Disability notes

Question 1

Who is at highest risk of a subdural haemorrhage?

Answer 1

• infants
• elderly
• alcoholics (thrombocytopenia/ prolonged bleeding)
• epileptics (due to falls) and anticoagulated

Question 2

What is the symptoms of subdural haemorrhage? (5)

Signs? (3)

Answer 2

• fluctuating levels of consciousness
• sleepiness
• headache
• personality change
• unsteadiness
• FNS
• Seizures
• increased ICP

Question 3

What does the CT scan look like?

What is the management?

Answer 3

• Crescent shaped
• Burr hole
• Conservative

Question 4

What is the cause of an extradural haemorrhage?

Answer 4

• after head injury: MMA/ Torn dural venous sinus

- fractured temporal/ parietal bone

Question 5

What is the symptom pattern of extradural haemorrhage?

Answer 5

• Lucid interval pattern

- then reduced GCS due to rising ICP

Question 6

What does it look like on CT?

What is the management?

Answer 6

• lentiform
• clot evacuation +/- ligation of bleeding
• mannitol: reduces cerebral swelling

Question 7

What is the two causes of SAH?

Answer 7

• rupture of berry aneurysm (80%)

- AVMs (15%)

Question 8

What are the symptoms of SAH? (5)

What signs would you elicit?

Answer 8

• occipital headache “thunderclap”
• vomiting
• collapse
• seizure
• coma
• brudzinskis/ kernig’s sign
• neck stiffness
• retinal/ vitreous bleeds

Question 9

Where are most common sites of berry aneurysms? (3)

Answer 9

• Posterior communicating to internal carotid
• Anterior communicating and anterior cerebral
• Bifurcation of MCA

Question 10

What kind of associations are there with SAH?

Answer 10

• PCKD
• coarctation of aorta
• Ehlers- Danlos syndrome

Question 11

What does SAH look like on CT?

What would you then do if CT negative?

Answer 11

• Starfish of death
• CT detects >90% of SH in 1st 48 hours
• LP if no contra-indications
• Do 12 hours after headache onset (if bloody could be due to the tap rather than SAH)

Question 12

What is management of SAH?

Answer 12

• refer to neurosurgery
• CT angiography
• Endovascular coiling/ stenting/ clipping

Question 13

What are the indications of C- spine mobilisation in suspected neck injury?

Answer 13

• > 65 years
• GCS <15
• midline pain/ tenderness
• altered sensation/ weakness
• dangerous mechanism of injury (axial load etc)

Question 14

When can a patient be cleared of a C-spine injury?(6)

Answer 14

• fully alert and orientated
• no head injury
• no drugs or alcohol
• no neck pain
• no abnormal neurology
• no significant other “distracting” injury

Question 15

What are common causes for a Hypo in diabetics?

Answer 15

• BM <4.0
• alcohol
• insufficient dietary intake
• delayed/ missed meals
• increased physical activity
• stress
• hot weather
• pregnancy (glucose control being tighter)

Question 16

What are the symptoms/ signs of a hypo

Answer 16

Autonomic: sweating, palpitations, shaking,hunger

Neuroglycopenic: confusion, drowsiness, odd behaviour, speech difficulty inc-ordination

General malaise: headache/ nausea

Question 17

What investigations should be done?

Answer 17

• FBC/ U+Es/ LFTs
• blood glucose
• insulin
• C-peptide (released by pancreatic beta cells)

Question 18

If a patient is having a hypo and is conscious, orientated and able to swallow what should you do?

Answer 18

• Step 1: 12-20g quick acting carbohydrate (lucozade, fruit juice/ 3-4 teaspoons of dissolved sugar)
• Step 2: Repeat BM 10-15 mins later, if <4 repeat step 1 x3. If BM >4 give long acting carb (two biscuits/ toast)
• If remains <4 despite 3x cycles of step 1, consider 1mg glucagon IM or 150-200mls IV 10% glucose over 15 mins

Question 19

If conscious and able to swallow but confused/ unco-operative/ aggressive what should you give in hypo?

Answer 19

• glucogel/ dextrogel (1.5- 2 tubes)

Question 20

If a patient is unconscious/ having a seizure/ aggressive what should you do in hypo?

Answer 20

• IV 20% glucose (75-100 mls)

OR
- 10% glucose over 15 mins (150-200mls)

• glucagon 1mg IM

REPEAT