17 Jan 24 Flashcards by Zoia Akram

Emergence from anesthesia

Normal ;
Fully awake within 15min of extubation

Delayed emergence ;
Hypoactive state , smnolence persisting >30-60min

Emergence delirium :
Hyperactive state , manifests in OR

How well did you know this?

Not at all

Perfectly

Cause and ttt of delayed emergence/emergence delirium

Residual effects of anesthetic /adjuvant meds.

Inhaled anesthetics
NM blockers
Benzodiazepines

Ttt: Reassure and reorient
Evalute for hypercapnia , stroke
CT
ABGs

How well did you know this?

Not at all

Perfectly

Tremor worsened by sertraline.

Enhanced physiologic tremor.

Medication enhanced tremor;

⛱Temporal relationship to initiation of medication
⛱Dose response relationship
⛱Lack of tremor progression
⛱Symmetry of affected limbs

How well did you know this?

Not at all

Perfectly

Causes of enhanced physiologic tremors

Medicines.

     Beta agonists 
     SSRI
     TCA
     Nicotine 
     Caffeine  Steroids.

Physiologic. :

           Stress 
           Anxiety

Medical conditions:

           Hypoglycemia 
          Alcohol 
          Opioid withdrawal 
          Thyrotoxicosis 
          Liver dx

How well did you know this?

Not at all

Perfectly

Ttt of enhanced physiologic tremor

Dose reduction
Stop medication

How well did you know this?

Not at all

Perfectly

Dystonic tremors

Irregular tremors
Exacerbated by stress
Sustained muscle contraction in the same area as tremor
Wrist spasm
Torticollis

How well did you know this?

Not at all

Perfectly

Pt with rigidity , upward gaze deviation restricted EOM after haloperidol.

Acute dystonia
(EP symptom of first gen antipsychotic)

Mech;
Dopamine antagonists cause imbalance between dopamine and acetylcholine in BG.

Ttt:
Anticholinergics
Benztropine trihexyphenidyl

How well did you know this?

Not at all

Perfectly

Acute dystonic reaction SS

Sudden sustained contraction of neck , mouth , tongue , eye muscle

Oculogyric crisis(forced upward gaze)
Torticollis
Blepharospasm
Trismus

How well did you know this?

Not at all

Perfectly

Akathisia ttt

(Subjective restlessness inability to sit still)

Ttt;
BB
BZ
Benztropine

How well did you know this?

Not at all

Perfectly

Parkinson EPS

Tremor rigidity bradykinesia

Ttt :
Benztropine
Amantadine

How well did you know this?

Not at all

Perfectly

Tardive dyskinesia def and ttt

Dyskinesia of mouth, face , trunk, extremities.

Gradual onset after prolongeddd therapy >6mo

Ttt: Valbenazine
Deutetrabenazine

How well did you know this?

Not at all

Perfectly

Pt taking metoclopromide has bradykinesia rigidity tremor

Drug induced parkinsons
Due to dopamine receptor blockade

Common agents :

First gen antipsychotics
Metoclopromide
Prochlorperazine

Tttt: discontinue drug

How well did you know this?

Not at all

Perfectly

If patient with H/o cancer seizes
Management?

Do MRI to see mets

How well did you know this?

Not at all

Perfectly

Trigger for seizures

Lack of sleep
Flashing light
Emotional stress
Alcohol withdrawal
Idiopathic

How well did you know this?

Not at all

Perfectly

Signs that suggest seizure over syncope

Seizure :

     Preceding aura ( olfactory hallucinations) 
     Can occur with sleeping/sitting
     Tonic/clonic movements
     Rapid, strong pulses 
     Tongue biting 
     Incontinence 
     Delayed return to baseline (postictal drowsiness or confusion)

Vasovagal syncope :

     Preceding lightheadedness       (presyncope)
     Never occur in sleep/sitting
     Uncommon to have clonic jerks 
     Weak slow pulses 
     Pallor , diaphoresis 
     Immediate return to baseline

How well did you know this?

Not at all

Perfectly

Types of seizures

Focal ; One brain hemisphere but can spread to entire brain
Generalized ; Both hemispheres

Cardiogenic syncope trigger and feature s

Trigger :
Exertion
Dehydration

CF:
Sudden LOC without prodrome

Post event:
Immediate return

Cause of perioral cyanosis in generalised seizures.

Muscle stiffening during initial tonic phase of gen tonic clonic seizure causes patient to fall and have difficulty breathing (due to contraction of chest wall muscles) leading to perioral cyanosis.
Ass with tongue biting , urinary incontinence.
Can go unwitnessed and is brief

Todds paralysis clues

Self limited focal weakness or paralysis that occurs in postictal period after focal onset seizure.
Transient hemiplegia after LOC with gradual return to baseline
Normal imaging studies

Resolves in 36hrs

Clues to hemipegic migraine

Adolescence
Family history
H/o headache with aura
Self resolves

Focal seizure CF

🍔 abnormal movements of one side
🍔 impaired awareness (staring episodes and lack if response to external stimuli) indicate spread to both hemispheres.
🍔 repititive semi purpose movements (chewing , picking) AUTOMATISMS
Seen in focal seizure with impaired awareness.
🍔 post ictal confusion and lethargy
🍔 EEG normal between episodes
During focal seizure EEG shows abnormal electrical activity

Absence seizure CF

Generalised (both hemispheres)
Staring spells
With or without automatisms 10-20s
(Chewing picking)
Easily provoked by hyperventilation

No post ictal period.

Fetal hydantoin syndrome

Microcephaly
Cleft lips and palate
Cardiac defects
Hypoplasia of nails and phalanges

Status epilepticus complication…

Single seizure lasting > 5minutes or > 2 seizure without return to baseline.
Occurs in cortex as it is site of seizure origin.

Complication ;
Cortical laminar necrosis
Permanent injury (lasting neurologic deficits)

Febrile seizure diagnostic criteria

Age 6mo to 5years No prev Afebrile seizures No signs of CNS infection No acute metabolic cause(hypoglycemia)

Ttt of febrile seizures

Supportive Reassure Counsel about inc risk of future feb seizures No longterm sequel

Febrile seizure definition

Gen tonic clonic movements lasting<15 mins In the setting of fever > 100.4 in children age 6mo to 5 years. Normal neurologic exam Do not recur in 24hrs. No diagnostic testing required.

Phenytoin toxicity CF

Cerebellar dysfunction ; Horizontal Nystagmus Ataxia Dysmetria Slurred speech NV Hyperreflexia AMS (lethargy, confusion) Coma Seizures. Death

Mechanism of phenytoin toxicity

PHenytoin is hepatically metabolised by cytP450. CYP450 inhibitors TMPSMX , fluconazole , displace phenytoin from Plasma proteins and inc the risk of drug toxicity. Ttt: gastric lavage , dialysis

Myoclonic status epilepticus cause

Severe neurologic injury (prolonged hypoxia) eg cardiac arrest

Myoclonus status epilepticus CF

🧇Comatose patients 🧇Appears within 72hrs injury 🧇Involuntary muscle contraction in a joint or limb 🧇Gen symmetric 🧇 marker of poor prognosis Ttt; Antiepileptics Dx. : EEG helps diff between myoclonus and seizures

How to evaluate an adult e first time seizure ?

Labs : CBC, glucose , electrolytes , renal function, liver function, urine drug screen Neuroimaging; CT scan without constrast acutely MRI in elective cases LP : To rule out meningitis EEG

Indications to start antiepileptic in adults

Abnormal EEG or neuroimaging Nocturnal seizure Focal neurologic exam

Intoxicated pt fell downstairs and seized labs sent … next step?

CT without contrast (To rule out intracranial bleed)