Hemodynamics & Neurocritical Care
This formula is used to calculate cerebral perfusion pressure and determines risk for brain ischemia.
What is CPP = MAP − ICP?
This line provides real-time blood pressure monitoring and requires immediate firm pressure if dislodged due to risk of exsanguination.
What is an arterial line?
Oxygen saturation below this level requires immediate modification or stop.
What is <88–90% SpO₂?
This scale evaluates 5 functional tasks including rolling and walking.
What is FSS-ICU?
Patient becomes short of breath with RR 32 during ambulation. Action?
STOP therapy → respiratory distres
A patient has MAP = 75 mmHg and ICP = 20 mmHg. Interpret the clinical significance.
CPP = 55 mmHg → below 60 = high risk of cerebral ischemia; PT is contraindicated
During ambulation, a Foley bag is at waist level. What is the risk?
Retrograde urine flow → UTI risk
Must be below bladder at all times
A “high peak pressure” alarm indicates what likely problem?
Airway obstruction
Tube kink
Bronchospasm
A score of 20 on FSS-ICU suggests what functional level?
Transitional mobility → begin standing + assisted ambulation
Patient with femoral A-line—what major precaution during mobility?
Limit hip flexion <60–80
Explain why elevating HOB to 30° is neuroprotective but going >60° may be harmful.
30° improves venous drainage → ↓ ICP
60° may ↓ MAP → ↓ CPP → compensatory ICP rise → worsens perfusion
Why is shoulder flexion >90° contraindicated in subclavian CVC patients?
Risk of catheter kinking/dislodgement
Can disrupt central venous access and cause embolism risk
Why must PT coordinate with RT before mobilizing ventilated patients?
Adjust vent settings
Ensure tubing slack
Prevent ventilator dyssynchrony
Why is PERME more sensitive than FSS-ICU in ICU settings?
Accounts for lines, cognition, barriers, endurance
ICP patient suddenly shows pupil asymmetry during PT.
STOP immediately → possible herniation
During therapy, ICP spikes to 24 mmHg and remains elevated for 2 minutes. What is your action and why?
STOP therapy immediately
Elevated ICP >20–25 mmHg = intracranial hypertension
Persistent elevation = risk of secondary brain injury
A chest tube disconnects during gait training. What is your immediate action and rationale?
Cover site with occlusive dressing/gloved hand
Prevent tension pneumothorax
ABG: pH 7.30, PaCO₂ 50 mmHg, HCO₃ normal. Interpret and PT implication.
Respiratory acidosis
Indicates inadequate ventilation → caution with exertion
RASS score of -4 means what and PT implication?
Deep sedation → no participation
Only passive interventions appropriate
G-tube placed 12 hours ago. What is PT decision?
HOLD therapy (24 hr restriction)
A patient with EVD is mobilized without clamping. Predict pathophysiological consequences.
Uncontrolled CSF drainage → ventricular collapse OR
Backflow → acute ICP elevation
Possible herniation or ischemia
A Swan-Ganz catheter waveform changes to “wedged.” What is your clinical response?
STOP therapy immediately
Wedged = occlusion of pulmonary artery → risk of infarction/rupture
Explain how Valsalva during mobility impacts ICP and cardiopulmonary status.
↑ intrathoracic pressure → ↓ venous return
↑ ICP via venous congestion
Can drop CPP
Optimal RASS range for safe mobilization and why?
-1 to +1
Alert enough to follow commands, not agitated
A patient improves from PERME 8 → 16. Why is this clinically significant?
Transition from passive to active mobility + sitting independence
Major prognostic improvement