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51 Cards in this Set
- Front
- Back
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What are indications for CT scan of head (non-enhanced)? |
GCS of 12-14 Decreasing LOCATION Focal Neurological Symptoms Potential skull fracture Increasing or persistent severe headache with N/V Seizures post injury Alcohol intoxication Amnesia post injury |
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What are TBI: diagnostics? |
Neck AP & lateral x-ray of c-spine Drug screen or alcohol level |
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When do hospitalize a patient for a traumatic brain injury? |
Altered LOC Focal neuro deficits: paralysis, paresthesia Post injury seizure Persistent headache, N/V CT abnormal Skull fracture: Lack of responsible person at home to observe |
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When do you avoid doing a CT of head? |
No loss of consciousness No amnesia No focal/ neurological signs |
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What should be monitored every 2 hours for the first 24 hours for a person with a traumatic brain injury? |
Test orientation Test strength Check pupils |
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What medications should be avoided with traumatic brain injury for one week? |
Aspirin Alcohol Narcotics |
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What post concussion syndrome symptoms must be taught? |
They can last weeks to 1 to 2 years: Headache Tinnitus Memory loss Dizziness Poor concentration Irritability Disturbed sleep |
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Red flag: yes or no? Worse headache of my life, personality change, change in headache type or pattern, onset progressively worse and over age 50 |
Yes |
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If headache has: asymmetry of pupils or papilledema, decreased deep tendon reflexes, stiff neck, fever, malaise, N/V, aphasia, weakness, poor coordination, painful temporal arteries, what should you think? |
Red flag |
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What must be included in a physical exam for a headache? |
VS, mental status, head, neck, sinuses, TMJ, neuro: CN (PERRLA, EOM, fundi), tandem gait (heel to toe), tiptoes & heels, romberg test, symmetry on: motor, sensory, DTRS, coordination |
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What labwork diagnostics should be done for a headache? |
CBC, CMP, TSH, Sed rate r/o temporal arteritis, Lyme titer, rheumatoid factor |
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When should a non-enhanced CT scan or MRI be obtained for a headache? |
Worst headache Focal neuro findings Nucal rigidity Altered mental status HA with exertion, cough, or sexual activity |
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What are medications that are considered abortive therapy (reduction of duration & intensity of pain) for headaches?
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5HT receptor constrictors Sumatriptan (Imitrex ) Zolmitiptan (Zomig) Naratriptan (Amerge) Rizatriptan (Maxalt) Almotriptan (Axert) Frovatriptan (Frova) Eletriptan (Relpax) |
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When are triptans contraindicated and why?
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HTN, MI, CAD because they are arterial constrictors and they can cause flushing, chest tightness |
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What are Ergot derivatives in headache abortive therapy?
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Dihydroergotamine (D.H.E. 45) IV or IM (Migranal) nasal Ergotamine/ caffeine (Cafergort) |
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What are analgesics in headache abortive therapy?
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Tylenol, NSAIDs Caffeine combinations, Excedrin |
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What are narcotic analgesics in headache abortive therapy?
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Butorphanol (Stadol) Butalbital combination (Fioricet, Fiorinal) |
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What are anti-emetics in headache abortive therapy?
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Metoclopramide (Reglan) Prochlorperazine (Compazine) Promethazine (Phenergan) |
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When do analgesic rebound headaches occur?
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Regular use for >3 months of 1 or more drugs taken for acute or symptomatic treatment of headaches headache is worse during medication overuse |
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What can be done to correct analgesia rebound headaches or prevent the occurrence?
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Limit analgesic use to 2 days per week or less
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What is the treatment plan for tension headaches?
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OTC analgesics Triptan agents Muscle relaxants Ice/Heat >identify and avoid triggers |
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What is the treatment plan for cluster headaches?
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Oxygen 7L/min via non-rebreather mask First choice: verapamil or lithium Triptans: Sumatriptan (Imitrex) 6mg SQ or intranasal 20mg; may repeat dose in 2 hours Zolmitriptan (Zomig) |
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What is the indication for preventative therapy for headaches?
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>4 / month prolonged attacks refractory to other treatment |
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Which anti-seizure meds may be given daily to decrease headache intensity and frequency?
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Divalproex sodium (Depakote) Topiramate (Topamax) Gabapentin (Neurontin) |
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Which anti-depressant meds may be given daily to decrease headache intensity and frequency?
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*Tricyclic Antidepressants: Amitriptyline (Elavil) Nortripyline (Pamelor) *SSRI: Zoloft |
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Which anti-hypertensive meds may be given daily to decrease headache intensity and frequency?
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*Beta-blockers: Propranolol (Inderal) *Calcium Channel Blockers: Diltiazem (Cardizem) Amlodipine (Norvasc) |
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What medications cause orthostatic hypotension?
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Nitrates Vasodilators Beta Blockers Analgesic Anti-Parkinson Anti-depressants |
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In the components of a vertigo examination (Cardiac & Neuro) what should be done?
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Check VS, orthostatic BP Heart sounds Carotid Bruit Vision / Hearing EOM - check for nystagmus Gait, Romberg Induce dizziness - vertigo positioning, Valsalva |
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What diagnostics are done of vertigo is caused by suspected vestibular disorders?
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Audiogram CT scan / MRI of brain MRI angiography Vestibular testing (electronystagmography, rotational testing, posturography) |
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What diagnostics are done of vertigo is caused by suspected cardiac disorders?
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EKG 24 hr holter monitor Exercise stress test Carotid ultrasound |
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What labwork is done for vertigo diagnostics?
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Glucose, metabolic panel, CBC, TSH, vitamin B12 level, VDRL/RPR
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What are the differential diagnoses for vertigo?
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peripheral central syncope disequilibrium |
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When would a patient be admitted for vertigo or dizziness?
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cardiovascular disease EKG changes chest pain >70 years |
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What should be prescribed for acute vertigo?
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antiemetic: promethazine (Phenergan) prochlorperazine (compazine) vestibular sedative: meclizine (antivert) |
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What should be prescribed for chronic vertigo?
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vestibular rehabilitation- PT referral clonazepam (klonopin) carbamazepine (tegeretol) |
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What should be prescribed for Meniere's diease vertigo?
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HCTZ/triamterene (diazide)
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What is the preferred diagnostic for a stroke?
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non-contrast CT head abnormal = hemorrhagic normal = ischemic, first then abnormal in 12 hr |
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What labwork should be done for a suspected stroke?
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CBC w/ diff, PT/INR, PTT, Lytes, BUN, Cr, Glucose, Lipid profile, Toxicology screen, Fibrinogen, Sed rate,
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Other than a CT head (non-contrast) for a suspected stroke, what other diagnostics should be done?
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EKG pulse ox Carotid ultrasound r/o carotid stenosis EEG r/o seizures Lumbar puncture r/o infection |
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What is plan for BP management after a stroke?
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>220 / >120 gradual BP reduction labetalol or lisinopril |
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Who do you refer to after a stroke occurs?
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hemorrhagic - neurosurgeon ischemic - neurology PT, OT, speech therapy |
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How quickly should tPA be administered?
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3 to 4.5 hour window DO NOT GIVE IF BLEEDING |
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What are preventative meds offered for stroke risk reduction?
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Antiplatelet (ASA, warfarin, Plavix, ticlid) [indications: prevent embolism, LV congestion, valve patency] |
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What are lifestyle modifications offered for stroke risk reduction?
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control BP tight glycemic control stop smoking diet / exercise: reduce obesity/hypercholesterolemia |
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What should be done during the physical examination assessment for Bell's Palsy? |
check cranial nerves corneal reflex check ear canal for lesions / vesicles photograph for facial muscles |
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What labwork should be done for Bell's Palsy?
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**Lyme titer CBC w/ diff, TSH, glucose, pregnancy test, ESR (sed rate) |
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What diagnostics should be done for Bell's Palsy?
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MRI with gadolinium to visualize facial nerve Referral to specialist for: EMG, Nerve conduction velocity studies, Audiology studies |
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What measures should be taken to protect the eye with Bell's Palsy?
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prevent exposure keratitis --> blindness moisture: methylcellulose gtt lacri-lube ointment patch or tape to keep eye closed at night refer to ophthalmology |
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What medications should be prescribed for Bell's Palsy management?
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prednisone 60-80mg/day for 1 week then taper acyclovir, valacyclovir, famcyclovir 85% recover spontaneously in 4-6 weeks |
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What are diagnostics for trigeminal neuralgia?
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autoimmune labs MRI r/o Multiple sclerosis or mass MRA of posterior fossa r/o vascular abnormalities |
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What is the treatment plan for trigeminal neuralgia?
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Carbamazepine (Tegretol) 1st choice Oxycarbazepine (trileptal)Secondary:Gabapentin (Neurontin)Divalproex (Depakote)Clonazepam (Klonopin)Lamotrigine (Lamictal)Side effect education: Rash r/o Steven's Johnson syndrome, sedation Referral to Neurologist
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