PM&R Emergencies

Question 1

Does Autonomic Dysreflexia cause fever?

Answer 1

No

Question 2

What level do you get Autonomic Dysreflexia?

Answer 2

T6 & above

Question 3

What is the second most common cause of Autonomic Dysreflexia after bladder issues?

Answer 3

Bowel (constipation, bowel program)

Question 4

What are the post-acute places for patients t be discharged to?

Answer 4

SNF, IRF, LTAC, nursing home

Question 5

First steps in treatment of Autonomic Dysreflexia?

Answer 5

Sit patient up
Raise HOB
Lower legs
Unfasten abdominal binder and tight clothing
Assess bladder/bowels/find source

Question 6

First medication to use in Autonomic Dysreflexia

Answer 6

Nitropaste 1 inch above level of the SCI injury level

Question 7

Why do you use propanolol over metoprolol in autonomic storming?

Answer 7

better CNS penetration

Question 8

What medicine do you use in propanolol overdose?

Answer 8

Glucagon 5 mg IV once

Question 9

How to manage fever/diaphroresis in autonomic storming?

Answer 9

Bromocriptine 2.5 mg q12hr up to 30-40 mg/day (dopamine agonist), cooling blankets

Question 10

How do you treat dystonia in autonomic storming?

Answer 10

Dantrolene (check LFT’s first, Works by inhibiting Ca release from sarcoplasmic reticulum by antagonizing ryanodine receptors)

Question 11

What medical complication do you need to monitor for in Autonomic Storming?

Answer 11

Rhabodomyolysis (check CK)

Question 12

What level Rancho Los Amigos score is agitated?

Answer 12

Rancho 4

Question 13

What level Rancho Los Amigos score does a patient emerge from coma state?

Answer 13

Rancho 4

Question 14

What level Rancho Los Amigos score does a patient give appropriate responses?

Answer 14

Rancho 6

Question 15

How can you limit stimulation to a TBI patient?

Answer 15

Brain rest, limit TV/radio/conversation, Turn off lights, Limit visitors, Therapy timing

Question 16

Which blood pressure medication can be used for agitation in TBI?

Answer 16

Propanolol 10 mg q12hr, titrate up as tolerated

Question 17

Which typical antipsychotic is not recommended in TBI?

Answer 17

haloperidol (can delay recovery in TBI and QTc prolongation)

Question 18

What can use you to restore sleep cycle?

Answer 18

Seroquel 25-100 mg qhs (Good for agitation, risk of QTc prolongation)
Melatonin 3 mg qhs
Trazadone 25-100 mg qhs (priaprism {raise the bone}, QTc prolongation)

Question 19

DDX for mental status change

Answer 19

Stroke​ 
Hydrocephalus​ 
Cerebral edema​ 
Traumatic​ Infection​ Electrolyte/Metabolic imbalance (Hypoglycemia, Hypo/hypernatremia)​ Hypoxia/hypoxemia​ 
Seizure​ 
Sundowning​ 
Medication effect​malingering/conversion

Question 20

Symptoms of intrathecal baclofen pump

Answer 20

"ITB"- itchy, twitchy, bitch, High fever​ 
exaggerated rebound spasticity​ 
AMS
agitation​ 
muscle rigidity​ 
variable blood pressure​ Rhabdomyolysis​
Seizure

Question 21

How to treat anaphylaxis

Answer 21

Epinephrine 0.3-0.5 mg SQ repeat ~q20min, prepare to intubate, antihistamines, observe for 6-8 hours as symptoms may recur, send to ED

Question 22

What do you do if a patient pulls a PEG tube out?

Answer 22

Place a temporary foley catheter and call GI

Question 23

What do you do if a patient develops an acute DVT?

Answer 23

Hold therapy for 24 hours and start therapeutic anticoagulation

Question 24

What are the criteria for Canadian CT head guidelines?

Answer 24

“GCS <15 at 2 hours post-injury
Suspected open or depressed skull fracture
Any sign of basilar skull fracture
Hemotympanum. Raccon eyes, Battle’s sign, CSF
2 or more episodes of vomiting
Age >65 yo
Retrograde amnesia to the event >30 min
“Dangerous” Mechanism
Pedestrian struck by MV, ejected from MV, fall from >3ft or >5 stairs”