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
