critical care cns Interview Questions and Answers

1. What is your experience with managing patients with traumatic brain injury (TBI)?

   • Answer: I have extensive experience managing patients with TBI, including assessing Glasgow Coma Scale (GCS) scores, implementing ICP monitoring and management strategies (e.g., hyperventilation, osmotic diuretics, cerebrospinal fluid drainage), managing cerebral edema, and monitoring for complications like seizures and infections. My experience encompasses various TBI severities, from mild concussion to severe diffuse axonal injury. I am proficient in utilizing neuroimaging (CT, MRI) to guide treatment decisions and collaborate effectively with neurosurgeons and other members of the interdisciplinary team.

2. Describe your experience with intracranial pressure (ICP) monitoring and management.

   • Answer: I am experienced in placing, calibrating, and interpreting data from various ICP monitoring devices (e.g., ventriculostomy, subarachnoid bolt). I understand the implications of elevated ICP and can implement appropriate management strategies including sedation, paralytics, osmotic and loop diuretics, hyperventilation (with careful consideration of its limitations), and positioning. I am also familiar with the potential complications of ICP monitoring and the indications for surgical intervention.

3. How do you assess and manage cerebral perfusion pressure (CPP)?

   • Answer: CPP is calculated as mean arterial pressure (MAP) minus ICP. I carefully monitor both MAP and ICP to maintain adequate CPP (typically 60-70 mmHg, but this can be individualized). I understand the importance of maintaining adequate CPP to ensure sufficient blood flow to the brain. Management strategies include fluid resuscitation, vasopressors (e.g., norepinephrine, dopamine), and addressing the underlying causes of low CPP, such as hypovolemia or hypotension.

4. Explain your understanding of the Monro-Kellie doctrine.

   • Answer: The Monro-Kellie doctrine describes the relationship between intracranial volume components: brain tissue, cerebrospinal fluid (CSF), and blood. It states that an increase in one component must be compensated by a decrease in another to maintain intracranial pressure. Failure of compensation leads to increased ICP. I understand the implications of this doctrine for managing patients with intracranial hypertension.

5. How would you manage a patient experiencing status epilepticus?

   • Answer: Management of status epilepticus is a critical emergency. My approach would involve immediately securing the airway, administering high-dose benzodiazepines (e.g., lorazepam, diazepam), followed by other anticonvulsants like fosphenytoin or levetiracetam if the seizure persists. I would also monitor vital signs, obtain blood work (including electrolytes, glucose, and toxicology), perform an ECG, and consider advanced imaging (CT) to rule out structural causes. Continuous EEG monitoring is crucial in determining seizure cessation and guiding further management. Early consultation with neurology is essential.

6. Describe your experience with managing patients with stroke.

   • Answer: My experience with stroke management includes rapid assessment using the NIH Stroke Scale, initiating thrombolytic therapy (tPA) according to established guidelines, and managing complications like cerebral edema, seizures, and dysphagia. I am familiar with the various types of stroke (ischemic, hemorrhagic) and their management. I work closely with neurology and interventional radiology teams for optimal patient care. Post-stroke rehabilitation planning is a crucial aspect of my care.

7. How do you assess and manage a patient with increased intracranial pressure (ICP)?

   • Answer: Assessment involves neurological examination (GCS, pupillary response), ICP monitoring (if indicated), and neuroimaging (CT, MRI). Management focuses on reducing ICP through various strategies such as head elevation, osmotic diuretics (mannitol, hypertonic saline), hyperventilation (cautiously), sedation, and potentially surgical decompression. Careful fluid management is crucial to avoid both hypovolemia and fluid overload.

8. Discuss your experience with neuromuscular blockade agents and their management.

   • Answer: I have experience administering and managing neuromuscular blockade agents (e.g., vecuronium, rocuronium, cisatracurium) in critically ill patients, including those requiring mechanical ventilation. I am proficient in monitoring the effects of these agents using clinical assessments (train-of-four stimulation) and adjusting the dosage appropriately. I understand the importance of reversing neuromuscular blockade with agents like neostigmine or sugammadex when indicated, and the potential complications associated with prolonged paralysis.

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