A 25-year-old man presents in the evening to the emergency department of your tertiary metropolitan hospital. He is a singer who collapsed on stage whilst performing. He initially complained of a severe headache and chest pain.
On arrival, he appears confused, is slurring his words, and has weakness in his left arm with neck stiffness.
Observations
HR 98 bpm
BP 170/110 mmHg
SpO2 93% on room air
Temp 37.6°C
GCS 13 (E4 V4 M5)
An urgent cerebral CT angiogram has been performed and an image from the CT is displayed.
The neurosurgical team wishes to urgently perform a craniotomy and clip a presumed ruptured right middle cerebral artery aneurysm.
Sections covered in this viva
Section 1 - Cocaine toxicity with aneurysm rupture and haemodynamic controlSection 2 - Anaesthesia for craniotomy with brain swelling and bleedingSection 3 - Safe extubation and neurological decline in PACU