AM report pearls 4/25: carotid blowout syndrome / serotonin syndrome

Bonus pearl on head/neck SCC: traditional risk factors are etoh and smoking. Also think about HPV as a RF for young women! HPV-associated SCC is a/w with better prognosis!


Carotid blowout syndrome

  • Medical emergency! Is seen most frequently as a late complication of head and neck cancer – either from surgically exposed carotid artery, recurrent tumor, infection, or severe radiation damage
  • Management:
    • Precautions:
      • keep area moist (prevent it from drying out and bleeding)
      • aggressive BP control
    • Assess goals of care!
    • ABCs – consider tracheosomy WITH CUFF to protect airway if within GOC!
    • Engage consultants – ENT, anesthesia, IR
      • Consider coiling/embolization
      • Consider total carotid artery occlusion (runs risk of stroke)


Serotonin syndrome

  • Check out this old SFGH blog post! (including the nice table from Michelle Yu below)
  • Major distinctions between NMS and serotonin syndrome
    1. NMS: more likely to see AMS, elevated CK, slow onset and offset
    2. Serotonin syndrome: fast onset and offset (<24h)
    3. Both classically a/w fever, rigidity and offending drugs
  • SS table.png
  • Treatment:
    1. STOP offending agents!
    2. Supportive care to control agitation
      • Benzos
      • IVF if volume depleted
      • If hyperthermic – need to consider intubation and sedation + paralytics! Anti-pyretics don’t work!




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