Emergency medicine: Collapse Flashcards
Explain the Oxford Bamford classification?
Classifies stroke into region of brain affected based on clinical symptoms
TACS (all three of:)
- U/L weakness
- Homonymous hemianopia
- High cognitive dysfunction (dysphasia, visuospatial)
PACS (any two of above)
POCS (any one of)
- Isolated homonymous hemianopia
- Cerebellar or Brainstem syndromes
- Loss of consciousness
LACS (any one of)
- Pure sensory loss
- U/L weakness
- Ataxic hemiparesis
What is the ROSIER score
Classification system to determine likeliness of stroke based on symptoms
- Score of ≥ 1 = stroke
U/L arm weakness (1) U/L leg weakness (1) U/L facial palsy (1) Slurred speech (1) Visual disturbances (1) Seizure (-1) LoC or syncope (-1)
What is the FAST screen
Facial palsy
Arm weak
Slurred speech
Time to call 999
What is the management pathway for stroke?
- ABCDE - Oxygen 15L/min
- Urgent CT within 1 hr if:
- GCS < 13
- Severe headache at time of symptoms
- High risk of bleed
- Symptom onset within 4.5hr thrombosis window
- Signs of raised ICP
3a. Thrombolysis (streptokinase or alteplase) if:
- < 80 and within 4.5 hrs
- > 80 and within 3 hrs
- Non-haemorrhagic
- Symptoms not improving
3b. Decompressive hemicranectomy if MCA
3c. Surgery if haemorrhagic
4. Aspirin 300mg (14d) - Clopidogrel 300mg then 75mg (warfarin if AF)
5. Optimise diabetic, cholesterol, HTN and smoking control
What is the ABCD2 score?
The scoring system used to determine risk of stroke following TIA and therefore need for treatment
Score ≥ 4 requires treatment with Aspirin and Clopidogrel
Age > 60 (1) BP ≥ 140 systolic or 90 diastolic (1) Clinical presentation: U/L weaknesss (2), Dysphasia w/o weakness (1) DM (1) Duration: 10-59 mins (1), 60 mins (2)
What is the appropriate management of SAH?
- ABCDE - Oxygen
- Neurosurgery (urgent) - endovascular coiling, surgical clips
- Nimodipine 60mg 4hrly - reduce vasospasm
- Encourage fluids - maintain cerebral perfusion
What is the appropriate management of SAH?
- ABCDE - Oxygen
- Neurosurgery (urgent) - endovascular coiling, surgical clips
- Nimodipine (CCB) 60mg 4hrly - reduce vasospasm
- Encourage fluids - maintain cerebral perfusion
what is the Hunt and Hess scale?
Determines the risk of mortality following SAH based on clinical presentation
What is the cause of SAH?
Rupture of a berry anueurysm located in the circle of willis
What investigation must you do in all patients with a sudden transient loss of consciousness?
ECG to identify red flags
- Long or short QT interval
- ST or T changes
- Conduction abnormalities (heart block or BBB changes )
What are the symptoms of vast-vagal syncope?
- Brief, transient LoC following precipitant (fear, straining, standing up too quickly) - onset over seconds
- Myoclonic jerking of limbs may occur (Anoxic convulsions due to cerebral hypo perfusion)
- Full recover within minutes
Prodrome:
- Nausea
- Light headed
- Visual disturbances
What are the symptoms of HONK?
Polyuria Polydipsia Dehydration Nausea Leg pain/cramps, weakness, visual disturbance Confused, Drowsy, Dizzy, LoC
What are the investigative findings of HONK?
- Raised Urea and Creatinine (urea > creatinine)
- Highly raised glucose >33 (often 50)
- Plasma osmolality > 350mosm/ml
- U+E - raised Na+ (may be masked due to high glucose)
What is the treatment for HONK
Essentially the same to DKA
- Saline 0.9%
- 1L over 30 mins
- 1L over 2hrs with 20mmols K+
- 1L over 2hrs with 20mmols K+
- 1L over 6hrs with 20mmols K+ - Insulin
- 2-4Units per hour - Thromboprophylaxis
- LMWH or UFH
Once glucose < 15
- Stop insulin
- Start Dextrose 10% infusion
