10 10, 2013

Treating Ischemic Stroke with tPA in the ED: Time is Brain

2016-11-11T19:04:15+00:00

October 10th, 2013 | Critical Care/ Resus, Expert Peer Reviewed (Clinical), Neurology |5 Comments

By: Todd A. Seigel, MD

Ischemic stroke is an emergent and devastating neurologic disorder, and is a leading cause of both death and disability in the United States. With each minute of brain ischemia, two million neurons are irreversibly damaged. Total ischemic time is linked to functional outcome, and therefore, the role of the Emergency Department is paramount in the management of these patients. Fibrinolytic therapy has become a mainstay of therapy for acute stroke, but guidelines for the use of tPA are dynamic, and often even controversial. When you identify someone with symptoms of stroke, what is your approach to determining if a patient should receive tPA?

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8 08, 2013

Pediatric febrile seizure: When do I need to do a lumbar puncture?

2016-11-11T19:02:46+00:00

August 8th, 2013 | Neurology, Pediatrics |6 Comments

By: Steven Bin, MD

You are in the ED when a 7 month old is brought in by EMS after a witnessed generalized seizure. The grandmother reports that the child has had URI symptoms for a couple of days and then developed a fever today. Shortly after giving ibuprofen, the child began to seize with arms and legs twitching. The episode lasted approximately 8 minutes and when EMS arrived, the child was sleepy, but arousable. The glucose was 92 mg/dL en route. On exam in the ED, child is awake and staring at you to make the next move…

Vitals: Temp 39C, P 136, RR 28, Sat 100%

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1 08, 2013

A time-based approach to elderly patients with altered mental status

2016-11-11T19:52:23+00:00

August 1st, 2013 | Expert Peer Reviewed (Clinical), Geriatrics, Neurology |3 Comments

By: Christina Shenvi, MD PhD

It’s 7 am on a Monday. Your first patient is an 82 year-old woman who was brought in by EMS from an assisted living facility. All EMS can tell you is that she was not acting herself. You enter her room and introduce yourself. “Hello Mrs. Jones. How are you today?” The woman startles, “Well, you see, I went to put my dog out, and then I was just walking, and couldn’t remember. So it’s all coming full circle, and then I ate a sandwich.” Just then EMS rolls in with another patient, a 75 year-old male coming from home, who was found by his wife in his recliner minimally responsive, with a GCS of 6. He is followed by a 76 year-old female who had a fall from standing three days ago, and has been increasingly confused today, and is currently oriented only to person.

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15 07, 2013

Emergency Neurological Life Support (ENLS) course

2017-03-05T14:18:34+00:00

July 15th, 2013 | Neurology, Social Media & Tech |0 Comments

By: Fred Wu, MHS, PA-C

Emergency Neurological Life Support (ENLS) is a new online course that I am taking. It is sponsored by the NeuroCritical Care Society, which focuses on the first few hours of care to neurological emergencies. It is a collaborative effort between emergency physicians and neurointensivists, both of which author each individual module. The course is co-chaired by Scott Weingart, MD of EMCrit fame and is geared towards anyone who treats neurological emergencies (physicians, nurses, PA/NP, EMS personnel). The course utilizes technology to deliver its content by podcast, video presentation of ENLS guidelines, online reading of published guidelines and an online quiz. Completion of all modules awards the participant a certificate of certification in ENLS as well as 15 hours of CME. (more…)

25 05, 2013

On the Horizon: Propofol for Migraines

2016-11-11T18:37:24+00:00

May 25th, 2013 | Neurology, Tox & Medications |7 Comments

By: Zlatan Coralic, PharmD

Propofol for the treatment of migraines in the ED might be on the horizon. This will possibly be a new practice in emergency medicine, although it has been known for some time. Propofol, when given at procedural sedation doses, seems to miraculously terminate migraines refractory to usual treatment. Patients awake with minimal to no headache and may be discharged from the ED much quicker than traditional treatment with possibly less side effects. The proposed mechanism of action is described in below papers, but in short, propofol seems to “reboot” the brain and terminate the migraine.

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23 05, 2013

PV Card: Contraindications to Thrombolytics in Stroke

2017-03-05T14:14:29+00:00

May 23rd, 2013 | Neurology, PV Card, Tox & Medications |1 Comment

By: Michelle Lin, MD

This Paucis Verbis (PV) card is an updated version of the PV card on Contraindications to Thrombolytics for CVA from September 10, 2010, based on the Stroke 2013 AHA/ASA new guidelines that were just published.¹ Some changes include…

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16 04, 2013

Trick of the Trade: Rapid Oral Phenytoin Loading in the ED

2016-11-11T18:38:51+00:00

April 16th, 2013 | Neurology, Tox & Medications, Tricks of the Trade |10 Comments

By: Bryan D. Hayes, PharmD, FAACT, FASHP

A 57 y/o, 75 kg male presents to the ED after a witnessed seizure. He describes a history of seizure disorder and is prescribed phenytoin, but recently ran out. A level is sent and, not surprisingly, results as < 3 mcg/mL (negative). After a complete ED workup, the decision is made to ‘load’ him with phenytoin 1 gm and discharge him with a prescription to resume phenytoin. An IV was not placed.

Can you rapidly load him orally?

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