New to Meducation?
Sign up
Already signed up? Log In

Category

Preview
0
19

Emergency Medicine Literature of Note: The Case of the Bloody Lumbar Punctures

Would welcome your thoughts on this article - Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343. Perry JJ, et al.many thanks, Chris  
emlitofnote.com
over 5 years ago
Preview
0
12

Pediatric Ataxia

Thanks to our own Ross Simcoe, MD for providing this case history   HPI A 12 yo male with pmhx of headaches presents with a headache that began 4 days  
jeffem.org
over 5 years ago
Preview
0
33

Podcast of the week: concussion – Don't Forget the Bubbles

Ken Milne and Anthony Crocco discuss paediatric concussion. How long should patients rest up at home before returning to their normal activities? And can IV hypertonic saline help relieve a concussion-related headache?  
dontforgetthebubbles.com
over 5 years ago
Preview
1
29

Briefs: Migraine management meets magnesium

Migraines are a common sight during any shift in the ED. I have written about them before, and the benefits of antiemetics and depakote are reasonably well documented. A treatment for refractory headaches that seems to be gaining favor recently is IV magnesium. You may be familiar with Mag and its use in asthma exacerbation, or (gasp) preeclampsia – but emerging evidence suggests that magnesium may help with migraines as well.  
pemcincinnati.com
over 5 years ago
Preview
0
9

SGEM#41: Ultra Spinal Tap (Ultrasound Guided Lumbar Puncture)

Case Scenario: A 66YO man presents with a 48hr history of fever, lethargy and headache. No significant past medical history. On physical examination he has a temperature of 38.8C, GCS 15, stiff neck on flexion and no rash. Urinalysis and CXR are normal. Laboratory testing reports an elevated WBC with a left shift. You decide he needs a LP to check for meningitis.  
thesgem.com
over 5 years ago
8
0
16

Lab Case 56 – Interpretation

<10%  Background level in smoker 10%     mild H 20%     dizziness, N, dyspnoea, throbbing headache 30%     Vertigo, ataxia, visual disturbance 40%     confusion, coma, seizures, syncope 50%     CVS, Respiratory failure, arrhythmia, seizures, death  
emergucate.com
over 5 years ago
Preview
0
8

Approach to the pregnant patient with headache | EMBlog Mayo Clinic

Authors: Jessica Schoen, M.D., Ronna L. Campbell, M.D. and Annie T. Sadosty, M.D. Published in Western Journal of Emergency Medicine Cl…  
emblog.mayo.edu
over 5 years ago
5
3
196

Going to work in a different country? Different culture? Different language? Avoid getting tripped up as I did!

I grew up in Belgium and went to medical school in Louvain, Belgium. I came to the USA for my internship and selected a small hospital in upstate New York. What an initial culture shock that was! The first problem was the language. I knew enough "school" English to get by, or so I thought. Talking on the phone was the hardest. Initially, the nurses in the hospital thought that I was the most conscientious intern they had ever worked with. When I was on duty and the nurses called me on the phone at night, I would always go to the ward, look over the chart, see the patient and then write a note and orders, rather than just handle things over the phone like all the other interns did when called for rather minor matters. Little did the nurses realize that the reason I would get up in the middle of the night and physically go to the ward was due to the fact that I had no idea what they were talking about. I did not understand a word of what the nurses were telling or asking me on the telephone, especially not when they were using even common American abbreviations, like PRN, QID, LMP etc. [PRN (Latin) means as needed; QID (Latin) means four times a day and LMP means last menstrual period]. That problem rapidly resolved as I began to understand more and more of the English medical terms. However, there is a major difference between understanding day-to-day common English and grasping all the idioms and sayings. A rather amusing anecdote will illustrate that. About two months into my internship, I was on call at night when one of the nurses telephoned me in the early evening. A patient (Mrs X) was having a bad headache and wanted something for it. I was proud that I had understood the problem over the phone and was even more proud that I managed to order something for her headache without having to walk over to the ward. An hour or so later, the same nurse called me for the same patient because she had been constipated and wanted something for it. Again I understood and again I was able to prescribe a laxative over the phone without having to go to see the patient. A while later the same nurse called to let me know that Mrs X was agitated and wanted something for sleep. I understood again and prescribed a sleeping pill. Close to the 11pm shift change the same nurse called me once more: "Dr. LeMaire, I am so sorry to keep bothering you about Mrs X, but she is really a pain in the neck…" Immediately some horrible thought occurred to me. Here is a patient who has a bad headache, is constipated and agitated and now has a pain in her neck. These could all be symptoms of meningitis and here I have been ordering medications over the phone for a potentially serious condition. I broke out in a cold sweat and I told the nurse "I am coming." I ran over to the ward where that patient was hospitalized, went to her room and after introducing myself said "Mrs. X, the nurse tells me that you have a pain in your neck." The rest is history. The patient lodged a complaint about the nurse and me, but we both got off with a minor reprimand and in fact somewhat of a chuckle by the administrator handling the complaint. Such tripping up by the idioms and sayings can of course happen in any language. Be aware! Dr. William LeMaire  
DR William LeMaire
over 5 years ago
0
0
3

Lab Case 61

A 65 year old man presents to your ED complaining of general weakness, backache and headaches. He has recently arrived in the country from England.  
emergucate.com
over 5 years ago
Sinaiem dark
0
5

peek-through-the-orbit

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 normal.  However, you still feel concerned because she’s in the right demographic for idiopathic intracranial hypertension.  You think the optic disc looked okay, but if you’re anything like me you’re not super confident in that assessment.  What is another modality you could use to assess for increased intracranial pressure?  How good of a test is it?   
sinaiem.org
over 5 years ago
Preview
0
10

Headaches Health Rant

If you suffer from any type of headache, you definitely need to watch this and be sure to check out our full health talk videos for more detailed information...  
youtube.com
over 5 years ago
Www.bmj
0
13

Inadequate neurology services undermine patient care in the UK

“Neurology for the masses” announced The BMJ’s then editor, Richard Smith, in 1999.1 Old stereotypes may associate neurology with rare syndromes and a fondness for diagnosis not treatment, he went on, but it is also a specialty of common illnesses such as epilepsy and Parkinson’s disease. He might also have mentioned that neurological symptoms include some of the commonest complaints such as headache and fatigue. Sixteen years on and despite a doubling of consultants, a damning parliamentary report,2 thrombolysis for stroke, and an awareness of increasing neurodegenerative disease only people living in select areas, or able to travel, will encounter a neurologist. The Neurological Alliance, a patients’ organisation in England, reports that 31% of patients had to see their primary care doctor five or more times, and 40% waited more than 12 months with symptoms before seeing one.3 The UK is the only developed nation with this problem. We have one neurologist per 90 000 people4; the European average is one per 15 000,5 and in the United States concern has been expressed that one per 19 000 isn’t enough.6  
feeds.bmj.com
over 5 years ago
Preview
11
498

List of medical mnemonics - Wikipedia, the free encyclopedia

There are many mnemonics for the names of the cranial nerves, e.g. "OOOTTAFAGVSH" is "OLd OPen OCeans TROuble TRIbesmen ABout Fish VEnom Giving VArious ACute/SPlitting Headaches" (a mnemonic that gives enough letters to distinguish between nerves that start with the same letter), or "On old Olympus's towering tops, a Finn and German viewed some hops,"[11] and for the initial letters "OOOTTAFVGVAH" is "Oh, oh, oh, to touch and feel veronica's gooey v*g**a ... ah, heaven."[12] The differences between these depend on "acoustic" versus "vestibulocochlear" and "spinal-accessory" versus "accessory".  
en.wikipedia.org
about 5 years ago
Emlogomini 1
0
5

Emergency Medicine Literature of Note: Get on the Haloperidol Wagon

Bummer.There's at least one trial of olanzapine for undifferentiated headache in the ED, and it seems efficacious. I would wonder if it has some of the same effects as haloperidol and droperidol, but I'm not well-versed enough in its pharmacology to say.  
emlitofnote.com
about 5 years ago
6
0
16

Lab Case 65

A 61 year old female presents to your Emergency Department with 8 days of fevers and rigors which are worse at night. She also complains of headaches, nausea and generalised aches and pains. Her temperature has been as high as 39 degrees celsius at home.  
emergucate.com
about 5 years ago
Www.bmj
0
27

A dose of humility

Paracetamol has come in for a bit of a kicking in recent months (doi:10.1136/bmj.h1186). So we asked James Dear and colleagues to comment (doi:10.1136/bmj.h3705). They confirm that important questions about this most commonly used drug remain unanswered. The evidence of effectiveness is patchy and depends on the condition: it’s good for postoperative dental pain; okay for headache, though not as good as other analgesics; of small and probably clinically irrelevant benefit for hip and knee pain; no better than placebo for back pain; and without enough evidence of benefit for the common cold. As for its safety, nearly 60 years of widespread use are reassuring. But there are simmering concerns about subclinical liver and cardiovascular effects and questions about whether or not to intervene in cases of small therapeutic overdose.  
feeds.bmj.com
about 5 years ago
Www.bmj
0
8

Focal neurological deficits after trauma

A 38 year old woman developed headache (without neck pain) and weakness of her left upper and lower limbs after a concussive head trauma with scalp lacerations in a motor vehicle crash. On examination (more than 4.5 hours after the trauma), she was conscious, alert, and in cardiac sinus rhythm. There was no carotid bruit. She scored 7 points on the National Institute of Health stroke scale (maximum possible score 42). Positive neurological findings included mild blunting of the left nasolabial fold; left hemiparesis, with extensor muscles being weaker (3/5) than flexors in the left upper limb (4+/5), flexors being weaker (4 to 4+/5) than extensors in the left lower limb (4+ to 5/5), and distal more than proximal weakness in the left arm and leg. She also had brisk deep tendon reflexes in the limbs on the left side; a left extensor plantar response; left hemianopia; and left hemisensory (including the face) hypoaesthesia for pain, cold, and touch. Eyelid ptosis or paresis of extraocular movements were not present, and pupillary size and light reaction were normal.  
feeds.bmj.com
about 5 years ago
Preview
0
10

Cerebral mass in HIV infection

A 34 year old woman from the Republic of Congo with known HIV infection presented with a one day history of sudden weakness of the right arm and mild headache. She had a history of cardiomyopathy, hypertension, and epilepsy. She had not travelled abroad since she had moved to the United Kingdom 10 years ago. Other than weakness in the extensor muscles of the right arm grade 4/5 on the Medical Research Council scale, the physical examination was unremarkable.  
feeds.bmj.com
about 5 years ago
Www.bmj
0
19

A young woman presenting with severe headache

A 20 year old woman with a history of migraine with visual aura in the form of both positive (fortification spectrum) and negative features was admitted to hospital because of unilateral pulsatile right sided headache of one day’s duration. The headache was associated with photophobia, intense nausea and vomiting, right sided facial and upper arm numbness, and a right sided temporal visual field defect. She described the headache as similar to her habitual migraines in character but “the worst ever.” On examination she was normotensive and her Glasgow coma scale was 15. On neurological examination the visual field defect was confirmed and she reported reduction in light touch over the right side of her face and right upper limb.  
feeds.bmj.com
about 5 years ago
Www.bmj
0
17

A pain in the neck type of headache

A 29 year old right hand dominant chef presented to the emergency department with a four day history of feeling “not normal.” He was sent home from work because of a gradual onset of dull pain on the left side of his neck radiating up into his head, which was getting progressively worse, as well as “seeing two of everything.” The pain was not influenced by changes in posture. In addition, his right side felt numb and he was dropping things at work. He felt unsteady on his feet, which prompted him to seek medical advice. He thought all his symptoms had come on suddenly and were gradually getting worse. He denied any recent alcohol consumption, illicit drug use, seizure activity, head injury, or loss of consciousness. He had no medical history of note, apart from hypothyroidism, for which he was taking thyroxine.  
feeds.bmj.com
about 5 years ago