Monday, November 22, 2010

I Saw This Mismanaged

A 60 year old patient comes in with bradycardia in the 40s. He doesn't have the typical symptoms of bradycardia; he doesn't feel weak and hasn't had syncope, but instead he complains of headache, nausea, and vomiting. His other vital signs include a temperature of 37C, a blood pressure of 170/90, a heart rate of 42, and an irregular respiratory rate ~8. I saw this case mismanaged because the diagnosis wasn't recognized.

Challenge: Who is the man shown above and how is he related to this case?

Image is in the public domain.


sid said...

Increased intra cranial pressure..... bradycardia, increased blood pressure and pulse pressure are all part of the Cushing's triad. The picture is of Dr. Harvey Cushing.

Eric said...

Increased intracranial pressure of some sort, causing a reflex bradycardia?

Alex said...

cushing's reflex??

Anonymous said...

increased ICP 2/2 bleed, cushings triad (bradycardia, systolic HTN, resp depression) named for harvey cushing

Craig Chen said...

yes! you are all right! nicely done. happy thanksgiving :)

I Saw This Mismanaged

Bradycardia, hypertension, and respiratory depression form Cushing's triad. The image shown is of Harvey Cushing, the neurosurgeon who put together this sign for increased intracranial pressure. Headache and vomiting are also very commonly seen in increased ICP. Other signs include cranial nerve VI palsies, papilledema, and periorbital bruising.

Sources: UpToDate; Wikipedia.