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63 Cards in this Set
- Front
- Back
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How might a person with a dystonic drug rxn present?
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may present with rapid peduliar athetoid involuntary movements of the face, eyes, tongue, neck, and trunk. Also, the pt may not be able to speak
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What is Oculogyric crisis?
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deviated, roving extraocular movements
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What is Torticolis?
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peculiar invuluntary facial and neck spasms, distortions, grimacing, and posturing movements
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What is Opisthitonis?
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arching, hyperextension, and spasms of the entire body
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What does Bucculingual mean?
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Protruding, wrything, athetoid movments of the mouth, lips, tongue, and throat muscles
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What does tortipelvic refer to?
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painful spasms, contractions, and rigidity of the abdomen
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Name 5 drugs that are most likely to cause DDR?
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-haloperidol/Haldol
-prochlorperazine/Compazine -chlorpromazine/Thorazine -promethazine/Phenergan -metoclopramide/Reglan |
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Besides drugs, what are some other dx/dx for DDR?
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-partial seizures
-lyte imbalanc -psychosis -tetanus -stychnine poisoning |
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What drugs can you give for DDR IV?
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-benztropine/Cogentin 1-2mg
-diphenhydramine/Benadryl 25-50mg -dystonia should improve in 2 minutes and abate w/in 10-15 minutes |
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What is the peds Benztropine/Cogentin dose for DDR?
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0.01-0.02 mg/kg IV/IM/IO for those 3 y/o and up
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For DDR you only procede with a diagnostic workup only when?
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there is no improvement after tx
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When should Cogentin or Benadryl be prescribed for 24-72 to prevent a DDR relapse?
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when pt is on a long acting neuroleptic agent
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WHat drug do you not want to use for the tx of DDR?
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Diazepam or Valium because it will not be helpful for dx
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For a Vasovagal Syncope (VVS) there is initially a period of what?
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increased sympathetic tone with increased pulse and BP
-also a sense of warmth, flushing, nausea, diaphoresis, weakness and anticipation of impending LOC |
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What happens in the 2nd phase of VVS?
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-there is a precipitous drop in symphathetic tone, and an increase in parasympathetic tone
-peripheral vasodilation -bradycardia -hypotension -loss of postural tone, LOC, and pt falls |
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What a some things that a witness will see in a VVS?
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-transient bradycardia
-monoclonic jerks or tonic spasms -spontaneous recovery w/in 30 seconds |
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WHat are some signs that are NOT suggestive of VVS?
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-sustained seizures, or sequelle
-incontinence -tongue biting |
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WHat are some precipitating factors that can cause VVS?
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-phlebotomy
-painful stimuli -emotional stress -prolonged standing -dehydration/diarrhea -valsalva during cough, micturation, or defecation |
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What are some typical prodromal symptoms of benign VVS?
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-lightheadedness
-nausea -diaphoresis |
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WHat are some nontypical prodromal sympotms that suggest a more malignant cause of syncope?
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-collapse w/out warning
-seizure activity -postictal confusion -focal neurologic symptoms or HA -CP, SOB, palpitations -orthostatic symptoms -hemorrhage -new medications |
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What things do you want to get out of a medical history of a VVS pt?
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-previous syncopal episodes
-underlying cardiac disease -risk factors for CAD, ACS -previous CVA, TIA -Hx of GI hemorrhage -Hx of psychiatric illness |
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What medications do you want to pay close attention to when assessing meds that could cause VVS?
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Medications that could cause:
-hemorrhage -osrthostasis -hypotension -bradycardia -arrhythmias -QT prolonation |
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What family hx do you want to get when assessing a VVS pt?
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-hx of benign fainting
-hx of sudden cardiac death -hx of long QT syndrome |
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An EKG should be done on what pts that present with VVS?
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virtually all pts except for obviously healthy young pts
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When is cardiac done in VVS pts?
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if no clear cause of syncope is found
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When would you do a H/H and stool for OB for a VVS pt?
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if suspect acute blood loss
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What test for VVS do you run in childbearing aged women?
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B-hCG
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When would you admit a VVS pt to the hospital?
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-hx or evidence of CAD, CHF, VHD, or arrhythmias
-CP or anginal equivalents -EKG findings of eschemia, arrythmias, prolonged QT, or BBB -FHx of sudden cardiac death -low Hct (<30%) -systolic BP < 90 |
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For VVS you don't obtain routine labs unless what?
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there are abnormalitites in the H and P
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For VVS you don't get a head CT unless what?
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there are:
-seizures -focal neurologic findings -evidence of ICM or hemorrhage |
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For VVS, you don't send for EEG unless what?
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there were witnessed tonic-clonic movements or potictal confusion
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For VVS, you don't discharge a pt with hx or evidence of what?
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-CVD
-focal neurologic disease -EKG abnormalities |
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When would you refer a VVS pt for a Tilt-Table Test?
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when the pt has obvious VVS without an obvious cause
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Don't attempt to arrouse a VVS pt with the use of what?
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ammonia capsules, slapping, or cold water
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What is Vertigo?
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the illusion of motion, either of the pts or of the pts surroundings
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The most important determination to make in vertigo is to do what?
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determine whether vertigo is Peripheral (Benign) or Central (more serious)
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Vertigo may be caused by a disorder where?
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anywhere in the vestibular system IE the inner ear, vestivular nerve, brainstem and cerebellum
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Balance and stability require the intactness of 2 of the 3 mechanisms. What are those 3 mechanisms?
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-vision
-proprioception -vestibular system |
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True Vertigo is usually occompanied by what things?
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-nystagmus if caused by inner ear disease
-nausea -vomiting |
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If a person with vertigo has neurologic symptoms such as diplopia, visual defects, or unilateral paresis/parasthesias you want to consider what dx?
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-TIA
-vertebrobasilar insufficiency (VBI) |
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If there is syncope or orthostatic changes in vertigo, what things do you want to consider?
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-CVD
-CAD -cardiac dysrhythmias -blood loss -medications |
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If in vertigo there is dysequillibrium or unsteadiness, what dx do you want to consider?
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diabetic peripheral neuropathy
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What are some causes of peripheral/benign vertigo?
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-BPPV
-vestibular neuronotis -labrinthitis -Meniere's disease -acoustic neuroma |
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What is the most common form of peripheral vertigo?
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vestibular vertigo
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50% of the time, vestibular neuronitis is preceded by what?
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common cold
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Vestibular neuronitis can also be caused by a reactivated dormant what?
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herpes virus affecting the vestibular nerve
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Viral labyrinthitis is vertigo accompanied by what?
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hearing changes
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When do you want to consider Acoustic neuroma in a vertigo pt?
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if vertigo has been gradual, chronic, and mild
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How does an acoustic neuroma typically present?
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usually not with vertigo but with progressive unilateral loss of hearing and of auditory discrimination
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What is the MCC of vertigo in the elderly?
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BPPV
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BPPV is believed to be caused by what?
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displaced canaliths
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What is used to dx BPPV?
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Dix-Hallpike maneuver
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What maneuver can be used to tx BPPV?
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Epley's
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What are some Central (more serious) causes of vertigo?
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-drugs
-MS -vertebrobasilar artery insufficiency -cerebellar mass or stroke -temporal lobe epilepsy |
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What are some drugs that are associated with Central causes of vertigo?
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-ETOH
-tobacco -aminoglycosides -benzodiazopines -ASA -NSAIDS -CO |
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What population are more likely to have vertebrobasilar artery insufficiency, TIA or Cerebellar mass os stroke?
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thos older than 50
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WHat are some CN and/or Cerebellar signs of vertebrobasilar artery insufficiency, TIA, cerebellar mass or stroke?
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-diplopia
-ataxia -sensory or motor deficits |
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What are some S/S of peripheral vertigo?
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-onset is sudden, in minutes to hrs
-severe intensity -N/V common and often severe -any age, but mostly young -movement exacerbates symptoms -symptoms intermittent -nystagmus worse w/head movement and fatigue -NO CN or cerebellar signs -hearing often decreased unilaterally with tinnitis |
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What are some S/S of Central vertigo?
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-gradual onset, weeks to months
-mild to moderate intensity -nausea & vomiting often absent -usually elderly -symptoms unrelated to movement -symptoms continuous -nystagmus does not fatigue or abate -CN and or cerebellar signs present -usually no auditory symptoms |
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What does a work-up of central vertigo include if you suspect cerebellar hemorrhage, skull fracture, or acute CNS event??
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-head CT w/out contrast
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When would you do a head MRI for central vertigo?
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you suspect CNS neoplasm
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What is the Rx for vestibular neuronitis or Labrinthinitis inpatient?
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-Atropine 0.5-1 mg IV
-Compazine, Zofran for persistant N/V |
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WHat is the outpatient Rx options for Vestibular Neuronitis or Labrinthitis?
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-transdermal Scopalamine (topical)
-meclizine (Antiver) 12.5-25 mg QID PO -perdnisone (Medrol dose pack) |
