Neurology Archives - Page 3 of 9 - The Emergency Medical Minute

Neurology

Just the Flu?

Just the Flu? Chief Complaint: Seizure HPI: Patient is a 13 month old M presenting to the ED via EMS following a tonic clonic seizure that per EMS, began around 9:30 AM and lasted at least 15 minutes. The patient’s family is primarily Spanish-speaking and was unable to give adequate history secondary to the language…

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Podcast 534: Nerve Agents

Author: Michael Hunt, MD Educational Pearls: Organophosphate “nerve agents” were developed in the 1930’s These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE” Salivation Lacrimation Urination Defecation  GI cramping Emesis  The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to…

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Podcast 531:  Migraine Cocktail 

Contributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.  The most effective agent in the cocktail is a dopaminergic agent  Routine IV fluids have not shown efficacy  There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl) Decadron reduces rebound headache …

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Podcast 523:  A Dizzying Diagnosis 

Contributor: Don Stader, MD Educational Pearls: It can be difficult to distinguish between central and peripheral causes of vertigo. Cerebellar stroke should be considered with any dizzy patient.  Signs and symptoms that suggest stroke as the cause of vertigo include: ataxia, cranial nerve deficits, and rapid onset of symptoms When cerebellar stroke is being considered,…

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Podcast 509: Circadian Rhythm and Shift Work, From Z to Z

Contributor: Jared Scott, MD Educational Pearls: Sleep deprivation and disturbed sleep cycles increases the risk of many acute and chronic medical issues such as motor vehicle accidents, diabetes, cardiovascular disease, psychiatric disease,  and shift work sleep disorder (difficulty sleeping, fatigue, interference with daily activities) Stages of sleep  Stage 1: 5-10 minutes (light sleep, may not…

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Podcast #499: Posterior Circulation Ischemia

Podcast # 499: Posterior Circulation Strokes Contributor: Neal O’Connor, MD Educational Pearls: Dizziness is a very common complaint in the emergency department, but how can we find patients with a dangerous cause of their symptoms, namely a posterior circulation stroke? Consider a posterior circulation stroke in those with an abrupt onset of headache with neck…

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Podcast # 490: Canadian Syncope Rule

Contributor: Don Stader, MD Educational Pearls: Syncope is usually benign but can be caused by serious etiologies which include: PE, certain cardiac arrhythmias, AAA, intracranial bleed/stroke The Canadian Syncope Rule appears to identify those patients with syncope and low risk of serious outcomes The score is based on vital signs, EKG and history Negative scores…

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Podcast # 485: Cerebellar Stroke

Contributor: Jared Scott, MD Educational Pearls: Cerebellar strokes make up a disproportionate number of missed or delayed diagnosis for stroke likely due to the subtle nature of the presentation Cerebellar strokes can present with vomiting, dizziness, and ataxia.  Unlike anterior circulation stroke, exam findings in a cerebellar stroke are ipsilateral to the lesion  On neuro…

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Podcast # 484: Elevated ICP

Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma.  While definite treatment is to remove the offending cause, there are emergency medicine   Non-pharmacologic methods include elevating head of bed and removing noxious stimuli Pharmacologic options include mannitol and hypertonic saline Hypertonic saline is best delivered through…

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Podcast # 483: Dual Antiplatelet Therapy in TIA

Contributor: Don Stader, MD Educational Pearls: Antiplatelets include Aspirin and Clopidogrel, and are generally used for arterial clotting (MI, stroke) Anticoagulants such as Coumadin, Xarelto, Eliquis are generally used for venous clotting (DVT/PE) Growing data suggests that dual antiplatelet therapy (Aspirin+Clopidogrel) is superior to aspirin alone in reducing stroke for diagnosed with TIA References: Kheiri…

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