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Tag Neuro

GCS & AVPU

Glasgow coma scale is the standard used in assessing and documenting level of consciousness in head trauma. The AVPU (Alert, responsive to Verbal stimuli, responsive to Pain, Unresponsive) scale is a quicker assessment also commonly documented and used. It can… Continue Reading →

Question: Syncope

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Question: Onc

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Question: Syncope

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an adolescent who had a syncopal episode at school. It occurred 10 minutes after P.E. class had finished, when she was in… Continue Reading →

Question: febrile seizures

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 18-month-old brought in by ambulance for simple febrile seizure that lasted 2 minutes. You have determined the source of his fever… Continue Reading →

Question: Back Pain

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old child with 3 weeks of gradually progressing low back pain, now impacting her ability or willingness to walk…. Continue Reading →

Question: Behavior

(Click the link to comment and to vote – voting not working through email, sorry!) You are evaluating a 15 year old girl brought in from a foster home for symptoms of psychosis. 

Question: Neuro

(Click the link to comment and to vote – voting not working through email, sorry!) Which of the following physical exam findings on a newborn’s sacrum does NOT mandate an MRI to rule out occult closed spinal dysraphism?

Question: Neuro

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 12 year old child that presents with altered mental status, fever, and history of headache and vomiting before the decline in… Continue Reading →

Question: Neuro

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 8 year old boy brought in by ambulance for a first time unprovoked afebrile seizure. The seizure was generalized tonic-clonic and… Continue Reading →

Question: Neonate

(Click the link to comment and to vote – voting not working through email, sorry!) A 10 day old presents with shaking of bilateral upper extremities and jitteriness. The patient was a term infant born NSVD with no complications. He… Continue Reading →

Question: Neuro

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 9 year old boy who returned from a camping trip in Colorado 6 days ago. He had some vague complaints of… Continue Reading →

Question: VP Shunt

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old ex-premature infant who has a ventriculoperitoneal shunt in place. The patient presents with fever to 38.3, cough, and… Continue Reading →

CT 1st afebrile seizure?

(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →

Question: Neuro

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Migraine Tx

(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →

Question: Stroke

(Click the link to comment and to vote – voting not working through email, sorry! You are seeing a 3 year old child with unrepaired Tetralogy of Fallot who presented with a generalized tonic-clonic seizure, and residual hemiparesis and speech… Continue Reading →

Question: Seizures

(Click the link to comment and to vote – voting not working through email, sorry!) EMS is bringing you a 10yo patient that has been actively seizing for 20 minutes. They are unable to obtain IV access.

Question: Migraines

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Hand exam: nerves

PEM Infographics (linked here) has many helpful infographics. One of my all-time favorites is how to use rock-paper-scissors-OK sign to test children’s peripheral nerves in the upper extremity / hand exam

Status epilepticus

Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →

Question: Post-ictal

(Click the link to comment and to vote – voting not working through email, sorry!) EMS has brought in an 8 month old child who had a generalized tonic-clonic seizure at home. The child has a history of 2 prior… Continue Reading →

Question: Spasms

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 6 year old boy with a few days of episodes of crying and jaw clenching, decreased oral intake, and intermittent painful… Continue Reading →

Question: Neuro

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 15 month old who became angry about a toy being taken away, cried, turned blue in the face, passed out, and… Continue Reading →

Unvaccinated w/febrile seizure

(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →

CT for headache

(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →

Question: Seizures

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 1yo child in status epilepticus (first time seizure). The child received 0.2 mg/kg intranasal midazolam in the field, 0.1 mg/kg IV… Continue Reading →

Early stylet removal for infant LP

Success rates in infant lumbar punctures may be declining as we do fewer and fewer (doing fewer is a good thing, except that we get less experience). One thing that can improve success is early stylet removal. The stylet is… Continue Reading →

Question: Neuro

(Click the link to comment and to vote – voting not working through email, sorry!) A 12 year old boy with a history of ADHD on Adderall comes in for acute onset weakness of his bilateral upper arms, particularly on… Continue Reading →

Question: Congenital condition

(Click the link to comment and to vote – voting not working through email, sorry!) A 2 year old child has a flat lesion of the entire left forehead and upper eyelid the color of light red wine that has… Continue Reading →

Levetiracetam dosing for status

(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →

Question: VP shunt

(Click the link to comment and to vote – voting not working through email, sorry!) A 4 year old with ventriculoperitoneal shunt revision 1 month ago, presents with headache and vomiting and increased sleepiness according to mom. The patient is… Continue Reading →

Question: Tox

(Click the link to comment and to vote – voting not working through email, sorry!) A 14 month old is brought in with lethargy and obtundation. The patient is breathing spontaneously and has stable vital signs. The parents admit that… Continue Reading →

Question: DKA

(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 5 year old fully immunized patient with 2 weeks of new onset bedwetting, 3 days of cough and fever, and 2… Continue Reading →

Complex febrile seizures

Do you do a CT and LP on all complex febrile seizure patients?

Question: Tox

A 19yo man presents with progressively worsening extremity numbness in a glove and stocking distribution and ataxia x 1 month. He has areflexia, weakness, and a wide-based gait on exam. (Click the link to comment and to vote – voting… Continue Reading →

Improvised mucosal atomizer device

Mucosal atomizer devices improve administration of intranasal medications. Intranasal fentanyl 1.5 mcg/kg is a great way to give stronger pain medication (eg for fractures) without placing an IV. Intranasal midazolam 0.2 mg/kg (use concentrated 5mg/mL form to keep total volume… Continue Reading →

Question: Trauma

A 10yo was a rear seat passenger in a high-speed MVA, belted only with a lapbelt, and had a hyperflexion injury mechanism during impact. The patient cannot move his legs, and does not have lower extremity sensation to light touch… Continue Reading →

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