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31 Cards in this Set
- Front
- Back
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ddx for headache
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migraine
cluster HA sinusitis narrow angle glaucoma carbon monoxide meningitis SAH cerebral ischemia / stroke temporal arteritis venous sinus thrombosis hypertensive encephalopathy uremia hypertensive encephalopathy |
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history questions for ED headache
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sudden vs gradual
location syncope? neck pain? |
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physical exam foci for suspected temporal arteritis
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febrile?
high BP? EYES NECK: meningeal SINUSES TMJ SCALP full neuro exam |
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sens of neck stiffness, ams in meningitis
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around 70%
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rash with headache, think ...?
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meningitis
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Normal WBC in spinal fluid
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< 5
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What are contraindication for LP for meningitis?
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absolute obstructive hydrocephalus and infection at puncture site
relative: ANTICOAGULANTS papilledema intracranial mass |
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In general you don't do a CT scan before an LP. The indications for it are:
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FOCAL NEURO signs
PAPILLEDEMA suspected mass trauma HIV, IVDA unable to do exam |
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WBC in bacterial meningitis
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100-10,000, PMN predominant
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WBC in viral meningitis
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10-1000, monocyte predominant
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Normal serum glucose: CSF glucose ratio value?
What is suggestive of bacterial meningitis? |
0.60
<0.50 suggests meningitis |
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Normal protein level in CSF?
high value? |
15-45
>45 |
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Meningitis management in ED
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isolate pt w/o waiting for tap results
IV abx w/o waiting for tap results STEROIDS 10 mg dexamethazone 10 minute before or with abx ALWAYS ADMIT |
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Preferred abx for meningitis
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Ceftriaxone 2g IV
Vancomycin 1 g IV rifampin 600 mg IV (aids uptake of vanco into CNS, offsets steroids) |
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Should close contacts of meningitis get prophylactic tx?
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yes
options: Cipro one dose 500 mg Azithromycin one dose 500 mg ceftriaxone 250 mg (pregnant) rifampin x 4 days |
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risk factors for SAH
men or women more likely? |
smoking, alcohol, HTN (SAH)
women! |
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Sentinel headaches can precede SAH..."cerebral angina" ... what is median time
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2 weeks
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tests of choice for SAH
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CT noncontrast
lumbar puncture: xanthrochromia, > 1000 RBC |
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How do you distinguish bloody tap from xanthochromia?
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decreasing blood in tubes for bloody tap
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How do you manage blood pressure for a subarachnoid hemorrhage?
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if systolic > 220 or MAP > 130, then reduce MAP by 20%
use nitroprusside, esmolol, nimodipine (less vasospasm) |
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How do you calculate cerebral perfusion pressure?
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CPP = MAP - ICP
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Who decides what hypertensive meds a SAH patient should get?
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The neuro consult!!
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What meds beside HTN should an SAH patient get?
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Antiseizure meds
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What are the risk factors for venous sinus thrombosis?
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HYPERCOAGULABLE state: blood dyscrasia or pregnancy, immobility
LOW FLOW in sinus: VOLUME DEPLETED, cardiac dz COMPRESSION or INVASION: infectious or malignant...sinusitis, mastoiditis, tumor |
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What are best diagnostic tests to ID venous sinus thrombosis?
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though CT may find it, MRI/MRV are better
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What is treatment for venous sinus thrombosis?
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heparin
treat underlying cause admit to hospital |
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Constitutional sx of temporal arteritis?
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wt loss, proximal weakness,
MASSETER CLAUDICATION PERIOCULAR DISCOMFORT |
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What do you do if you suspect temporal arteritis?
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IV steroids immediately
consult optho for biopsy consult rheum for steroid management |
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What is the confusing sx in narrow angle glaucoma?
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N/V can cause GI symptoms to predominate with HA
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Physical exam suggestive of narrow angle glaucoma
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unilateral red eye
nonreactive mid dilated pupil corneal edema shallow anterior chamber high intraocular pressure (normal is 10-20) |
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What instrument should you go get if you suspect glaucoma
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tonopen
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