M&M - Dr. Modisett

Case 1 - Is that Tube in the Right Place?

• There are no fail-safe ways to confirm endotracheal placement of anairway, but end-tidal CO2 monitoring should be standard.
• Direct visualization with NasoPharyngeal Scope down the tube also works effective.

Case 2 - Locked-In

• Consider a basilar artery thrombosis in any patient with altered mental status or catatonic/locked-in exam.
• All patients with atrial fibrillation carry a risk of ischemic stroke.
• Basilar occlusions are hard to diagnose, frequently missed, variable in presentation and highly litigated.
• Stroke therapy is in flux, and earlier studies may need to be redone now with new data... MRI brain perfusion, newer catheters, size of clot burden vs tpa.
• In acute stroke if tPA fails, intra-arterial tPA and thrombectomy are options to discuss with consultants with little definitive evidence.

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