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Clin Med IV: Emergency Medicine > EM Neurology/Neurosurgical Emergencies > Flashcards

EM Neurology/Neurosurgical Emergencies Flashcards

1
Q

What is the highest GCS score

A

15

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2
Q

what is the lowest GCS score

A

3
even if you’re dead

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3
Q

what is included on GCS

A

eye opening
best verbal response
best motor response

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4
Q

What GSC sore do you intubate

A

less than 8

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5
Q

what is the presentation of head trauma progression

A

HA
drowsiness
agitation
slowing of cognition
confusion
LOC
respiratory changes
pupillary dilation
visual fields
defects
gaze palsy

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6
Q

What is the treatment of headache

A

ketorolac 15-30mg
acetaminophen
IV fluids
compazine 10mg IV
Benadryl 25mg IV

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7
Q

what are the H bombs of Head trauma

A

avoid:
Hypotension
Hypoxia
Hypo/hypercarbia
hyper/hypothermia
hypoglycemia

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8
Q

what is the presentation of epidural hematoma

A

classically have initial LOC followed by lucid period than rapid decline
HA, V, declining AMS, uncal herniation - ipsilat CN3 palsy, contralat hemiparesis

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9
Q

What is the treatment of epidural hematoma

A

evacuation

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10
Q

what is the presentation of an subdural hematoma

A

acute or chronic presentation
involved bridging veins
m/c in elderly populations
can cross suture lines

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11
Q

what is the tx of subdural hematoma

A

immediate eval if:
GCS < 9
hematoma >10mm
midline shift
pupils fixed or asymmetric

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12
Q

what is the presentation of subarachnoid hemorrhage

A

“thunderclap” headache
photophobia
meningeal sings
altered level of conciousness
no focal deficits
dilated puils

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13
Q

how is a subarachnoid hemorrhage worked up

A

CT scan
CTA will show aneurysm or AVM
LP

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14
Q

what is the treatment of subarachnoid

A

if there is indication for elevated ICP or hypocephalus - ventricular drain can be placed externally
maintain BP < 140/80

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15
Q

What is the presentation of cerebral aneurysm

A

subarachnoid hem
“thunderclap” headache
LOC
seizure
diplopia
Nuchal rigidity
photophobia

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16
Q

What is the initial management of SAH

A

pay attention to GCS and reassess frequently
BP goal is to maintain around pts baseline BP if knonw
tx seizures if needed
if progressing or decrease ICP - mannitol, 3% or intubation

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17
Q

what is interparenchymal bleeds

A

bleeding of a vessel within the brain parenchyma
hugely varied presentation
associated with trama, HTN, AV malformation, tumor, aneurysm, contusion

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18
Q

when do you do image adults for head injury

A

> 65
HA
2 episodies vomiting
seizure
intoxicated
GCS 15 2hrs after injury
Amnesia > 30 min prior
focal deficits
evidence on exam of significant trauam to head/neck
anticoagulated
evidence of basilar skull injury
dangeous mechanism

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19
Q

what is the tool used for pediatric head injuyry

A

PECARN
risk of radition induced fatal cancer goes up 0.14% with each abdominal CT

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20
Q

when is diffuse axonal injury usually seen

A

after trauma (often coup, countercoup injury)
sheering injury of axonal fibers
- reduces conduction
- would see physical tearing with electron microscope

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21
Q

what is cerebral heriation

A

increase in ICP to the point the pressure needs to be relieved out of the body cranial bounderies

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22
Q

what is cushings triad

A

widened pulse pressure (increasing systolic, decreasing diastolic) bradycardia, and irregular respirations.

23
Q

what are the types of cerebral herniation

A

subfalcine
uncal (transtenorial)
central
tonsilalr
upward

24
Q

what is subfalcine herniation

A

cingulate gyrus pushed into falx cerebri

25
Q

what is uncal (transtenorial) herniation

A

temporal lobe is pushed under tentorium, compresses brain stem
most common

26
Q

what is the presentation of cerebral herniation

A

HA
N/V
AMS
cushings triad
recheck pupils frequently

27
Q

What is a CVA

A

ischemic event where blood flow is disrupted to the brain
initial insult results b/c of lack of O2 and glucose
broken into ischemic or hemorrhagic stroke

28
Q

what is ischemic stroke

A

thrombotic, embolic, low-flow

29
Q

what is hemorrhagic stroke

A

intracerebral and nontraumatic subarachnoid hemorrhage

30
Q

What is a TIA

A

ischemic without infarction or permanent tissue injury due to:
- thrombosis
- embolism (m/c d/t afib)
- cryptogenic
- dissection

usually recover within 24 hours

31
Q

what is the initial managment of CVA/TIA

A

ABC, IV/O2/Monitor
Glucose
FAST-ED
CT

32
Q

what is FAST-ED

A

Facial palsy
Arm weakness
Speech changes
Eye diviation
Denial/neglect

33
Q

what is the presentation of CVA

A

very broad (do a good exam)
facial droop
arm drift
chagne in speech
weaness
sensory changes
AMS

34
Q

What is the NIHSS CVA exam

A

pitfall is lacking sensing of posterior circulation stroke

determines severity of stroke

35
Q

What is the HINTS exam

A

Head Impulse test
Nystagums
Test of Skew

used to determine peripheral vs central vertigo

36
Q

what are you ordering for CVA/TIA

A

ABC
IV/O2/Monitor
BGL
Fast-ed exam
CT
ECG
labs: CBC, CMP, coags
if no bleed on CT, CTA of head and neck

36
Q

what is the intitial management of CVA if blood on CT

A

keep pt calm/confortable
goal SBP < 160
reverse anticoag
call neurosurg

37
Q

what is the initial management of CVA if NO blood on CT

A

NIHSS
onset < 4.5 hrs?
screen for contraindications for tPA and discuss risks/benefit
call neuro
endovascular therapy up to 24 hours

38
Q

what is the treatment of Ischemic CVA

A

Aspirin
Plavix
thrombolytics - alteplast
BP goal:
- if giving tPA SBP <185 and DBP < 110
- if no tpa SBP <220, DBP < 120

39
Q

what are contraindicatios for tPA

A

> 4.5 hours
SBP > 185, DBP >110
any previous ICH
stroke in last 3 months
active bleeding anywhere

40
Q

What is the definition of status epilepticus

A

single seizure lasting >30 min or repetitive seizures between which the pt does not return to baseline
clinical: 5 min or 2 seizures between which the patient does not fully recover

41
Q

What is the initial management of status epilepticus

A

ABC, IV/O2/Monitor
turn on side
Benzo, Benzo, Benzo (ativan)
check glucose
intubate if needed

42
Q

What are the first line medicatiosn for seizures

A

Benzos
Lorazepam
diazepam
midazolam

43
Q

what are second line medications for siezures

A

phenytoin
keppra
valproic acid

44
Q

what is the last line medication for seizures

A

phenobarbital

45
Q

when can ETOH withdrawal begin

A

2-6 hours after reduced and can last 2 weeks

46
Q

At what level with withdraw symptoms begin

A

DEPENDS on patient - may occur at any blood alcohol level

47
Q

how much does one drink raist ETOH level

A

15-25mg/dL
- maximal concentration peaks at 1 hour after ingestion

48
Q

What screening tool is used for alchol wihtdrawal

A

CIWA

49
Q

what are symptoms of alcohol withdrawal

A

hand tremors
N/V
diaphroesis
insomnia
tachycardia
HTN
fever
cracing
anxiety
hallucinatins within 12-48 hours

50
Q

what is delirium tremens

A

waxing/waning conciousness
confusion
agitation
hallucinations
seizures

max between 48 and 72 hours

51
Q

what can cause heaptic encaphalopathy

A

Ammonia
- starts with AMS, asterixis, jaundice
- can lead to coma

52
Q

What is the tx of alcohol withdrawal

A

Benzos to reduce autonomic hyperactivity and reduce risk of delirium tremens
IV thiamine

53
Q

What is Guillian-Barre Syndrome

A

Demyelinating disorders: Schwann cells (autoimmune)
Progressive neurologic dysfunction, typcially starting with tingling or weakness in legs
may lead to paralysis of LE, can progress to respiratory compromise

Clin Med IV: Emergency Medicine (18 decks)

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