Neuro Emergency Flashcards
if a neurological emergency is occurring and onset is less than 4 hours ago, what should we do?
initiate stroke alert
what are the different parts of the glasgow coma scale?
“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
in a neurological emergency, when can a patient stop being NPO?
after passing swallow test
what should we attempt to determine if a patient presents with stroke-like symptoms?
last known well
what are all focal neurological deficits treated as until they improve or another etiology if identified?
stroke
what is our first order of business when a patient presents with stroke-like symptoms?
differentiate between ischemic vs hemorrhagic with brain CT w/o contrast
what diagnostics do we want for ischemic stroke?
labs
EKG
what diagnostic should we get if we suspect a cerebellar stroke?
emergent brain MRI
what is the management for ischemic stroke? (5)
protect airway (intubate as needed)
elevated bed to 30 degrees
manage glucose
manage hypertension with IV nicardipine / labetalol / esmolol
thrombolytics
in an ischemic stroke, we should only lower BP if:
SBP > 220
OR
DBP > 120
what criteria must the patient meet in order to receive thrombolytics for an ischemic stroke? (2)
measurable deficit
sx onset < 4 hrs
what are 3 exclusion criteria to starting thrombolytics for ischemic stroke?
SBP > 180
DBP > 110
active bleeding
LOC with blow to head followed by immediate lucid period, followed by mental decompensation
epidural hemorrhage
acceleration-deceleration injury sheering veins and more common in elderly d/t atrophy
subdural hemorrhage
thunderclap HA, worse HA of their life with neck stiffness
subarachnoid hemorrhage
caused by a hypertensive emergency, bleeding mass, or trauma
intracerebral hemorrhage
what 3 diagnostics should we get for possible hemorrhagic stroke?
brain CT w/o constrast
labs
EKG
management for hemorrhagic stroke? (5)
elevate bed 30 degrees
protect airway
reverse anticoagulation
reduce SBP to 140-160 w/ IV nicardipine / labetalol / esmolol
neurosurgeon
how is increased intracranial pressure from hemorrhagic stroke managed? (2)
mannitol
OR
hypertonic saline
what is the PaCO2 goal in hemorrhagic stroke?
30-35
what should be avoided in migraines and tension headaches?
opiates
5 diagnostics for headaches?
CT brain w/o contrast
labs
head CT w/in 6 hours
CTA brain
LP after 6 hours
what is the 1st line treatment for migraine? (5)
IV fluids
IV Toradol
PO Tylenol
IV metoclopramide (Reglan)
IV benadryl
what is the 2nd line treatment for migraine? (2)
IV magnesium
IV methylprednisolone (sulo-medrol)
