I85PREP
⌘ K
EDIC Part I study materials
EDIC Part I study resources

EDIC Part I: Neuro-Intensive Care

EDIC Part I · Work through your exam, one topic at a time.

All guide sections

Neuro-Intensive Care

Neuro-intensive care tests traumatic brain injury, intracranial pressure, status epilepticus and subarachnoid haemorrhage.

Core rules

  • CPP = MAP − ICP; target 60–70 mmHg in TBI and ICP <22 mmHg.
  • Monroe–Kellie doctrine: brain, blood and CSF occupy a fixed skull; herniation syndromes follow raised ICP.
  • TBI: avoid hypotension (SBP ≥110 mmHg) and hypoxia; head elevation 30°, normocapnia; hyperosmolar therapy for raised ICP; short-term hyperventilation only for herniation.
  • Status epilepticus: benzodiazepine first, then levetiracetam or valproate; refractory cases need anaesthetic agents and EEG.
  • SAH: nimodipine, secure the aneurysm, monitor hydrocephalus and vasospasm.

Worked example

MAP 60 mmHg and ICP 25 mmHg give CPP 35 mmHg, below target. Treat ICP and raise MAP with fluids or vasopressors; do not hyperventilate prophylactically. If pupillary dilation suggests herniation, brief hyperventilation to PaCO2 30–35 mmHg is a bridge to definitive treatment.

Traps

  • Steroids in TBI increase mortality.
  • Prophylactic hyperventilation causes ischaemia.
  • Equating ICP with brain injury severity.
  • Missing non-convulsive status; use EEG.