62-year-old female, day 4 in the ICU, who presented with a collapse. She was off sedation but remained unresponsive. Clinical findings included treatment with nimodipine and noradrenaline, 2 external ventricular drains with blood stained CSF and normal ICP, reduced level of consciousness, some brainstem signs, present cough and gag, temperature of 38.2 degrees. A CT brain demonstrated subarachnoid and intraparenchymal haemorrhage.
Candidates were asked to assess the patient to assess a likely cause for collapse and provide the current priorities in management.