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Transcript coming soon!
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Episode summary coming soon!
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Critical Actions:
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Orbital Compartment Syndrome – needs to be diagnosed CLINICALLY
On exam, LOOK for: Proptosis, Ophthalmoplegia, Afferent Pupillary Defect, Vision Loss
On exam, FEEL for: Rock hard globe, tense eyelids, resistance to retropulsion
IOP > 40 means immediate canthotomy is indicated!
Don’t perform if open globe is present
Lateral Canthotomy Procedure: Anesthetize, Devascularize, Canthotomy, Cantholysis (inferior crus first)
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Symptoms of stroke – weakness, facial droop, slurred speech. vision loss, vertigo, ataxia, confusion or changes to mental status.
The “typical” stroke workup – blood glucose level, CTH non-con, CTA head/neck, CT Perfusion, CBC BMP Troponin EKG CXR and Coags.
Common stroke mimics – hypoglycemia, drug/alcohol intoxication, Bell’s palsy, aortic dissection, complex migraines, and seizure with Todd’s paralysis.
Management/treatment – thrombolytics (within 4.5 hrs), thrombectomy (within 24 hrs) , and blood pressure control (<185/110 if treating, <220/120 if no treatment).
Remember that time is brain, so move fast!
AHA Stroke – “Getting the Gist Across Is Enough for Informed Consent for Acute Stroke Thrombolytics”
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Phase One: CNS
Phase Two: Cardiopulmonary
Phase Three: Renal
Diagnosis:
Treatment:
Further Reading:
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Hypertensive Emergencies of Pregnancy
PreEclampsia, Eclampsia, HELLP syndrome
Diagnosis: BP >140/90 plus end organ dysfunction
Treatment
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Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion
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The 6 STEMI Equivalents:
Other atypical ischemic EKG findings:
Further Reading (see photos in the article):
ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of Cardiology
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Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.
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Indications for LP: CNS infection, SAH, Guillian Barree, IIH
Contraindications for LP: Space occupying lesion with mass effect ; severe thrombocytopenia and coagulopathy; cellulitis over LP site or concern for epidural abscess ; traumatic injury to spine
Complications for LP: Post LP Headache, spinal hematoma, brainstem herniation
Technique for LP: Positioning is everything. Use US if necessary. Check for CSF early and often.
When to CT before LP?: AMS; focal neuro deficit; new onset seizures, known CNS lesions; immunosuppression; papilledema
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Obtain IV Access – get two large bore IVs (18g or larger)
Resuscitate – un-crossmatched blood at first, don’t forget type and screen!
Medicate – Give Pantoprazole always, Octreotide and Ceftriaxone if hx liver disease, reverse anticoagulation if indicated
Imaging – Upright CXR to assess for perforation, CTA if concerned for lower GIB
Consult – GI if unstable / if variceal bleeding
Disposition – based on amount of bleeding and hemodynamic stability
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You are working at Clerkship General when the charge nurse grabs you – “hey we got a real sick one, a 57yo Male who I just put in the resuscitation bay, he is vomiting blood”.
Initial Vitals:
BP: 77/34
HR: 135
RR: 24
O2%: 95%
Temp: 98.8F
Critical Actions:
Further Reading: EMDocs – GI Bleed
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Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta
Further Reading:
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You are working at Clerkship General when the base command phone rings –
“Hey doc just wanted to give you a heads up on this stroke alert we’re bringing you – we have a 70yo M with sudden onset left arm numbness and weakness, last known well 2 hours ago, we’ll be there in about 5 minutes”
Initial Vital Signs:
HR 120
BP 180/90
RR 22
O2 97%
Temp 97.7F
Critical Actions:
1. Check a blood glucose
2. Diagnose Aortic Dissection
3. Give Esmolol first, titrate to HR<60
4. Give Nicardipine/Clevidipine second, titrate for SBP 100-120
5. Consult cardiothoracic surgery for type A dissection
Further Reading:
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Not your typical wellness episode – by Zack
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You are working at Clerkship General Hospital when EMS calls in a female with opioid overdose, but she won’t stop complaining of leg pain…
Initial Vitals:
Temp: 98
BP: 120/80
HR: 89
RR: 20
O2 Sat: 100%
Critical Actions:
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