NCCEd: Neurocritical Care Education for Residents

A 75 year-old woman with CAD s/p PCI to RCA (2020) initially presented to the ED with an acute onset of facial asymmetry, moderate dysarthria, neglect of her left hemibody, and marked left hemiparesis. She was found to have a proximal right MCA occlusion. She was treated with mechanical thrombectomy. She had some emesis right before intubation.

On post-stroke day 2, an interval non-contrast head CT is obtained, and reveals a large frank infarct with scant petechial hemorrhaging. She begins to work with PT, OT, and SLP.

On post-stroke day 3, you are paged by her nurse that he suddenly became tachycardic. A 12-lead ECG is obtained.

You review the ECG print-out, and then the patient's monitor starts alarming. Her heart rate is variable, now bouncing around between the 110s and 120s. You cycle the blood pressure cuff, and it reads 90/65. (Her BP since admission has generally been in the 100s/70s.) SpO2 is 88%, so nursing puts on a nasal cannula at 3L. Her neurologic exam is stable. You get a chest X-ray, which shows no pulmonary edema. There's some questionable haziness over the right lower lobe, atelectasis vs. consolidation.