EM Neuro and Neurosurgery Flashcards
A ESR is included in initial orders of headache, what are you evaluating?
Inflammation associated with Temporal Arteritis
What is the initial intervention for symptomatic headache management?
What if unsuccessful?
- Ketorlac
- Acetaminophen
- IV fluids
- Compazine
- Benadryl
- Dexamethazone
Sumatriptan
What is the headache management in a pregnant patient?
What can you give for nausea?
Give Tylenol and Reglan
Can give benadryl for nausea
What is the initial management of head trauma?
- ABC/IV/O2/Monitor
- GCS <8 intubate
- Prevent hypotension with fluid resusitation
- Elevate HOB > 30*
- Contact trauma team or neurosurgery
- Off to CT
What should be used for fluid resuscitation in head trauma?
Crystalloids, blood if ongoing hemorrhage
In a head trauma what can be given for seizure prophylaxis?
Kepra or Phosphenatoin
What are the H-bombs?
- Hypotension
- Hypoxia
- Hypo/hypothermia
- Hypoglycemia
What are the signs and symptoms of Epidural Hematoma?
- 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
What is the treatment for an epidural hematoma?
Evacuation
If hematoma is removed before patient deteriorates to herniation, can have a full recovery
Immediate burr hole if GCS < 9 and deteriorating
Collywobbles?
Bellyache
Blatherskite
A person who talks at great length without making much sense
Tactile agnosia
Inability to recognize objects by touch
Prosopagnosia
Inability to recognize faces
Frankenfood
Genetically modified food
What hemmorhage type is more common in elderly?
Subdural
A subdural hematoma requires immediate evaculation if:
- If GCS < 9
- Hematoma > 10mm
- Midline sift
- Pupils fixed or asymmetric
What type of hematoma presents as a thunderclap headache
Subarachnoid
It is crucial to maintain BP in a subarachnoid hemorrgage, what should the BP goal be?
What are the medications to help control?
Maintain BP < 140/80
IV labetalol or nicardipine
Remember, treating anxiety, pain, nausea can all help with BP
In a SAH that is progressing or need to decreased ICP aggressively, what can be considered?
- Mannitol
- 3% Saline
- Intubation with hyperventilation
What score is used to assess the need for brain imaging after pediatric head injury?
PECARN
What type of injury is at high risk for a diffuse axonal injury?
Cou-countercoup
What is Cushing’s Triad?
- Widened pulse pressure
- bradycardia
- bradyapnea
What are the types of cerebral herniation?
What is the most common?
- 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
What is the initial triage and management of a stroke alert?
- ABC, IV/O2/Monitor
- Glucose level
- FAST-ED
- CT (within 10 minutes)
