Neuro emergencies Flashcards
Altered mental status- Sx
- Change in arousal, consciousness
- Delirium, dementia and coma
Altered mental status- Tx
- Determine underlying cause
- Glucose
- Stabilize vitals
Coma- Sx
- Unarousable to stimuli, including pain
- Doll eyes
Coma- Tx
- Tx underlying cause
Stroke/ TIA- Sx
- Jumbled speech- aphasia and apraxia
- Unilateral motor deficits
- AMS
Stroke/ TIA- Tx
- Airway
- Asses for trauma
- Tx cerebral edema
- Thrombolysis if indicated
Status epilepticus- Sx
- Seizure lasting 5-15 min with out intervening periods of consciousness
Status epilepticus-Tx
- Protect airway
- Benzos then phenytoin
Spinal cord injury- Sx
- Head injury or trauma as mech of action
- Neuro deficits and complaints
- AMS, seiure
Spinal cord injury- Tx
- Immediate immobilization
- ABCs
Headache- Sx
- Sudden severe onset most concerning
- Focal neuro defecits
- Hx or trauma or nuchal rigidity, photophobia
Headache- Tx
- CT to determine if emergency
- Neuro consult
Syncope- Sx
- Transient loc
- May be due to CV issues, seizure
Syncope- Tx
- Determine and tx underlying cause
- ECG, vitals
Meningitis/ encephalitis- Sx
- Nuchal rigidity, photophobia, CSF findings
- Seizures and CN deficits
Meningitis/ encephalitis- Tx
- Abx and steroids
Basilar skull fracture- Sx
- Base of skull- temporal occipital sphenoid or ethmoid
- Sig force fracture to base
- Sig risk for inter-cranial fx
- Otorrhea and rhinorrhea due to torn dura
- Battle signs and raccoon eyes
Basilarskull fracture- Tx
- Caution for epidural hematoma
- Order CT
- Consult neuro
Epidural hematoma- Sx
- Head trauma and LOC
- Lucid interval
- Rapid neuro deterioration
- Blood between skull and dura
- Increased IC pressure
- Lenticular shape
Epidural hematoma- Tx
- Evacuate fluid for recovery
Subdural hematoma- Sx
- Sudden acceleration
- Hematoma between dura and arachnoid
- Slower collection longer time course
- Falling elders chronic x 2 weeks
- Crescent shaped on CT
Subdural hematoma- Tx
- Reverse anticoagulation
- Surg to evacuate
Subarachnoid hemorrhage- Sx
- Sudden onset of HA worst of life
- Thunder-clap
- Meningeal signs photophobia
- Blood in CSF
Diffuse axonal injury- Sx
- Disruption of axonal fibers
- post-traumatic coma
- GCS 3-8
- Amnesia > 7 days
- CT- poor grey-white matter discrimination
punctuate hemorrhages cerebral edema
Concussion- Sx
Grade 1: Transient confusion, no LOC. sx 15 min
- Grade 3: LOC
Other sx: amnesia, vomiting, confusion, behavior change
- GCS 13-15
Concussion- Tx
Grade 1: Remove from contest
- Grade 2: Remove, return after 1 wk asymptom
- Grade 3: 1-2 asymp wks
Moderate head trauma- Sx
- Initial GCS 9-12
- Post traumatic amnesia 24 hrs - 7 days
Mild to moderate head trauma- Tx
- Close f/u with PCP
Diffuse axonal injury- Tx
- Reduce cerebral edema
- Mannitol
- Volume resuscitation
Skull fracture- Sx
- Open- underlying laceraciton
- Closed- swelling and hematoma
- Depressed- visible on CT, palpation
Skull fx- Tx
- Open- abx, consult neuro
- Closed- Close observation
- Depressed- hospitalize and consult
Whiplash= Sx
- Appear 12-24 hrs after injury
- Tenderness, limited ROM
- Hoarse, dysphagia
- No neuro defecit
Whiplash- Tx
- Xray and MRI
- Immobilization
- Musc relaxants, heat, NSAIDs
Encephalopathy- Sx
- AMS
- Ophthalmoplegia, ataxia and confusion
- Tremors
- wide, unsteady gait
- Decerebrate posturing
Encephalopathy- Tx
- Thiamine for wernikes
- Lactulose for hepatic
- glucose fluids and benzos for metabolic
