Hi! I'm new to a neuro ICU.
Had a head trauma patient with a subdural and a shift. Low GCS at first, but they did a massive craniectomy (entire parietal/temporal bone flap). By the time I got the patient (3 hours post-op) he was following commands and nodding to some questions off sedation. Pupils equal and brisk, moving all extremities equally. The neurosurgeon seemed surprised and impressed. Follow-up CT scan showed the shift had resolved.
1. Should I worry about too much fluids with this patient? Would it cause brain swelling? He was getting maintenance fluid and he was on a protocol for potassium replacement (standard for trauma patients, not necessarily neurosurg patients). So with a K rider I was running 250 ml/hr intake. I decreased the maintenance to KVO but didn't know if they maybe needed the fluid as traumas often do.
2. What kind of prognosis and outlook would this patient have? I encouraged the family that it's good he's able to wake and follow commands, but cautioned them that swelling might still occur. Could this patient be, you know, okay today and then swell tomorrow and be in a coma forever? Could they be okay today and then still suffer cognitive deficit or personality changes as TBI patients often do?
I mean, it's great that this patient seemed resolved, but that's without half their skull in place. What happens from now on?