RT Book, Section
A1 McPhee, Laura
A1 Seder, David B.
A2 Lee, Kiwon
SR Print(0)
ID 1101644950
T1 The Neurocritical Care Airway
T2 The NeuroICU Book
YR 2012
FD 2012
PB McGraw-Hill Education
PP New York, NY
SN 9780071636353
LK neurology.mhmedical.com/content.aspx?aid=1101644950
RD 2024/04/19
AB A  58-year-old  hypertensive  man  is  evaluated  in  the  emergency  department  after  being  found  on  the  floor  in  his  home  with  left  hemiparesis,  a  left  frontotemporal  scalp  laceration,  and  somnolence.  Because  the  patient  does  not  remember  the  onset  of  symptoms  and  the  mechanism  of  injury  is  uncertain,  a  rigid  cervical  collar  is  placed  by  emergency  medical  services  in  the  field.  Computed  tomography  (CT)  of  the  head  demonstrates  a  right  thalamic  intracerebral  and  intraventricular  hemorrhage  involving  the  right  lateral  and  third  ventricles.  There  is  no  skull  fracture,  cervical  spine  injury,  or  gross  cervical  misalignment.  Initially,  he  is  interactive  and  speaks  clearly.  The  blood  pressure  is  rapidly  controlled,  and  preparations  are  made  for  transfer  to  the  intensive  care  unit  (ICU).  But  before  transfer  occurs  he  becomes  progressively  obtunded,  with  a  symmetric  increase  in  bilateral  lower-extremity  tone.  He  begins  to  struggle  with  respiration,  making  grunting  sounds  and  activating  accessory  muscles  on  inspiration.  It  is  not  known  when  he  last  ate,  and  examination  of  the  oropharynx  reveals  a  blunted  gag  reflex  and  weak  cough.