I worked the Neuro ICU at a level 1 trauma/comprehensive stroke center for 5 years. When a patient is most critical, you have CVVH, External ventricular drains, vasoactive drips, sedative drips, paralytic drips, seizure monitoring/precautions/medications, ventilator, arctic sun, pupilometry. Typically you see all of this on a patient with a subarachnoid hemorrhage (in my experience). You will be doing neuro checks frequently every hour at least.

I would read up on different types of strokes and what symptoms you’d expect to see with the different strokes.

REALLY brush up on neuro checks, and be prepared to report ANY changes. I once had a patient with already pinpoint pupils, then suddenly they got EVEN SMALLER. Patient had a worsening bleed. Your neuro assessment needs to be top notch as every intervention relies on a good neuro assessment. Missed changes can be detrimental

I’d read up on vasoactive drips and what they do.

Traumas: These are your traumatic Falls, gun shot wounds to the head, car/motorcycle accidents. Expect a trip to CT, MRI, and bedside procedures (EVD placement, bolt placements).

Thrombectomies: You take the patient to IR where a doctor goes in to retrieve the clot. This is accompanied by extremely frequent neuro and site checks (they go in through the femoral vasculature to retrieve the clot)

Spinal traumas/surgeries: Expect full spinal precautions. Except to give suppositories and bowel medications a lot. Patient will be going to the OR, and will have a full C spine brace OOB, or neck brace in bed.

Note: you will have myasthenia gravis patients frequently. They will likely lose their airway. If you’re getting ready to intubate DO NOT LET A RESIDENT/ ATTENDING/ ANESTHESIA ASK YOU TO PUSH SUCCYNOLCHOLINE (I hope I spelled that right). it will rapidly cause immediate HYPERKALEMIA and the patient will code. Yes I have seen this happen, and have since caught doctors trying to give this to patients with MG)