Severe Neurotrauma and Neurocritical Emergencies — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style severe neurotrauma and neurocritical emergencies viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 22-year-old motorcyclist without a helmet is brought to the ICU following a high-speed collision. On arrival, GCS is 6 (E1V1M4), the right pupil is 6 mm and non-reactive to light, left pupil is 3 mm and reactive. Heart rate is 52 beats/min, blood pressure is 185/105 mmHg, respiratory rate is 10 breaths/min with irregular snoring respirations, and SpO₂ is 88% on room air. Describe your immediate step-by-step emergency airway securing, tier-1/tier-2 ICP reduction measures, and preparation for urgent decompressive craniotomy.
• SCENARIO 2: A 34-year-old female driver is admitted with a complete C4/C5 cervical fracture-dislocation following a motor vehicle accident. She has complete tetraplegia below the C4 level, heart rate is 44 beats/min, blood pressure is 76/40 mmHg, and she is exhibiting paradoxical abdominal breathing with SpO₂ 89%. Detail your complete anaesthetic and intensive care management over the first 72 hours, focusing on airway control, haemodynamic targets, and complications of neurogenic shock.
• SCENARIO 3: A 50-year-old male with a history of hypertension is admitted to the ICU 4 days post-coiling of a ruptured anterior communicating artery aneurysm (Fisher Grade 3). He develops acute onset of left-sided hemiplegia, aphasia, and a drop in GCS from 14 to 9. A repeat non-contrast CT brain shows no re-bleeding or hydrocephalus. Outline your diagnostic workup for delayed cerebral ischaemia (DCI)/vasospasm and your comprehensive ICU therapeutic protocol.
• SCENARIO 4: A 29-year-old female is admitted in refractory status epilepticus having seized continuously for 45 minutes despite 8 mg IV lorazepam and a 40 mg/kg IV levetiracetam loading infusion. She is cyanotic, hyperthermic (temperature 39.8°C), heart rate 158 beats/min, blood pressure 160/100 mmHg, and rhabdomyolysis is suspected. How will you aggressively manage her airway, induce pharmacological coma, and protect systemic organ function in the ICU?