EM Neurology/Neurosurgical Emergencies Flashcards by Lindsey Dutton

What is the highest GCS score

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what is the lowest GCS score

3
even if you’re dead

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what is included on GCS

eye opening
best verbal response
best motor response

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What GSC sore do you intubate

less than 8

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what is the presentation of head trauma progression

HA
drowsiness
agitation
slowing of cognition
confusion
LOC
respiratory changes
pupillary dilation
visual fields
defects
gaze palsy

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What is the treatment of headache

ketorolac 15-30mg
acetaminophen
IV fluids
compazine 10mg IV
Benadryl 25mg IV

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what are the H bombs of Head trauma

avoid:
Hypotension
Hypoxia
Hypo/hypercarbia
hyper/hypothermia
hypoglycemia

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what is the presentation of epidural hematoma

classically have initial LOC followed by lucid period than rapid decline
HA, V, declining AMS, uncal herniation - ipsilat CN3 palsy, contralat hemiparesis

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What is the treatment of epidural hematoma

evacuation

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what is the presentation of an subdural hematoma

acute or chronic presentation
involved bridging veins
m/c in elderly populations
can cross suture lines

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what is the tx of subdural hematoma

immediate eval if:
GCS < 9
hematoma >10mm
midline shift
pupils fixed or asymmetric

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what is the presentation of subarachnoid hemorrhage

“thunderclap” headache
photophobia
meningeal sings
altered level of conciousness
no focal deficits
dilated puils

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how is a subarachnoid hemorrhage worked up

CT scan
CTA will show aneurysm or AVM
LP

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what is the treatment of subarachnoid

if there is indication for elevated ICP or hypocephalus - ventricular drain can be placed externally
maintain BP < 140/80

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What is the presentation of cerebral aneurysm

subarachnoid hem
“thunderclap” headache
LOC
seizure
diplopia
Nuchal rigidity
photophobia

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What is the initial management of SAH

pay attention to GCS and reassess frequently
BP goal is to maintain around pts baseline BP if knonw
tx seizures if needed
if progressing or decrease ICP - mannitol, 3% or intubation

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what is interparenchymal bleeds

bleeding of a vessel within the brain parenchyma
hugely varied presentation
associated with trama, HTN, AV malformation, tumor, aneurysm, contusion

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when do you do image adults for head injury

> 65
HA
2 episodies vomiting
seizure
intoxicated
GCS 15 2hrs after injury
Amnesia > 30 min prior
focal deficits
evidence on exam of significant trauam to head/neck
anticoagulated
evidence of basilar skull injury
dangeous mechanism

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what is the tool used for pediatric head injuyry

PECARN
risk of radition induced fatal cancer goes up 0.14% with each abdominal CT

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when is diffuse axonal injury usually seen

after trauma (often coup, countercoup injury)
sheering injury of axonal fibers
- reduces conduction
- would see physical tearing with electron microscope

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what is cerebral heriation

increase in ICP to the point the pressure needs to be relieved out of the body cranial bounderies

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what is cushings triad

widened pulse pressure (increasing systolic, decreasing diastolic) bradycardia, and irregular respirations.

what are the types of cerebral herniation

subfalcine
uncal (transtenorial)
central
tonsilalr
upward

what is subfalcine herniation

cingulate gyrus pushed into falx cerebri

what is uncal (transtenorial) herniation

temporal lobe is pushed under tentorium, compresses brain stem **most common**

what is the presentation of cerebral herniation

HA N/V AMS cushings triad recheck pupils frequently

What is a CVA

ischemic event where blood flow is disrupted to the brain initial insult results b/c of lack of O2 and glucose broken into ischemic or hemorrhagic stroke

what is ischemic stroke

thrombotic, embolic, low-flow

what is hemorrhagic stroke

intracerebral and nontraumatic subarachnoid hemorrhage

What is a TIA

ischemic without infarction or permanent tissue injury due to: - thrombosis - embolism (m/c d/t afib) - cryptogenic - dissection usually recover within 24 hours

what is the initial managment of CVA/TIA

ABC, IV/O2/Monitor Glucose FAST-ED CT

what is FAST-ED

Facial palsy Arm weakness Speech changes Eye diviation Denial/neglect

what is the presentation of CVA

very broad (do a good exam) facial droop arm drift chagne in speech weaness sensory changes AMS

What is the NIHSS CVA exam

pitfall is lacking sensing of posterior circulation stroke determines severity of stroke

What is the HINTS exam

Head Impulse test Nystagums Test of Skew **used to determine peripheral vs central vertigo**

what are you ordering for CVA/TIA

ABC IV/O2/Monitor BGL Fast-ed exam CT ECG labs: CBC, CMP, coags if no bleed on CT, CTA of head and neck

what is the intitial management of CVA if blood on CT

keep pt calm/confortable goal SBP < 160 reverse anticoag call neurosurg

what is the initial management of CVA if NO blood on CT

NIHSS onset < 4.5 hrs? screen for contraindications for tPA and discuss risks/benefit call neuro endovascular therapy up to 24 hours

what is the treatment of Ischemic CVA

Aspirin Plavix thrombolytics - alteplast BP goal: - if giving tPA SBP <185 and DBP < 110 - if no tpa SBP <220, DBP < 120

what are contraindicatios for tPA

>4.5 hours >SBP > 185, DBP >110 any previous ICH stroke in last 3 months active bleeding anywhere

What is the definition of status epilepticus

single seizure lasting >30 min or repetitive seizures between which the pt does not return to baseline clinical: 5 min or 2 seizures between which the patient does not fully recover

What is the initial management of status epilepticus

ABC, IV/O2/Monitor turn on side Benzo, Benzo, Benzo (ativan) check glucose intubate if needed

What are the first line medicatiosn for seizures

Benzos Lorazepam diazepam midazolam

what are second line medications for siezures

phenytoin keppra valproic acid

what is the last line medication for seizures

phenobarbital

when can ETOH withdrawal begin

2-6 hours after reduced and can last 2 weeks

At what level with withdraw symptoms begin

DEPENDS on patient - may occur at any blood alcohol level

how much does one drink raist ETOH level

15-25mg/dL - maximal concentration peaks at 1 hour after ingestion

What screening tool is used for alchol wihtdrawal

CIWA

what are symptoms of alcohol withdrawal

hand tremors N/V diaphroesis insomnia tachycardia HTN fever cracing anxiety hallucinatins within 12-48 hours

what is delirium tremens

waxing/waning conciousness confusion agitation hallucinations seizures ## Footnote max between 48 and 72 hours

what can cause heaptic encaphalopathy

Ammonia - starts with AMS, asterixis, jaundice - can lead to coma

What is the tx of alcohol withdrawal

Benzos to reduce autonomic hyperactivity and reduce risk of delirium tremens IV thiamine

What is Guillian-Barre Syndrome

Demyelinating disorders: Schwann cells (autoimmune) Progressive neurologic dysfunction, typcially starting with tingling or weakness in legs may lead to paralysis of LE, can progress to respiratory compromise