Patients presenting to the ED with migraine pain can often present a challenge in terms of pain control. For patients who have pain refractory to NSAIDs, IV fluids, and migraine abortive therapies, or those who would prefer not to receive a…
In 2016, ACEP published “Clinical Policy: Critical Issues in the Evaluation of Adult Patients with Suspected Transient Ischemic Attack (TIA) in the Emergency Department” in the Annals of EM. Here is a brief refresher. Transient ischemic att…
Does it matter if my patient getting tPA is on prestroke antiplatelets? The neurology and ED teams have decided to give tissue plasminogen activator (tPA). As an outpatient, the patient is on aspirin and clopidogrel dual antiplatelet…
Traumatic Brain Injury & Neurocritical Care You’ve just intubated your traumatic brain injury patient and the repeat pupil exam shows signs of herniation. In addition to your other interventions (e.g., Reverse Trendelenburg positioning,…
“Nobody travels on the road to success without a puncture or two.” -Navjot Singh Sidhu Ultrasound can assist in determining the best site for lumbar puncture. Here is how to do it! 1. Palpate for the superior iliac…
Intubating a patient with a suspected head bleed is one of the highest risk situations we encounter as ED physicians. A failed attempt with enough airway manipulation can potentially increase ICP and have profound negative effects on patien…
A diver shows up to your trauma bay in a c-collar and with complete motor paralysis of legs, torso, hands and weakness of shoulder muscles. He has no sensation to pain or temperature below his clavicles. His proprioception is intact. Which…
Status epilepticus is one of the few neurologic emergencies. Many protocols for persistent status involve dosing with a benzodiazepine, then another benzo, then an antiepileptic medication, and finally, continuous sedation with intubation….
Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency…
One of your patients arrived with stroke and was treated with tPA. On reevaluation the patient reports a new severe headache and then becomes lethargic. What should you do?
32 yo overweight female presents with a headache. This headache is similar to prior headaches, which she gets frequently. The rest of her story seems consistent with a migraine and her physical exam, including a through neuro exam, is nor…
69 yo M with remote h/o CVA with residual aphasia and R–sided hemiparesis, BIBEMS from NH with concern for status epilepticus (SE). Per EMS, the patient began to have 3-4 episodes of generalized convulsive activity that began about 30 minut…
A 60 year-old male patient with a history of hypertension is BIBEMS with his spouse two hours of sudden onset memory loss. She noticed he began asking her if she wanted coffee every 3 or 4 minutes, apparently not remembering he had already…
Question: -In acute stroke, does the addition of intra-arterial management improve outcomes compared to usual care? Methodes: -Multicenter, randomized, open-label (but blinded end points) in the Netherlands. 502 patients in 16 centers. -Co…
@JoePinero 50 yo M hx of NIDDM, recent left shoulder surgery x 4 mo ago for rotator cuff tear, currently presenting with left arm pain from shoulder to hand with swelling and tightness of the left hand and fingers. Exam: Well-appearing male…
