Heavy Lies the Helmet Episode 127 - P.R.E.S. Sure
Feb 24, 2025
Explore the complexities of diagnosing Posterior Reversible Encephalopathy Syndrome, a condition often missed in critical care. Discover the nuances of hypertension management and how vital it is to communicate effectively with patients. Learn about advanced imaging techniques, especially MRI, in pinpointing neurological issues. The hosts share valuable insights from their experiences and discuss the interplay of ventilator settings for critically ill patients, all while weaving in personal anecdotes to make the medical journey relatable.
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The Case of the Altered Patient
- Dan was called to the ED for an altered patient with extraordinarily high blood pressure (320/180).
- The patient, a mid-20s female dialysis patient, also exhibited nystagmus, prompting Dan to suspect a neurological issue.
What is PRES?
- PRESS stands for Posterior Reversible Encephalopathy Syndrome.
- It's a difficult diagnosis, often requiring a thorough understanding of potential causes like autoregulation failure or endothelial dysfunction.
Rate of Pressure Rise Matters
- In PRES, the rate of blood pressure rise may be more critical than the absolute value, similar to febrile seizures.
- This suggests that rapid changes in pressure can trigger neurological symptoms.