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Subarachnoid Hemorrhage 01

Topic: Adult

Created on Wednesday, November 28 2007 by jdmiles

Last modified on Wednesday, November 28 2007.


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A 60 year old male is found down and brought by paramedics to the emergency departement. GCS is 8, and the patient is intubated for airway protection. The patient withdraws all extremities to painful stimuli. A stat head CT reveals the above abnormalities.

An angiogram is performed, and the source of the bleeding is found and secured. The patient is admitted to the neurological intensive care unit.

This patient still remains at risk for mortality from which of the following causes (choose the one best answer)?


 
        A) Vasospasm
 
        B) Constipation
 
        C) Hypertension
 
        D) Acidosis
 
        E) Hypernatremia
 

 


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This question was created on November 28, 2007 by jdmiles.
This question was last modified on November 28, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Vasospasm

This answer is correct.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death.  (See References)

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B) Constipation

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death.  (See References)

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C) Hypertension

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death.

This patient may have increased blood pressure after a subarachnoid hemorrhage, and may require nitroprusside or another antihypertensive. However, the central venous pressure should be kept supranormal to help prevent vasospasm and infarction.

  (See References)

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D) Acidosis

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death.

  (See References)

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E) Hypernatremia

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death.  (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)Advertising:
2. Rowland, L.P. (Ed) (2000). Merritt's Neurology, 10th Edition. Lippincott Williams & Wilkins, Philadelphia. (ISBN:0683304747)Advertising:
3. Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J.(Eds.) (2004). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia. (ISBN:0750674695)Advertising:
4. Floyd, T. (1999). "Bear-inflicted human injury and fatality." Wilderness Environ Med, 10(2) 75-87. (PMID:10442155)
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adult
Subarachnoid Hemorrhage 01
Question ID: 112807154
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 11/28/2007
Modified: 11/28/2007
Estimated Permutations: 85800

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