Contributor: Aaron Lessen, MD Educational Pearls: Recent study looked at the impact of screen time on duration of post-concussive symptoms 125 patients aged 12-25 diagnosed with a concussion were randomized to either abstain from or have unrestricted screen time for 48 hours after injury Patients with unrestricted screen time averaged approximately 5 hours/day of screen…
Read MoreContributor: Don Stader, MD Educational Pearls: Pain sensation is generated and modified by the brain Multiple case reports provide evidence that the degree of pain a patient experiences correlates with how severe they perceive their injury/illness to be Patients who feel safe and reassured about the care they are receiving have less pain The patient’s…
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The Not So Simple Status Epilepticus From A Tumor That’s Not A Tumor Chief Complaint: Seizure HPI: 16-year-old male brought in by EMS for seizure-like activity for 15 minutes while at his uncle’s house. On arrival to scene, EMS noted tonic clonic activity was noted in all extremities by EMS and 5mg IM Versed given…
Read MoreContributor: Ricky Dhaliwal, MD Educational Pearls: CRASH 3 Trial looked at over 12,000 patients with traumatic intracranial bleeds, randomizing patients to a therapy with TXA or standard of care without TXA Dosing was 1 gram over 10 min for loading dose and then an infusion of 1 gram over 8 hours Found Improvement in survival…
Read Moredon’t pick your brain Chief Complaint: Generalized Weakness HPI: 69-year-old male with a self-diagnosis of obsessive-compulsive disorder (OCD) presents to the ED via EMS for being “sick”. The patient reports he has not been able to get up so he has not eaten in 4 days. The patient reports he has not seen a doctor…
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the silent killer strikes Chief Complaint: Stroke Alert HPI: 68 year old female with past medical history of coronary artery disease status post stent, hypertension, hypothyroidism, hyperlipidemia is brought in by EMS as a stroke alert after being found unresponsive in bed by family prior to arrival. Last known normal is 10pm last night when…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: When evaluating a thunderclap headache, don’t forget RCVS! RCVS: reversible cerebral vasoconstriction syndrome Due to reversible spasms of cerebral blood vessels Can sometimes be seen on CTA or MRA, but often the imaging is normal and formal angiograms only occasionally show it It can be caused by medications, intense…
Read MoreContributor: Tom Seibert, MD Educational Pearls: High altitude cerebral edema (HACE) is the end stage of acute mountain sickness and is diagnosed when patients develop neurologic dysfunction, ataxia, and altered mental status. The pathophysiology of HACE is thought to be due to increased cerebral blood flow and increased capillary permeability causing vasogenic edema and brain…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Serum prolactin levels can be used to help differentiate epileptic seizures from non-epileptic seizures It is also released and elevated after epileptic seizures but not non-epileptic seizures A level must be checked 10-20 minutes after the episode and if possible a next day level should be checked to…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Hand raising test: a simple but effective tool to diagnose carpal tunnel Patients hold their hands over their head and if symptoms of carpal tunnel develop within 2 minutes, it is considered positive, meaning they likely have carpel tunnel Symptom included numbness and dull pain in the distribution of…
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