not hypertensive. The last time this question appeared, the college examiners had commented that "some candidates failed to recognise this as an emergency situation". Thus:
Endpoints of therapy