Emergency Medicine Topics

Terms in this set (257)

-Any vascular injury that reduces cerebral blood flow to a specific area of the brain
-Ischemic (MC): occlusion of cerebral vessels
-Hemorrhagic: neuro impairment d/t rupture of a blood vessel
-Risk factors: atherosclerosis (MCC), HTN, HLD, vasculitis, DM, smoking, cocaine use
-PE: HTN, bradycardia, abnormal breathing, do fundoscopic exam, neuro exam will help localize lesion
--MCA (MC): contralateral weakness and numbness of arms > legs, aphasia
--ACA: contralateral weakness of legs > arms
--PCA: diplopia, sensory changes, subtle presentations like dizziness
--Vertebrobasilar artery: syncope, weakness, CN changes
-Diagnosis: CBC, lytes, cardiac markers, coags, u/a, CXR, EKG for Afib, CT to differentiate hemorrhagic vs. ischemic but may be negative in ischemic strokes for 12 hours, CTA is becoming more common, MRI for subtle ischemic infarcts
-Ischemic tx:: determine time of onset, STAT brain imaging, ABCs with supplemental oxygen, serum glucose control, temp control, call stroke team/neuro consult, do BP control, tPA therapy for ischemic
-Contraindications for tPA: SBP > 180, hx of hemorrhagic stroke, any stroke w/in the past year, suspected aortic dissection, active bleeding

-Hemorrhagic tx: ABCs, early intubation, treat SBP > 160 and DBP > 105. Treat with nitroprusside, labetalol, or nicardipine, control seizures (25% will seize) with lorazepam followed by fosphenytoin, glucose control, prompt neurosurgical evaluation. Anti platelet therapy for ischemic strokes, anticoagulation for embolic strokes, stop smoking, strict HTN control, control HLD and DM