WikEM - User contributions [en]

Idiopathic intracranial hypertension

2016-10-13T17:18:58Z

Leriotth:

==Background==
*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)
*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi
*Associated with OCPs, vitamin A, [[tetracycline]] and thyroid disorders

==Clinical Features==
*[[Headache]]
*[[Nausea and Vomiting]]
*Vision blurring
*Irregular menses or amenorrhea

==Differential Diagnosis==
*Aneurysm rupture and [[Subarachnoid Hemorrhage]]
*[[Brain tumor]]
*[[Encephalitis]]
*[[Head Injury]]
*Hydrocephalus (increased CSF)
*Hypertensive brain hemorrhage
*Intraventricular hemorrhage
*[[Cerebral venous sinus thrombosis]]
*[[Meningitis]]
*[[Subdural Hematoma]]
*[[Status epilepticus]]
*[[Stroke]]

==Evaluation==
*Young, obese women
*[[Headache]] (worse in AM / with manuvers increasing ICP)
*Papilledema (optic atrophy/vision loss)
**can be visualized with [[Ocular ultrasound|ultrasound]]
*[[Neuro Exam]] frequently normal
**May have cranial nerve palsies in severe, most often CN 6

===Work-Up===
*CT scan (negative or slit-like ventricles)
*[[LP]] (Opening pressure >25)
*MR venogram (to rule out cerebral venous sinus thrombosis)

==Management==
*Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
*[[Acetazolamide]] 500mg BID (decrease CSF production)
*[[Furosemide]] 20mg PO BID, give potassium supp as needed
*Weight loss
*CSF Shunt
*Optic nerve sheath fenestration

==Disposition==
*Admit for:
**Severe pain
**Focal findings
**Vision changes
*Otherwise, discharge with ophtho follow up for formal visual field monitoring

==External Links==
*[http://www.stemlynspodcast.org/mobile/e/an-approach-to-headache-in-the-ed-induction-series/ Induction to EM: An approach to headache in the ED. St.Emlyn’s]

==See Also==
*[[Ocular ultrasound]]

==References==
<references/>

[[Category:Neurology]]

Cluster headache

2016-10-11T13:20:24Z

Leriotth:

==Background==
*Occur most often in middle aged men
*Classically occur in "clusters" over days to weeks typically at the same time of day and same anatomical location.
*Triggers may be alcohol, nitroglycerin, histamine

===Definition<ref>International Headache Society Diagnostic Criteria</ref>===
''At least 5 attacks of headache fulfilling the following criteria:''
#Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
#Headache accompanied by at least one of the following:
#*Ipsilateral conjunctival injection and/or lacrimation
#*Ipsilateral nasal congestion and/or rhinorrhea
#*Ipsilateral eyelid edema
#*Ipsilateral forehead and facial sweating
#*Ipsilateral miosis and/or ptosis
#*A sense of restlessness or agitation
#Attacks have a frequency from one every other day to eight per day
#Not attributed to another disorder

==Differential Diagnosis==
{{Headache DDX}}

==Evaluation==
*Consider other emergent causes of [[headache]] based on H&P
**Consider CT, LP, and/or eye pathology
*Typically a clinical diagnosis

==Management==
*High-flow O2 (effective in 70% of patients)<ref>Headache. 2013 Jul-Aug;53(7):1191-6. doi: 10.1111/head.12145. Epub 2013 Jun 14. Cluster headache: conventional pharmacological management. Becker WJ1.</ref>
*Intranasal [[lidocaine]] 4%
*DHE
*[[Sumatriptan]]
*Intranasal zolmitriptan
*Subcutaneous or IM dihydroergotamine and intranasal sumatriptan are additional options

==Disposition==
*Normally outpatient

==See Also==
*[[Headache]]

==References==
<references/>

[[Category:Neurology]]

Trigeminal neuralgia

2016-10-10T21:23:04Z

Leriotth: added clinical features

==Background==

==Clinical Features==
*Paroxysms of severe unilateral pain in trigeminal nerve distribution lasting only seconds
*Normal neuro exam
*No pain between paroxysms
*Variant with headache
*More common in Middle aged women

==Differential Diagnosis==
{{Headache DDX}}

==Evaluation==
*Sensory loss, bilateral involvement, and younger age (<40) are associated with a higher risk of secondary TN, but their absence does not rule out secondary TN
*Consider CT/MRI in these patients to rule out structural etiology
*<5% of patients have V1 distribution, examine carefully for [[zoster]] in these patients

==Management==
===[[Phenytoin]]===
*250mg IV to abort an acute attack
*Relief lasts from four hours to three days
*[[Fosphenytoin]] seems to work similarly

===[[Carbamazepine]]===
*First-line agent with 75% success rate initially
*Proposed Mechanism: Decreases the response of neurons to peripheral stimulation
*Started at 100mg one to two times per day
*Increase by 100-200mg every 3 days
*Usual maintenance dose is 400-800mg (rare >1500mg)
*Pain relief occurs within several hours to days (94% within 48 hours)
*Target serum concentration is 24-43 μmol/L
**If unsuccessful, [[phenytoin]] 200-400mg/day is used in combination

===Other agents===
*[[Baclofen]], clonazepam, [[valproic acid]], [[lamotrigine]], [[gabapentin]], Oxcarbazepine, [[topiramate]]

===Surgery===
*Posterior fossa microvascular decompressive surgery
**Approximately 50% of patients will require surgery
*Successful in 70% of patients

==See Also==
*[[Headache]]

==References==
*J Pain Symptom Manage 2001; 21(6):506-510.

[[Category:Neurology]]

Dopamine

2016-09-30T17:54:46Z

Leriotth: updated facts

==General==
*Type: [[Vasopressors]]
*Dosage Forms: IV
*Common Trade Names: Intropin

==Adult Dosing==
===Dosing===
*Low dose:
**1-5 mcg/kg/min - Vasodilation (renal, mesenteric, coronary)
**5-10 mcg/kg/min - predominant β1
*High dose: 10-20 mcg/kg/min - predominant α1
*Titrate to clinical effect
**Use lowest dose possible (prevent tachyphylaxis)
*May use in peripheral IV temporarily
**Avoid using in same line as alkaline infusions
===Rate of Titration===
*Q2-5 min

==Pediatric Dosing==

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Class C
*Lactation:
*Renal Dosing
**Adult
**Pediatric
*Hepatic Dosing
**Adult
**Pediatric

==Contraindications==
*Allergy to class/drug
*Tachyarrhythmias

==Adverse Reactions==
*Low doses:
**Hypotension
*High doses:
**Hypertension, ectopic beats
*Tissue necrosis (if extravasates)
**If occurs use phentolamine 5-10mg in affected area

===Serious===

===Common===

==Pharmacology==
*Half-life:
*Metabolism:
*Excretion:
*Mechanism of Action:
===Primary Receptor===
*Low dose: DA, β1
*High dose: DA, α1 >> β1
===Relative Effects===
*Low dose: Natriuresis, ↑↑HR, ↑↑SV
*High dose: ↑SVR and ↑SV

==Notes==
===Indications===
*Hypotension caused by:
**Septic shock
**MI
**Trauma/spinal shock
**Heart failure

==See Also==

==References==

<references/>
[[Category:Pharmacology]]

Albert Einstein Medical Center

2016-07-25T21:58:52Z

Leriotth:

==History==
Einstein Medical Center formed from the merger of Jewish, Mount Siani and Northern Liberties Hospitals in 1951. Fully accredited AOA and ACGME approved combined Emergency Medicine residency. Participates in both the AOA and ACGME matches. Accepts 15 DO/MD residents per year and 2 physician assistant residents.
==Curriculum==
*4 weeks per block, 13 blocks an academic year.
*20 days of paid vacation (Including either Christmas or New Year's Eve week off)
===PGY1===
*6 blocks Emergency Medicine (including random ultrasound and emergency psychiatry shifts mixed in)
*1 block internal medicine
*1 block Trauma/Surgical ICU
*1 block Medical ICU
*1 block Cardiac ICU
*1 block Obstetrics
*1 block Anesthesia
*1 block Pediatrics

===PGY2===
*8 blocks Emergency Medicine (1 block at Community Hospital)
*1 block Medical ICU
*1 block Neurology
*1 block Neonatal ICU
*2 weeks Orthopedics
*2 weeks Radiology/Ultrasound
*2 weeks ENT
*2 weeks Opthalmology
===PGY3===
*7 blocks Emergency Medicine (1 block at Community Hospital)
*1 block Burn ICU at Temple Hospital
*1 block Scholars
*1 block Pediatric ICU at Children's Hospital of Pennsylvania
*1 block Pediatric EM at St. Christopher's Hospital
*1 block EMS
*2 weeks Toxicology
*2 weeks Elective

===PGY4===
*8 blocks Emergency Medicine (2 blocks at Community Hospital)
*1 block EM at Children's Hospital of Pennsylvania
*1 block Cardiothoracic ICU
*1 block Scholars
*1 block Administration
*1 block Elective

==Electives==
*Ultrasound, Pediatric Anesthesia, Dental, Hyperbarics, International..etc

==Fellowships==
*EMS
*Toxicology
==Contact Information==
5501 Old York Road, Korman B-9<br />

Philadelphia, PA 19141<br />

215-456-3480<br />

==External Links==
[http://www.einstein.edu/education/emergency-medicine/ Official Residency Page]<br />

[https://twitter.com/einsteinemed Residency Twitter]

==See Also==
*[[Council_of_Emergency_Medicine_Residency_Directors|Council of Emergency Medicine Residency Directors (CORD)]]
*[[Residency programs]]

[[Category:Resources]]