APPROACH TO STROKE

Goals and Objectives Goals Resident will be comfortable with initial evaluation and basic management of patients with stroke Learning Objectives Resident will be able to describe common presentations of acute ischemic and hemorrhagic stroke Resident will be able to describe anatomic distribution of lesions based on neurologic deficits Resident with be able to list risk factors for ischemic and hemorrhagic strokes Resident will be able to list acute interventions commonly indicated for patients presenting with suspected or confirmed stroke Glucose measurement / control Airway management Blood pressure management Anticoagulation reversal Resident will be familiar with guidelines for administration of tPA Resident will describe an approach to the bleeding patient on tPA

Recommended Resources Prior to Conference Approach to Stroke in the ED (Sunnybrook) Additional Resources General Imaging for Acute Neurologic Conditions (EBMedicine) Ischemic Stroke Ischemic Stroke (CDEM) The rational clinical examination. Is this patient having a stroke? (JAMA) Focus On: Acute Ischemic Stroke (ACEP News) tPA for Acute Ischemic Stroke (ACEP Clinical Policy) Posterior Stroke Diagnosing Posterior Stroke (EMCrit) Ischemic Posterior Circulation Stroke (Front Neurol 2014) (pdf) Posterior Stroke Video (EMCrit) iPhone for Head Impulse Testing (EMCrit) HINTS to Diagnose Stroke in Acute Vestibular Syndrome (Stroke 2009) (pdf) Hemorrhagic Stroke Intracranial Hemorrhage (CDEM) The rational clinical examination. Does this patient have a hemorrhagic stroke? (JAMA) Subarachnoid Hemorrhage (EMCrit) Aneurysmal SAH Management (Crit Care Med 2009) (pdf / pdf) Critical Care of Poor-Grade SAH (Curr Opin Cit Care 2011) (pdf) Consensus Statements Guidelines for the Early Management of Patients With Acute Ischemic Stroke (Stroke 2013) (pdf) Guidelines for the Management of Aneurysmal SAH (Stroke 2009) (pdf)  tPA for Acute Ischemic Stroke (ACEP Clinical Policy) Editorial How to Avoid Stroke-Related Medicolegal Disasters (ACEP News, 2009)

Original Post by Eric Shappell on 11/16/2014
Reviewed by James Ahn on 01/06/2015
Last Updated by Eric Shappell on 03/17/2015 Contact / Feedback

APPROACH TO ALTERED MENTAL STATUS

Goals and Objectives Goals Resident will be comfortable with initial evaluation and basic management of patients with altered mental status Learning Objectives Resident will be able to define and describe the differences between delirium, dementia and psychosis Resident will be able to outline steps in the initial assessment to the patient with altered mental status Resident will be able to produce a differential diagnosis for altered mental status Resident will be able to list rapidly reversible causes of altered mental status and appropriate interventions for each diagnosis Hypoglycemia --> Dextrose Hypoxia --> Supplemental O2 Hypercarbia --> Assisted ventilation Opioid intoxication --> Naloxone Alcohol withdrawal --> Benzodiazepines Resident will be able to describe common diagnostic studies used to determine the etiology of altered mental status Resident will be able to describe basic treatments for each disease category included in the differential diagnosis of altered mental status

Recommended Resources Prior to Conference Altered Mental Status: Evaluation and Etiology in the ED (Am J EM, 2002) Altered Mental Status (EM in 5) Additional Resources Overview Approach to AMS Part 1 (EM:RAP) Approach to AMS Part 2 (EM:RAP) Approach to AMS (Flipped EM Classroom) CDEM on AMS Consensus Statements ACEP Clinical Policy: AMS (pdf)

Original Post by Eric Shappell on 7/23/2014
Reviewed by James Ahn on 7/26/2014
Last Updated by Eric Shappell on 02/16/2016 Contact / Feedback