- Pres syndrome
Diagnosis of exclusion
Keep in your differential
Treat for hypertension, consider MRI
- MS
3 associated conditions – INO, optic neuritis, dysautonomia
- Spinal cord syndromes
Anterior cord – hyperflexion
Central cord – hyperextension, elderly
Brown sequard – stab in the back classic
- Transverse myelitis
Bilateral, highly associated with MS
High dose steroids and plasma exchange
- NMJ disorder
Botulism – presynaptic acetylcholine receptor
Myasthenia gravis – post synaptic acetylcholine receptor
Lambert Eaton -presynaptic ca channel
NIF is the negative inspiratory force, strength of inhale. 0- -20 is weak, needs intubation
- GBS
Steroids worsen mortality
Ascending weakness
Miller fisher variant
Albuminocytologic disassociation
- Bell’s palsy
Peripheral cause of facial weakness
Does not spare the forehead
Steroids
Acyclovir if presents within time frame
Artificial tears
- Ramsey hunt syndrome
Zoster
Vesicles of the ear
Steroids
Acyclovir
- Bilateral Bell’s palsy – Lyme disease
- Lumbar puncture
Contraindications – Cellulitis, Fracture, Epidural abscess
Platelet must be atleast 50k
Head CT before LP , r/o increased icp
L3-4 or l4-5
20 gauge is good, decreased spinal headache
Traumatic and larger needles have higher chance of LP headache
Lateral decubitus position (if you want pressure) versus sitting position
- LP headache
- need fluids
- Worse with standing or position changes
- Blood patch if refractory
- Worse with standing or position changes
- need fluids
- Multiple Sclerosis
Demyelinating CNS disease
INO
Optic neuritis – pulfrich test (feels something is coming at them when its not), red saturation test (changes to pink on affected eye)
MRI gold standard
Oligoclonal bands in CSF highy suggestive of MS
High dose steroids is treatment
- Posterior rib fractures in child should raise suspicion for fracture
- WPW
Short PR
Delta Wave
SVT is high yield test question, will need procaimaide If wider QRS
- Wellens Syndrome
Bipashic T wave in anterior leads
Chest pain usually resolved
Needs urgent catheterization
- Brugada
Needs AICD
Downsloping ST segment
- AAA
Typically infrarenal
When ruptured – need blood, but allow for permissive hypotension – call for your aorta team
- Heart blocks
Mobitz Type II and 3rd degree block need AICD/pacer
- SVT
Vagal maneuver —> Adenosine (6, 12, 12) if hemodynamically stable
If unstable, synchronized cardioversion
- Lefort fractures
3 types
Type III may have CSF rhinorrhea
Avoid NG tube placement
- Chest tube output for OR indication
1500cc of output right away (~20cc/kg)
200 cc an hour for 3 hours (~3 cc/kg)
- Boorhave syndrome
Hammans crunch
Massive vomiting or iatrogenic (most common)
Broad spectrum antibiotics
- Button battery needs emergent endoscopy if in esophagus
- Rectal prolapse
Slow, steady pressure
Sugar as pre treatment
Avoid if toxic appearing or nectroic appearing
- Trachinominate fistula
First attempt to overinflate the cuff
Next try manually compressing against the sternum through the trash
- PE
Most common sign is tachypnea
Most common symptom is dyspnea
Most common EKG finding is sinus tachycardia
Most specific finding on EKG Is S1Q3T3, T wave inversions in the anterior leads
- Status Epilepticus
Benzo first
Midazolam (can be given IM or intransal (great option for patient who doesn’t have access))
Lorazepam, Diazepam
Keppra (40-60 mg/kg IV. (Max dose of 4500 mg)), Fosphenytoin
Lacosamide or Valproic acid
Fosphenytoin and Valproic acid cannot be used together
Intubate with Propofol, Ketamine, or Versed as induction agents as these have anti-epileptic properties
Need continuous EEG to r/o subclinical seizures and further monitoring
GOODLUCK on ITE
I discovered your blog website on google and check just a few of your early posts. Continue to keep up the very good operate. I simply additional up your RSS feed to my MSN News Reader. Searching for ahead to reading more from you later on!?
You could certainly see your enthusiasm in the work you write. The world hopes for more passionate writers like you who are not afraid to say how they believe. Always follow your heart.