M&M - Dr. Kiefer

Case 1: Venous Sinus Thrombosis

- Headache evaluation should always include:
1. Fundscopic exam
2. Posterior circulation- gait, coordination, speech
3. Cranial nerve exam
4. History for HIV, immunosuppression, thrombophilia

- Venous sinus thrombosis
1. Largest risk factor is in young females (presumed secondary to pregnancy and OCPs)
2. Sx can range from severe headache only, to coma
3. Only 1/3 have neurological deficit
4. Diagnosis by either CT venography or MR venography (MR will give more information regarding edema and effects if clot if present)


Case 2: Tension Pneumothorax following CPR

- Always look at CT C spine or other studies that offer extra views of the lungs.  Occult pneumothorax Is a frequently missed radiological entity because the radiologists are not looking for it.

- Protective ventilator strategies reduce risk of barotrauma
1. Tidal volume 6-8 ml/kg of predicted body weight (Always calculate predicted weight!!!)
2. Plateau pressure less than 30 mmH2O
3. Accept lower oxygen saturation

- Anytime a major hemodynamics change occurs, a FULL assessment should be performed and documented

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