Focal Weakness

Acute Care Casebook ◽

10.1093/med/9780190865412.003.0041 ◽

2018 ◽

pp. 201-206

Author(s):

Jordan Tozer

Keyword(s):

Blood Pressure ◽

Key Management ◽

Cerebrovascular Accident ◽

Early Recognition ◽

Initial Step ◽

Pressure Control ◽

Computer Tomography Scan ◽

Tight Blood Pressure Control ◽

Tomography Scan ◽

Neurosurgical Intervention

The case illustrates how to approach the management of intracranial hemorrhage related to severe hypertension. Early recognition is the key initial step, which will mediate downstream management and help distinguish this entity from mimics such as ischemic cerebrovascular accident, encephalopathy, and hypoglycemia. Management of intracranial hypertensive hemorrhage is predicated upon tight blood pressure control, reducing intracranial pressure, and possible neurosurgical intervention. Prognosis is uniformly poor, even when recognized early. Key management issues include the consideration of hypoglycemia in the differential diagnosis, obtaining an emergent noncontrast head computer tomography scan in a patient with stroke-like symptoms, and rapid blood pressure management.

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Head Trauma

Acute Care Casebook ◽

10.1093/med/9780190865412.003.0002 ◽

2018 ◽

pp. 8-11

Author(s):

Todd W. Thomsen

Keyword(s):

Blood Pressure ◽

Head Injury ◽

Key Management ◽

Rapid Assessment ◽

Decision Rules ◽

Clinical Decision ◽

Loss Of Consciousness ◽

Ct Head ◽

Neurosurgical Intervention

Head injury is often associated with other serious trauma. Clinical decision rules such as the Canadian CT Head Rule can guide clinicians in the judicious use of neuroimaging, which can then guide the appropriate course of treatment. Rapid assessment of patients requiring neurosurgical intervention is critical, as is appropriate management of blood pressure and hypoxia. This chapter considers a case study of blunt head injury with loss of consciousness of a skier in the backcountry, The author addresses patient history, physical exam, differential diagnoses, clinical course, and key management steps. The patient’s condition relative to the Canadian CT Head Rule is specifically discussed.

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Critical upper airway obstruction as the first symptom of acute myeloid leukemia - an anesthesiologic reminder

Clinics and Practice ◽

10.4081/cp.2020.1214 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Øyvind Bruserud ◽

Øystein Wendelbo ◽

Nils Vetti ◽

Frederik Kragerud Goplen ◽

Silje Johansen ◽

...

Keyword(s):

Emergency Management ◽

Airway Obstruction ◽

Myeloid Leukemia ◽

Early Recognition ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Airway Control ◽

Computer Tomography Scan ◽

Surgical Tracheotomy ◽

Tomography Scan

Acute upper airway obstruction can be fatal. Early recognition of airway distress followed by diagnostic laryngoscopy and prompt intervention to secure airway control is crucial. We here present a 62-year old male patient who presented with cough and increasing respiratory distress for three weeks. Within the next 24 h, he developed symptoms of critical upper airway obstruction, endotracheal intubation was not possible, and an acute surgical tracheotomy was performed to retain patent airways. A computer tomography scan revealed severe laryngopharyngeal soft tissue thickening and upper airway obstruction caused by leukemic infiltration. He was diagnosed with acute leukemia and responded to induction chemotherapy. This case report points out the importance of establishing the diagnosis of critical upper airway obstruction in patients presenting with respiratory symptoms, and highlights the emergency management of airway obstruction due to malignant infiltration of leukemic blasts.

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