Chapter 4 of 618% of exam

Musculoskeletal, Neurological and Behavioral/Psychosocial

This section combines trauma and orthopedic complications, the full range of neurological emergencies and the behavioral problems common in the ICU. Brain injury, stroke, seizures and spinal cord injury carry the most weight, alongside delirium, withdrawal and patient safety.

Musculoskeletal complications

Compartment syndrome is a surgical emergency that hides in sedated patients. Deconditioning starts within days of ventilation and is prevented by keeping patients mobile. In major trauma, early antifibrinolytic therapy is time-dependent.

Compartment syndrome

Pain out of proportion, unrelieved by medication or elevation, with numbness or weakness; fasciotomy is needed right away.

MedlinePlus (NLM), Compartment syndrome

Sedated patients

Diagnosis is often delayed when patients cannot report pain.

MedlinePlus (NLM), Compartment syndrome

Physical conditioning

Maintaining and improving conditioning is an essential practice for ventilated adults.

SHEA/IDSA/APIC 2022 Update

Tranexamic acid

Survival benefit in bleeding trauma was seen only when started within 3 hours of injury.

CRASH-2 analysis, Crit Care 2014

Brain injury and intracranial pressure

Management of severe traumatic brain injury is tiered, starting with basic neuroprotection and escalating when ICP stays high. Know the thresholds and the treatments that are no longer recommended. Late signs such as the Cushing response and a unilateral dilated pupil mean herniation risk.

Thresholds

Treat ICP above 22 mm Hg; keep cerebral perfusion pressure (MAP − ICP) at 60 mm Hg or more.

SIBICC 2019 / Brain Trauma Foundation

Hyperventilation

Only mild hyperventilation (PaCO2 32–35 mm Hg) as a tier-two option; routine PaCO2 below 30 is not recommended.

SIBICC 2019

Fever

Avoid core temperature above 38 °C as part of basic care.

SIBICC 2019

Epidural hematoma

Brief loss of consciousness, a lucid interval, then rapid decline with an ipsilateral dilated pupil and contralateral weakness.

MedlinePlus (NLM), Epidural hematoma

Cushing response

Bradycardia, rising blood pressure and irregular breathing with rising ICP.

Cureus 2026 case review

Stroke, seizures and spinal cord injury

Stroke care depends on excluding bleeding quickly and treating within the time window. Status epilepticus is defined operationally at 5 minutes. High spinal cord injuries threaten breathing and blood pressure regulation.

Before thrombolysis

A CT or MRI must exclude bleeding; clot-dissolving therapy is given within 4½ hours of onset.

MedlinePlus (NLM), Stroke

Status epilepticus

Treat seizures lasting over 5 minutes with a benzodiazepine; IM midazolam works well without IV access.

American Epilepsy Society guideline 2016

Autonomic dysreflexia

Sit the patient up, loosen clothing and look for the trigger, most often a blocked catheter or constipation.

MedlinePlus (NLM), Autonomic dysreflexia

Neurogenic shock

Hypotension and bradycardia from loss of sympathetic tone after injury at T6 or above.

Colomb Med 2021 neurogenic shock review

Behavioral and psychosocial problems

Delirium is common, fluctuating and often preventable. Alcohol withdrawal has a predictable timeline, and nutritional deficiency can cause a separate encephalopathy. Overdose and suicidal statements require continuous safety measures.

Delirium

Sudden onset and fluctuating attention; reorient, restore glasses and hearing aids, protect sleep and minimize sedatives.

MedlinePlus (NLM), Delirium

Withdrawal timeline

Seizures usually 12–48 hours and delirium tremens 48–96 hours after the last drink.

MedlinePlus (NLM), Delirium tremens

Wernicke encephalopathy

Confusion, ataxia and eye movement changes in thiamine deficiency; give thiamine promptly.

MedlinePlus (NLM), Wernicke-Korsakoff syndrome

Naloxone

Its effect may wear off before the opioid, so observation continues for hours.

MedlinePlus (NLM), Opioid intoxication

Suicide risk

Screen, assess and protect patients at risk.

The Joint Commission NPSG.15.01.01

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