A 33-year-old primigravida at eight weeks’ gestation by dating sonography is referred by her primary care provider to your high-risk obstetrics unit for chronic kidney disease. She takes perindopril 8 mg daily. The patient does not have any obstetric complaints.

Neurological complications after a cardiac surgery are common and have a large impact on patient outcomes. They are the result of a combination of numerous factors, many of them associated with cardiopulmonary bypass (CPB). Blood pressure control is essential to reduce the incidence of cerebral hypoperfusion and ischemic stroke during and after cardiac surgery. Cerebral oxygen saturation can be tracked using near infrared spectroscopy to assess cerebral perfusion and oxygenation. Careful temperature management plays a key role in preventing cerebral morbidity. Despite multiple attempts to find pharmacologic strategies to prevent neurologic injury, no such solution has been found to reduce the burden of neurologic complications associated with cardiac surgery.

While the neurosurgical patient is not normally one junior prescribers should be caring for in a nonspecialist area, they may encounter them in the acute setting while a referral is being made. Readers are provided with key information on the management of subarachnoid haemorrhage, including how to manage blood pressure, prevent vasospasm and rebleeding. Adjuncts to reduce the chances of secondary brain injury, including steroids, mannitol and anticonvulsants, are also discussed, while the importance of good quality analgesia is also emphasised.