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Emergency Medicine > Neuro Emergency > Flashcards

Neuro Emergency Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

if a neurological emergency is occurring and onset is less than 4 hours ago, what should we do?

A

initiate stroke alert

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2
Q

what are the different parts of the glasgow coma scale?

A

“EYES” “VOICE” “OLD BEN”

1 - Eyes are shut
2 - Y shaped prickly object
3 - Ear piercing sound
4 - Spontaneous

1 - Voiceless
2 - Obscure
3 - Inappropriate
4 - Confused
5 - Elegant

6 - Obey
5 - Localizes towards pain
4 - Draws away
3 - Bends
2 - Extension
1 - None

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3
Q

in a neurological emergency, when can a patient stop being NPO?

A

after passing swallow test

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4
Q

what should we attempt to determine if a patient presents with stroke-like symptoms?

A

last known well

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5
Q

what are all focal neurological deficits treated as until they improve or another etiology if identified?

A

stroke

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6
Q

what is our first order of business when a patient presents with stroke-like symptoms?

A

differentiate between ischemic vs hemorrhagic with brain CT w/o contrast

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7
Q

what diagnostics do we want for ischemic stroke?

A

labs
EKG

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8
Q

what diagnostic should we get if we suspect a cerebellar stroke?

A

emergent brain MRI

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9
Q

what is the management for ischemic stroke? (5)

A

protect airway (intubate as needed)
elevated bed to 30 degrees
manage glucose
manage hypertension with IV nicardipine / labetalol / esmolol
thrombolytics

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10
Q

in an ischemic stroke, we should only lower BP if:

A

SBP > 220
OR
DBP > 120

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11
Q

what criteria must the patient meet in order to receive thrombolytics for an ischemic stroke? (2)

A

measurable deficit
sx onset < 4 hrs

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12
Q

what are 3 exclusion criteria to starting thrombolytics for ischemic stroke?

A

SBP > 180
DBP > 110
active bleeding

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13
Q

LOC with blow to head followed by immediate lucid period, followed by mental decompensation

A

epidural hemorrhage

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14
Q

acceleration-deceleration injury sheering veins and more common in elderly d/t atrophy

A

subdural hemorrhage

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15
Q

thunderclap HA, worse HA of their life with neck stiffness

A

subarachnoid hemorrhage

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16
Q

caused by a hypertensive emergency, bleeding mass, or trauma

A

intracerebral hemorrhage

17
Q

what 3 diagnostics should we get for possible hemorrhagic stroke?

A

brain CT w/o constrast
labs
EKG

18
Q

management for hemorrhagic stroke? (5)

A

elevate bed 30 degrees
protect airway
reverse anticoagulation
reduce SBP to 140-160 w/ IV nicardipine / labetalol / esmolol
neurosurgeon

19
Q

how is increased intracranial pressure from hemorrhagic stroke managed? (2)

A

mannitol
OR
hypertonic saline

20
Q

what is the PaCO2 goal in hemorrhagic stroke?

A

30-35

21
Q

what should be avoided in migraines and tension headaches?

A

opiates

22
Q

5 diagnostics for headaches?

A

CT brain w/o contrast
labs
head CT w/in 6 hours
CTA brain
LP after 6 hours

23
Q

what is the 1st line treatment for migraine? (5)

A

IV fluids
IV Toradol
PO Tylenol
IV metoclopramide (Reglan)
IV benadryl

24
Q

what is the 2nd line treatment for migraine? (2)

A

IV magnesium
IV methylprednisolone (sulo-medrol)

25
Q

what is the most common cause of seizures?

A

known epileptic pt not taking their meds

26
Q

what should we do if a non-epileptic patient presents with their 1st seizure without other symptoms or inciting event?

A

rule out toxicity / metabolic issues
D/C home to follow PCP

27
Q

what should we do if a patient presents with their 2nd seizure?

A

refer to neurologist

28
Q

occurs in infants between 6-60 months, generalized, and lasts less than 15 mins

A

febrile seizure

29
Q

what is a post-trauma seizure until proven otherwise?

A

intracranial hemorrhage

30
Q

single seizure >5 mins or two or more seizures without recovery of consciousness between seizures

A

status epilepticus

31
Q

treatment for status epilepticus that is between 5-10 mins? (2)

A

IV lorazepam / diazepam +
phenytoin / fosphenytoin

+/- intubation

32
Q

treatment for status epilepticus that is lasts over 10 mins? (5)

A

IVP midazolam w/ drip +
propofol / ketamine +
phenobarbital

intubate
continuous EEG

33
Q

what is the management for concussion after ruling out intracranial hemorrhage?

A

D/C home
follow with PCP before returning to play

34
Q

what is the treatment for concussion while pt is waiting for PCP? (3)

A

physical + cognitive rest
acetaminophen prn x 2 days
ondansetron prn x 2 days
BEWARE OF 2ND HEAD INJURY

Emergency Medicine (12 decks)

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