Neurologic And Sedation Issues Practice Test

A 72-year-old man is in the ICU after subdural hematoma evacuation. Over 2 hours he develops worsening headache, vomiting, and decreased responsiveness. Exam: GCS drops from 14 to 10, left pupil 5 mm sluggish, right 3 mm reactive; new right arm weakness. Vitals: BP 178/92, HR 52, irregular respirations on ventilator triggering. Labs: INR 1.1, platelets 210k. CT head earlier today shows postoperative changes with small residual hematoma. Current regimen: fentanyl 50 mcg/hr, propofol 20 mcg/kg/min. What diagnostic test should be prioritized to assess the patient's neurologic status?

A 59-year-old woman is ventilated after complicated hysterectomy with massive transfusion. She is intermittently agitated and hypertensive during suctioning despite deep sedation. Exam: RASS -3 baseline but spikes to +2 with procedures; grimaces to pain. Labs: Hgb 8.1 g/dL, lactate 1.8, electrolytes normal; CT head normal. Current regimen: propofol 40 mcg/kg/min, no scheduled analgesic, midazolam PRN. What is the most appropriate next step in managing this patient's sedation?