RT Book, Section A1 Kumar, Avinash B. A1 Seder, David B. A2 Lee, Kiwon SR Print(0) ID 1143957146 T1 The Neurocritical Care Airway T2 The NeuroICU Book, 2e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071841443 LK neurology.mhmedical.com/content.aspx?aid=1143957146 RD 2024/03/29 AB A 58-year-old man with a known history of poorly controlled hypertension is evaluated in the emergency department after being found down for an unknown period of time. He has left-sided hemiparesis and neglect, a left frontotemporal scalp contusion, and somnolence. Because the patient could 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 large right thalamic intracerebral hemorrhage with intraventricular extension. There is no skull fracture, cervical spine injury, or gross cervical misalignment. During the initial evaluation, he is interactive and able to communicate verbally, and he denies cervical tenderness to a confrontational examination. Just prior to his transfer to the intensive care unit (ICU), he becomes progressively obtunded, with a symmetrical increase in bilateral lower extremity tone. His respiratory status rapidly declines; he is now making grunting noises and actively using his accessory muscles. It is not known when he last ate, and examination of the oropharynx reveals a blunted gag reflex and weak cough.