Podcast: Play in new window | Download

Stroke
  • Most appropriate initial tests
    • Blood Glucose
      • Hypoglycemia is a common stroke mimic
    • CT Head without contrast
      • Rules out HEMORRHAGIC strokes
Subarachnoid Hemorrhage
  • Classic description
    • “Worst headache of life”
    • “Sudden and maximal in onset”
    • “Thunderclap”
  • Testing
    • CT Head without contrast
    • (If negative CT) Lumbar puncture
      • Xanthochromia (yellowish fluid)
  • Treatment
    • Nimodipine (Given orally)
      • Prevents vasospasm
Causes of Stroke in Young People
  • Cervical artery dissection
  • Vasospasm
  • Vasculitis
  • Sickle Cell Disease
Meningitis
  • Treatment
    • Vancomycin, Ceftriaxone
    • Add ampicillin (covers listeria) in very young/old
    • Rifampin prophylaxis for close contacts (if patient has petechial rash)
      • Neisseria Meningitidis
HSV Encephalitis
  • Classic symptoms
    • Fevers
    • Headache
    • Altered Mental Status
    • Seizures
  • Treat with acyclovir
Altered Mental Status
  • The two most common causes on your test
    • Hypoglycemia
    • Infections (Especially in elderly)
      • Aka Delirium
Fat embolism
  • Trauma PLUS petechial rash
  • Common with long bone fracture
Schaphoid Fracture
  • Exam shows tenderness over anatomic “snuffbox”
  • Notorious for being missed on X-ray
    • High risk of osteonecrosis
  • If suspicious, place patient in thumb spica splint regardless of X-ray findings
    • Outpatient followup 1-2 weeks for repeat xray
Pericarditis
  • Patient complains of chest pain that is…
    • Sharp
    • Positional
    • Worse when laying flat
  • Friction rub on exam
  • EKG Findings
    • Diffuse ST segment elevation
    • Diffuse PR depression
  • Treat with NSAIDS
Kawasaki’s Disease
  • Mnemonic: CRASH and Burn
    • Conjunctivitis
    • Rash
    • Adenopathy
    • Strawberry Tongue
    • Hands/Feet Swelling
    • Burn = Fever for 5 days
  • Treat with aspirin

Burns

  • Parkland formula
    • Weight (kg) x BSA (%) x 4 = Volume of fluid needed in first 24 hours
    • Give half over first 8 hours
  • Rule of 9s
    • Estimates % Body surface area burned

Vascular Injury

  • Hard Signs
    • If present patient needs OR
    • Mnemonic: ABCDE
      • Active pulsatile hemorrhage
      • Bruit
      • Cerebral ischemia
      • Diminished Distal pulses
      • Expanding Hematoma
Infectious Disease Pearls
  • Gram positive cocci in CLUSTERS
    • Staphylococcus Aureus
  • Gram positive cocci in CHAINS
    • Streptococcus Pneumoniae
Additional Reading