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