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Flashcards in Neuro Emergencies Deck (52)
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1

Head Trauma- history

When, where & how
Mechanism of injury
LOC at the scene
Alcohol/drug involvement
Length of time from injury
Underlying medical problems
Allergies
Medications

2

Head trauma- physical

Vitals
Glasgow coma scale
Examine for outward trauma
C-spine collar
Pupils
Level of alertness
Look for focal deficits

3

Clinical features of TBI

+ or - LOC, confusion or amnesia (legnth)
Headache
Dizziness, vertigo, imbalance
Disorientation
N/V
Vacant stare
Inability to focus
Gross incoordination
Memory deficits
Delayed verbal expression
Slurred or incoherent speech
Labile emotions

4

Complicated TBI issues

Post-traumatic seizures
Focal neurologic signs
Neurologic deterioration
Worsening HA, confusion, focal neurological signs or lethargy
Other injuries to H&N

5

Guidelines for CT Scan in ER

GCS

6

CT scan abnormalities that require consult

Subdural hematoma
Intracranial bleeding
Cerebral edema
Significant skull trauma

7

Hospitalization or transfer

GCS

8

Outpatient observations warning signs

Inability to wake patient
Severe or worsening HA
Somnolence/confusion
Difficulties with vision
Incontinence
Weakness/numbness
Unsteadiness or seizure
Vomiting, fever, stiff neck

9

Clinically significant skull fractures

Pass through sinus
Associated with scalp lesion
Depressed below the level of the skull's inner table
Overlie a major dural venous sinus or middle meningeal artery

10

Depressed Fractures

Difficult to review on radiographs
Often can be felt

11

Basilar fractures

Linear fractures
Usually through the temporal bone
Fracture causes dural tear
CT for imaging

12

Signs of basilar fracture

Raccoon eyes
Battle's sign
Hemotympanum

13

Definition of open skull fractures

An overlying scalp laceration and the dura is disrupted

14

Primary Headaches Syndromes

Migraines
Cluster HA
"Worst HA ever"

15

Characteristics of migraines

Unilateral
Throbbing
Aura
Hx of migraines
N/V
Photophobia
Sound sensitive

16

Treatment of migraines

1st- Tryptans
2nd- Ketorolac + antiemetic
IV fluids

17

Characteristics of cluster HA

Men
Excruciating pain behind eye
Hx of cluster HA
Snot running out of nose

18

Treatment of cluster HA

1st- 100% oxygen
2nd- Sumatriptan

19

Thunderclap HA

Associated with N/V
+/- focal neurologic findings

20

Life threatening causes of HA

Subarachnoid Hematoma
Bacterial Meningitis
Cerebral Ischemia
Subdural Hematoma
Brain Tumor

21

Seizure etiologies

Alcohol associated
Metabolic
Infectious
Trauma
CVA
Sleep Deprivation
Noncompliance with anticonvulsant
First time idiopathic seizures

22

Status Epilepticus Etiologies

Hypo-natremia, -calcemia, -glycemia
CNS abscess
Meningitis/Encephalitis
Neoplasm
AV malformations
Actue hydrocephalus
Intracerebral hematomas
CVA
TCA's
Migraines
Failure to take anticonvulsant

23

Seizure management

Airway
Thiamine (alcoholic)
Hx of patient
Establish IV
1st- Benzodiazepines
2nd- Phenytoin, Phenobarbital
Possible dextrose bolus, Narcan

24

SE of Phenytoin

Hypotension
Bradycardia

25

SE of Phenobarbital

Sedation
Respiratory Depression
BP depression

26

Post-ictal state

Sleepy/confused
Often incontinent
Tongue bitten

27

Vertigo Etiologies

Central
Somatic
Peripheral

28

Central vertigo etiologies

Migrainous
Brainstem ischemia
Cerebellar infarction
Cerebellar hemorrhage
MS

29

Somatic vertigo etiologies

Panic attack
Weak, dizzy, nearly fainting patient

30

Peripheral vertigo etiologies

Benign paroxysmal positional vertigo
Vestibular neuritis
Herpes zoster oticus
Miner's disease
Labyrinthitis
Perilymphatic fistula
Acoustic neuroma
Aminoglycoside toxicity
Otitis media