Neuro Flashcards
(29 cards)
Vertigo
Retain on board
• Meclizine 25mg chew 1 tab PO
• Ondansetron 4mg 1 tab Sublingual
Insomnia
Retain on board
• Counseling on good sleep hygiene, limit caffeine, alcohol, and nicotine before bed
• Diphenhydramine HCL 25mg cap PO before bed
Chronic Pain Syndrome
Retain on board
• Referral to Physical therapy
• Educate on pain management
• NSAIDs
• Methocarbamol 500mg tab PO BID
• Follow up
Encephalitis
MEDEVAC
• Empiric tx
• Ceftriaxone 1 gram inj IM requires IV antibiotics
• Valacyclovir 1 gram tab PO TID for 7 days
Meningitis
MEDEVAC
• Ceftriaxone 1 gram inj IM tx pt requires IV antibiotics
• Ciprofloxacin 500mg tab PO for crew prophylaxis
• Isolate pt for droplet precautions
• Dark, quiet room, raise head of the bed 30 degrees
• CBC
• CT scan to r/o ICP
• Lumbar puncture to test CSF for infection
Bell’s Palsy
MEDADVICE
• 60% of cases recover w/o tx
• Prednisone 10 mg PO Q4hr daily for 5 days followed by a 5-day taper
• Artificial tears for eye lubrication
• Valacyclovir 1 gram tab PO if caused by herpes virus
Lumbar Disk Herniation
Possible MEDEADVICE
• Light Duty 48hrs
• NSAIDs
• Cyclobenzaprine 10mg tab PO
• phyiscal therapy
Radiculopathy
MEDADVICE
• Light Duty
• SIQ x24hr
• Cyclobenzaprine (Flexeril) 5mg PO Q8Hr
• Referral to physical therapy
• MRI
Carpal Tunnel Syndrome
- Wrist splint up to 3 months
- NSAIDS
- Dexamethasone 4mg inj into carpal tunnel
- Refer if sx persist more than 3 months despite tx or thenar muscle atrophy develops
Cauda Equina Syndrome
MEDEVAC
• Emergency spinal surgery to remove bits of bone or discs, or tumors
• T3’s
• MRI
Tension headache
- NSAIDS
- Amitriptyline
- Treat underlying anxiety or depression
- Refer to mental health
Cluster headache
- 12-15L/min for 15min via non-rebreather mask
- Prednisone 60mg daily for 5 days followed by gradual withdrawal over 7-10 days
Migraine
- Counsel pt on avoiding precipitating factors
- Rest in a quiet dark room
- Zolmitriptan 2.5mg sublingual
Post-traumatic Headache
• Acetaminophen 325mg 1-2 tabs PO Q6hr
Medication Overuse Headache
- Chronic daily headaches
- Unresponsive to medication
- Educate pt on weening off of meds and that the process will take about a month
- Gradual withdrawal from analgesics will eventually relieve headaches
Seizures
MEDEVAC
- Clear the room, maintain the airway if needed
- Started IV catheters
- Blood work
- Electrolytes, LFT, CBC
- Finger stick glucose
- Diazepam 5mg IM Q5-10 minutes; do not exceed 30mg
TIA
MEDEVAC
• EKG
• CBC
• FBG
• Rapid RPR
• CT/MRI
• Lipid panel
• Electrocardiography
• Thrombolytic therapy
CVA
MEDEVAC
• Aspirin
• EKG
• CBC
• FBG
• CT/MRI
• Lipid panel
• Electrocardiography
• Thrombolytic therapy within 6hr
Restless Leg Syndrome
Retain on board
• Ferrous sulfate 325 mg three times daily for 3-6 months
• Avoid aggravating drugs and caffeine
• Increase exercise
• Leg massage
Altered Mental Status
- Glasgow Coma Scale
- Less than 8 = intubate
- Supportive therapy, 02, fluids
- If opioid overdose is suspected give Naloxone
Closed head injury to include aneurysm
- MACE within 48hrs
- Direct observation for 24 hours
- Awaken the patient every 2 hours to ensure normal alertness
- No alcohol, sedatives, pain relievers other than NSAIDs should be given for 48 hours
- Ibuprofen 800mg tab PO max 3,200mg/d
Spinal Cord Injury
MEDEVAC
• ABCs first
• immobilize the C-spine with cervical collar
• Maintain oxygenation and blood pressure
• Insert a Foley catheter if bladder paralysis is suspected
• Sedate patient if necessary
• Consult MO before giving Corticosteroids
• X-ray
Basilar skull fracture
MEDEVAC
• Oxygen
• C-spine precautions
• Needs Head CT and Neurosurgeon
ICP
MEDEVAC
• Secure & maintain an open airway
• Elevate head of bed 25-30 deg Reverse Trendelenburg
• Ventilate to maintain oxygenation
• IV fluids NS or LR
• Consult MO before giving Furosemide
