Recordings from the 2025 Annual Conference-Why Is My Patient On Two Steroids

Video Transcription

Video Summary

Ashley Higgins’ presentation explains key challenges in caring for patients with subarachnoid hemorrhage (SAH), a life-threatening stroke that requires specialized care. She reviews the anatomy of the subarachnoid space, common causes and symptoms, and the use of the Modified Fisher and Hunt-Hess scales to assess vasospasm risk and clinical severity.<br /><br />The talk focuses on complications and treatments that can confuse bedside clinicians. Desmopressin (DDAVP) may be used not only for diabetes insipidus but also to help reverse medication-related platelet dysfunction and reduce rebleeding risk. External ventricular drains can monitor intracranial pressure and drain cerebrospinal fluid when blood impairs its circulation.<br /><br />Vasospasm can lead to delayed cerebral ischemia, so care includes frequent neurological checks, monitoring fluid balance and sodium, nimodipine, and—after the aneurysm is secured—sometimes permissive or induced hypertension. Higgins distinguishes cerebral salt wasting, which causes sodium and fluid loss, from SIADH and diabetes insipidus, emphasizing that treatment depends on the underlying problem.<br /><br />She also explains why some patients receive two steroids: dexamethasone may be used selectively for swelling or headache, while fludrocortisone can help retain sodium and fluid in salt wasting. Higgins concludes by highlighting the clinical nurse specialist’s role in supporting nurses and improving care.

Keywords

subarachnoid hemorrhage

SAH

vasospasm

delayed cerebral ischemia

Modified Fisher scale

Hunt-Hess scale

external ventricular drain

nimodipine