
OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education Innovation
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Medical Safety Principles
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Psychological Safety
New PAINTS episode with Dr. Joseph Sisk
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More than 450 mini-reviews on high-yield topics in anesthesiology, critical care, and perioperative medicine.
Question of the Day
Which of the following is MOST correct regarding aneurysmal subarachnoid hemorrhage?
Explanation
The incidence of subarachnoid hemorrhage (SAH) in the US is between 2-5% and accounts for 10% of all strokes. Sixty percent of cases occur in patients between 40 and 60 years of age. One-third of patients die due to an acute bleed. Of those who survive an initial bleed, one-half will die or be severely disabled. Most subarachnoid hemorrhages are due to cerebral aneurysms (75-80%), while arteriovenous malformations account for 4-5%. The rest of subarachnoid hemorrhages occur because of trauma, mycotic aneurysms, sickle cell disease, cocaine use, and coagulation disorders. Risk factors for aneurysm rupture are hypertension, pregnancy, vascular abnormalities (collagen and elastase abnormalities), and polycystic kidney disease. Smoking and alcohol abuse are associated with aneurysm formation and rupture. Accelerated aneurysm growth is seen in females and smokers. Cocaine use is associated with aneurysm rupture at an earlier age. There appears to be some component of genetic involvement as 7% of berry aneurysms are familial and 5-10% of patients with a ruptured aneurysms will have a 1st-degree relative who has also had an aneurysm rupture. The rate of rupture for a 5 mm aneurysm is 0.14% per year, while the risk of rupture for a 10 mm aneurysm is 1.1%. Death and disability associated with subarachnoid hemorrhage is due to initial bleeding, vasospasm, rebleeding, surgical complications, parenchymal hemorrhage, and hydrocephalus.
References:
International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention [published correction appears in N Engl J Med 1999 Mar 4;340(9):744]. N Engl J Med. 1998;339(24):1725-1733. doi:10.1056/NEJM199812103392401 Aneurysmal Subarachnoid Hemorrhage Part 1: Epidemiology, Pathophysiology, Diagnosis, Cardiac ComplicationsCottrell JE, Young WL, eds. Cottrell and Young’s Neuroanesthesia. 5th ed. Philadelphia, PA: Mosby Elsevier; 2010: pp. 218-246.
OA Series: July 2025
29:34
APSF Podcast
OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education InnovationAllison Bechtel, MD, University of Virginia, Charlottesville, VA
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14:43
PAINTS
Medical Safety PrinciplesMegan Nash, DO, Children’s Hospital Colorado, Aurora, CO, Tyler P. Morrissey, MD, University of Colorado, Aurora, CO
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14:02
PAINTS
Psychological Safety at WorkJoseph M. Sisk, MD, FAAP, University of North Carolina, Chapel Hill, NC
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