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Emergency Medicine > EM Neuro and Neurosurgery > Flashcards

EM Neuro and Neurosurgery Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

A ESR is included in initial orders of headache, what are you evaluating?

A

Inflammation associated with Temporal Arteritis

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2
Q

What is the initial intervention for symptomatic headache management?

What if unsuccessful?

A
  • Ketorlac
  • Acetaminophen
  • IV fluids
  • Compazine
  • Benadryl
  • Dexamethazone

Sumatriptan

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3
Q

What is the headache management in a pregnant patient?

What can you give for nausea?

A

Give Tylenol and Reglan

Can give benadryl for nausea

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4
Q

What is the initial management of head trauma?

A
  • ABC/IV/O2/Monitor
  • GCS <8 intubate
  • Prevent hypotension with fluid resusitation
  • Elevate HOB > 30*
  • Contact trauma team or neurosurgery
  • Off to CT
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5
Q

What should be used for fluid resuscitation in head trauma?

A

Crystalloids, blood if ongoing hemorrhage

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6
Q

In a head trauma what can be given for seizure prophylaxis?

A

Kepra or Phosphenatoin

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7
Q

What are the H-bombs?

A
  • Hypotension
  • Hypoxia
  • Hypo/hypothermia
  • Hypoglycemia
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8
Q

What are the signs and symptoms of Epidural Hematoma?

A
  • Classically, these patients have initial LOC followed by lucid period and then rapid decline
  • Headache
  • Vomiting
  • Declining AMS
  • Uncal herniation - ipsilateral CN III palsy or contralateral hemiparesis
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9
Q

What is the treatment for an epidural hematoma?

A

Evacuation

If hematoma is removed before patient deteriorates to herniation, can have a full recovery

Immediate burr hole if GCS < 9 and deteriorating

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10
Q

Collywobbles?

A

Bellyache

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11
Q

Blatherskite

A

A person who talks at great length without making much sense

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12
Q

Tactile agnosia

A

Inability to recognize objects by touch

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13
Q

Prosopagnosia

A

Inability to recognize faces

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14
Q

Frankenfood

A

Genetically modified food

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15
Q

What hemmorhage type is more common in elderly?

A

Subdural

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16
Q

A subdural hematoma requires immediate evaculation if:

A
  • If GCS < 9
  • Hematoma > 10mm
  • Midline sift
  • Pupils fixed or asymmetric
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17
Q

What type of hematoma presents as a thunderclap headache

A

Subarachnoid

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18
Q

It is crucial to maintain BP in a subarachnoid hemorrgage, what should the BP goal be?

What are the medications to help control?

A

Maintain BP < 140/80

IV labetalol or nicardipine

Remember, treating anxiety, pain, nausea can all help with BP

19
Q

In a SAH that is progressing or need to decreased ICP aggressively, what can be considered?

A
  • Mannitol
  • 3% Saline
  • Intubation with hyperventilation
20
Q

What score is used to assess the need for brain imaging after pediatric head injury?

A

PECARN

21
Q

What type of injury is at high risk for a diffuse axonal injury?

A

Cou-countercoup

22
Q

What is Cushing’s Triad?

A
  • Widened pulse pressure
  • bradycardia
  • bradyapnea
23
Q

What are the types of cerebral herniation?

What is the most common?

A
  • Subfalcine: cingulate gyrus is pushed into the falx cerebri
  • Uncal: temporal lobe is pushed under tentorium, compresses upper brainstem
  • Central: temproal lobes push through tentorial notch
  • Tonsillar: cerebrellar tonsils are pushed through the foramen magnum
  • Upward: brainstem is compressed by an infratentorial mass

Uncal

24
Q

What is the initial triage and management of a stroke alert?

A
  • ABC, IV/O2/Monitor
  • Glucose level
  • FAST-ED
  • CT (within 10 minutes)
25
Q

What is assessed in the FAST-ED exam?

A
  • Facial Palsy
  • Arm weakness
  • Speech changes
  • Eye deviation
  • Denial/Neglect
26
Q

What does the HINTS exam evaluate?

What is being evaluated?

A

Dizziness

Head impulse test, nystagmus, test of skew

27
Q

During a HINTS exam, there is an abnormal head impulse test that there is a corrective saccade. Does this suggest peripheral or central vertigo?

What type of nystagmus would also suggest this type of vertigo?

A

Peripheral

Horizontal nystagmus

28
Q

Vertical nystagmus is indicative of what type of vertigo?

A

Central Vertigo

29
Q

Is the HINTS exam more indicative of ischemic CVA than MRI?

A

Yes, but only if done well!

30
Q

What diagnoses can mimic a stroke?

A
  • Seizure
  • Hypoglycemia
  • Sepsis
  • Mirgraines
  • Bell’s Palsy
31
Q

If there is no bleeding identified on CT when working up a stroke/TIA what should be obtained next?

A

CTA of head and neck

32
Q

What are the absolute contraindications for tPA?

A
  • Significant head trauma or prior stroke in the previous 3 months.
  • > 4.5 hours
  • SBP ? 185, DBP > 110
  • Any previous ICH
  • Active bleeding anywhere (doesn’t count menses)
33
Q

If giving tPA your SBP has to be below what?

A

< 185 and DBP < 110

34
Q

A patient presents in active status epilepticus, their GCS is less than 8. Are you intubating them?

If intubating what do you use?

A

No, due to the anticipated course of treatment you can treat the seizure and prevent blockage of airway

Propofol with sux

35
Q

What are the first line seizure medications?

What is used more commonly in kids?

A
  • Lorazapam
  • Diazepam
  • Midazolam

Diazepam

36
Q

When can ETOH withdrawal begin?

A

Can begin 2-6 hours after reduced ETOH intake, can last 2 weeks

37
Q

How can you assess alcohol withdrawal?

A

CIWA

Available on MDCALC and Typically a Standing Order

38
Q

What ammonia level increases risk for brain herniation?

A

> 220 ug/dl

39
Q

What are the signs of hepatic encephalopathy?

A
  • Starts with AMS, asterixis, jaundice, hepatic fector
  • Can lead to coma
40
Q

What is the first line treatment for alcohol withdrawal?

A
  • Benzo’s (diazepam, lorazapam, midazolam)
  • Thiamine
41
Q

What are the scoring interpretation of CIWA?

A
  • </= 8: abset or minimal withdrawal
  • 9-19: Mild to moderate withdrawal
  • > /= 20: severe withdrawal
42
Q

Do patients with Guillain-Barre need to be admitted?

What are they at risk for?

A

YES!

Progression to respiratory compromise and death

43
Q

What nerve innervates the diaphragm?

A

Phrenic Nerve

Emergency Medicine (19 decks)

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