Urgent/Emergent Flashcards
33 y/o has GTC, two more with EMS, and another when you examine him lasting for 3 minutes. What is wrong?
Status Epilepticus
1 seizure > 5 minutes
or
2+ seizures w/o return to baseline
33 y/o has GTC, two more with EMS, and another when you examine him lasting for 3 minutes. How do you manage this patient?
1) ABC’s (including 2 large bore IV)
2) Simultaneus labs (CBC, CMP, Glucose, O2 level, AED level)
3)Thiamine + Glucose (if suspected EtOH)
4) Benzos (Midazolam 40 mg)
5) Phenytoin
6) Phenobarbitol/VPA/Keppra
7) Propofol + intubate
19 y/o college student brought to ED obtunded, not feeling well last night, bad headache today. Lethargic, incoherent, 39.3 F, neck stiff, brisk reflexes. DDx?
1) Bacterial Meningitis
2) SAH
3) Acute edema from brain tumor
4) Venus Sinus Thrombosis (not usually obtunded)
5) Toxic ingestion w/ elevated ICP
19 y/o college student brought to ED obtunded, not feeling well last night, bad headache today. Lethargic, incoherent, 39.3 F, neck stiff, brisk reflexes. Workup?
Worst HA of life
1) NCCT
2) LP
Bacterial Meningitis Causative Organisms
Neisseria, Strep pneumo, H flu
45 y/o healthy man w/ feet tingling. NExt day up to knees, unable to get up on toes for pushups. Later trouble getting out of car, unable to climb steps. H/o bloody diarrhea last week. PEx: diffuse weakness LE > UE, sensory loss in legs, reflexes absent. DDx?
1) GBS (predominantly motor, mild sensory loss, areflexia)
2) Cord Compression/infiltration (but no sensory level, bowel/bladder, UMN signs)
3) Myesthenia Gravis (but sensory sxs, areflexia, lack of fluctuation)
4) Botulism (but no bulbar sxs)
5) CIDP (if >4 weeks)
45 y/o healthy man w/ feet tingling. NExt day up to knees, unable to get up on toes for pushups. Later trouble getting out of car, unable to climb steps. H/o bloody diarrhea last week. PEx: diffuse weakness LE > UE, sensory loss in legs, reflexes absent. Tx?
GBS
1) May need to intubate
2) IVIG, Plasmapheresis
45 y/o healthy man w/ feet tingling. NExt day up to knees, unable to get up on toes for pushups. Later trouble getting out of car, unable to climb steps. H/o bloody diarrhea last week. PEx: diffuse weakness LE > UE, sensory loss in legs, reflexes absent. Complications?
GBS
1) arrhythmias
2) hypo/hypertension
3) ileus
4) resp. failure
5) aspiration / PNA
6) sepsis
7) Hyponatremia/SIADH
8) DVT
63 y/o M w/ leg weakness, worsening back pain x1 week, incontinence urine & stool, h/o prostatectomy/radiation, BLE weakness, 3+ leg reflexes, + babinski, decreased sensation to umbilicus. Dx?
Cord Compression
Weakness + UMN signs, + bowel/bladder involvement & Sensory level
19 y/o collefge student motor cycle MVA , helmet damage, loses consciousness x4 min. + confused & disoriented. A&O x3, poor concentration, no memory of accident. Bruise on head, c/o HA & nausea. No focal deficits, gait unsteady. DDx
1) Grade 3 Concussion (any loss of consciousness w/ normal NCCT)
2) Epidural Hematoma
3) SDH
4) SAH
5) Diffuse Axonal Injury
Grade 1: confusion <15 min
Grade 2: confusion >15 min
19 y/o collefge student motor cycle MVA , helmet damage, loses consciousness x4 min. + confused & disoriented. A&O x3, poor concentration, no memory of accident. Bruise on head, c/o HA & nausea. No focal deficits, gait unsteady. Management?
1) Imaging - NCCT
2) observed w/ frequent neuro checks
3) avoid narcotics (mask neuro changes)
