Post-Craniotomy Neuro-Critical Emergencies, Brain Death Determination, and Somatic Organ Donor Maintenance — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style post-craniotomy neuro-critical emergencies, brain death determination, and somatic organ donor maintenance viva scenarios with examiner probes and…

Scenarios covered

• SCENARIO 1: A 48-year-old woman is extubated in theatre following an 8-hour elective right parietal craniotomy for glioma resection. In the Post-Anaesthesia Care Unit (PACU) 45 minutes later, she becomes increasingly restless, vomits, her GCS drops from 14 to 8, her blood pressure rises to 195/105 mmHg, heart rate falls to 48 bpm, and her right pupil becomes fixed and dilated (6 mm). Outline your immediate, step-by-step resuscitation and diagnostic algorithm.
• SCENARIO 2: A 28-year-old male with severe traumatic brain injury arrives in the ICU following decompressive craniectomy. Two hours postoperatively, he suddenly develops severe pink frothy sputum from his endotracheal tube, oxygen saturation falls to 76 percent on FiO2 1.0, and bilateral diffuse crackles are heard throughout his lung fields. Echocardiography reveals hyperdynamic left ventricular base with basal sparing and apical akinesia. Describe the pathophysiology, differential diagnosis, and ventilatory/haemodynamic management of Neurogenic Pulmonary Oedema (NPO).
• SCENARIO 3: You are requested to perform a clinical evaluation for Brainstem Death on a 35-year-old man who sustained a severe closed head injury 72 hours ago. Outline the mandatory prerequisites, confounding factors to exclude, the specific brainstem reflex tests, and the detailed execution of the Apnoea Test.
• SCENARIO 4: Following brain death certification in a 24-year-old trauma patient, the family consents to solid organ donation (kidneys, liver, heart). The donor is currently hypotensive (BP 75/40 mmHg), polyuric (urine output 800 mL/hr), hypothermic (34.5°C), and acidotic. Detail your comprehensive somatic donor resuscitation protocol, including target parameters (the 'Rule of 100s') and endocrine replacement therapies.