non-traumatic neurological complaints in the ED Flashcards Preview

Emergency Medicine > non-traumatic neurological complaints in the ED > Flashcards

Flashcards in non-traumatic neurological complaints in the ED Deck (144)
Loading flashcards...
1

big question if you suspect a seizure

primary: without provocation-epliepsy

secondary: response to something

2

what does a post ictal state look like both in presentation and specifically with regards to chemistry panel

Disorientation, sleepy, amnesia, HA,

lactic acidosis (from the clonic muscle movements)

high PC02 metabolic acidosis

3

how long does a post ictal state last

Commonly lasts 30min-1hr – LOC gradually improves

4

grand mal seizures have been replaced by

generalized seizures

5

tell the store of a generalized convulsive seizure

the person experiences LOC

tonic movement followed by clonic

resolves spontaneously with post ictal state

6

rhythmic jerking of seizure pt

clonic phase

if they bit down they can
swallow it and swallow

7

what can you see that would point to a generalized seizure in a pt that has loc

stigmata of a seizure

urinary incontinence and tongue biting

8

generalized non-convulsant seizures

aka absense

like daydreaming

lasts seconds

formerly petit mal

9

simple partial seizure is now known as

focal aware seizure

10

three things key in focal aware seizure

awareness consciouness and memory preserved

11

sxs of focal aware seizures


Awareness, memory, consciousness is preserved

Uncontrolled movement, visual, auditory sx, autonomic sx’s

12

focal impaired awareness seizures aka

used to be a complex partial

13

focal impaired awareness

déjà vu,
jamais vu (You are in your house but you don’t know where you are; the familiar becomes the unfamiliar), sounds,
smell (“who is smoking a cigar right now? Nobody, we are in church”),
taste,
numbness,
automatisms,
fear/panic

14

Partial what is this and what are the 2 types

Limited area of brain

Sx’s match area affected


simple and complex or focal imparied and focal aware

15

Status Epilepticus

Seizure activity lasting > 5min
or repetitive seizures without CLEARING of mental state in between

16

what is the probelm with seizing for more than 5 minutes

Seizures >5min are unlikely to spontaneously resolve

17

Often result of secondary cause, so start looking... with status epilepticus

Electrolytes (especially: glucose (hypoglycemic), sodium, magnesium (hypomagnesemic))

Intracranial bleed, trauma


Tox, OD-until it is eliminated will not stop

18

status epilepticus tx

ABORT seizure before neuronal injury occurs

Benzodiazepines FIRST


THEN 2nd or 3rd line drugs (Dilantin, Phenobarb, etc)

these people are often intubated because they are not breathing

19

concerns with paralyzing someone

need to for intubation but can't tell if your pt is still seizing

20

Most common cause of seizures in EDMost common cause of seizures in ED

Out of meds? Most common cause of seizures in ED

21

Hx of a seizure

have you ever had this before
if you have epilepsy is the pattern changing?

Trauma Hx?
people that see fall with abandon

Substances used?

recent illness?

LMP?

Country of origin

22

seizure after trauma

concern for internal bleeding in the brian

23

why are we worried about substance abuse with seizing

lack of alcohol can cause seizing

if you are too sick to get alcohol you need to know

24

why are we asking lmp in a female pt

do not want to miss pre eclampsia

25

PE with seizure

Post-ictal or still seizing?

ABCDE’s first

VS should improve with recovery

Tongue trauma, urinary incontinence


AND head to toe exam

26

what is the head to toe exam in a pt with a seizure

• Trauma

• Neuro deficit

• Infection

• Evidence other Dz

• Stigmata of EtOH

• Toxidrome

27

Red flags in a seizure

First seizure: Why??

Head trauma: Bleed, ICP

VS not resolving: Why??

Alcohol withdrawal (these folks are SICK – ICU admit)

Fever, infection: Need LP? Shock?

Rash: Meningitis?

Vomiting: Airway disaster, aspiration risk

Electrolytes: Which ones? Mg,

Stimulants: Bleed? CVA?

Prolonged post-ictal state: Why?

Focal neuro deficit: CVA, bleed?

Travel/Endemic area?

Neurocystercercosis

Malignancy: Mets to brain? – Often present with a first time seizure

Renal/liver Dz: Uremic or encephalopathic??

HIV: Toxo-, histo-, infection

Coumadin/Plavix: Bleed?

Pregnancy: Eclampsia

28

Head trauma with seizure concerns

: Bleed, ICP

29

Fever, infection:

LP
meningitis

30

if vomiting we are worried about

airway