TY - CHAP M1 - Book, Section TI - The Neurocritical Care Airway A1 - McPhee, Laura A1 - Seder, David B. A2 - Lee, Kiwon PY - 2012 T2 - The NeuroICU Book 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - neurology.mhmedical.com/content.aspx?aid=1101644950 ER -