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clinical cases

The Scary Airway Series Part II: Mastering Obesity, Peds, and Burns

We’ve all heard it at one point or another: “Man, I’d HATE to have to intubate THAT!” Typically, this sentence is used to describe a patient in an ominous, sphincter-tightening situation, or the patient with the obviously suboptimal airway. You walk by the door to the Resuscitation Bay or Trauma Bay, see that the patient is in respiratory distress, and rapidly breeze through your airway mnemonics and ultimately come to the conclusion that this would be a scary airway. The airways of myths and legends, and where heroes are made.

practice updates

How To Be A Clinical Rock Star Managing Subarachnoid Hemorrhages

A New Way to Think About Subarachnoid Hemorrhage: It is helpful to remember that while a subarachnoid hemorrhage is in fact a “bleed”, it is also a stroke.  When compared to ischemic strokes, hemorrhagic strokes tend to have an increased risk death in the acute phase, but for those patients that don’t die, their overall prognosis for return-to-baseline is somewhat better than ischemic events.  Why is this?  During hemorrhagic strokes (i.e. bleeds), an artery bursts, bathing brain cells in blood.  The cells become “stunned”, but there is rarely significant cell death surrounding these events.  If the total volume of hemorrhage is small, a patient has a chance at making a full, or near-full recovery (depending on extent of injury and any herniation symptoms). In ischemic events, lack of blood flow to brain cells causes cellular destruction, and a watershed “penumbra” effect can cause large swaths of brain cell death relative to the small area of initial ischemia.  In ischemic cell death, brain cells don’t remodel or regain function, which is why ischemic stroke patients have a high likelihood of residual neurologic deficit.  This terminal cell death is also why there is such a push for early identification of ischemic stroke, and why thrombolytics and other neurologic intervention procedures have gained such momentum. Patients presenting with headaches are worrisome because it can be difficult to sift through so many associated symptoms to determine who has benign pathology and who has a catastrophe brewing in their brain.  It is my goal to give you the needed strategy to be a rock star when it comes to evaluating headache patients. [...]