Office Staff Training
For flu and corona virus epidemic For all patients with upper respiratory symptoms: cough, shortness of breath, runny nose Please ask patient to wear a face mask Office cleaning procedure Clean exam room, including door knob once every 2 hour while we are seeing patient Assign one office staff...
COVID-19 3-3-2020
COVID-19 Update 03/13/2020 New info Harvard Covid-19 Toolkit – including post for patient Tomas Pyeyo – Coronavirus: Why You Must Act Now updated 3/13/20 This article has received 24 million views in the last 72h. An indepth analysis of: How many cases of coronavirus will there be in your...
Ramsey Hunt syndrome
aka: herpes Zoster oticus Triad: ipsilateral facial weakness, ear pain, vesicles on the ear. May also have: ipsilateral taste change, tongue lesion, haring abnormality and lacrimation. May have vestibular disturbances. Cause: reactivation of virus in geniculate ganglia, spread to VIII nerve. Treatment: Valtrex 1 g tid x 7 day...
Cerebellar hemorrhage
Consider surgical treatment if hemorrhage is over 3 cm in diameter, or volume over 15 cm square deteriorating neurologically or Brainstem compression or hydrocephalus...
NOAC associated bleeding
Time Anticoagulation effect resolved 5 half live since last dose Dabigatran (Pradaxa): 2.5 to 3.5 days Rivaroxaban (Xarelto): 1-2 days Apixaban (Eliquis): 1.5 to 3 days Management Discontinue medication Specific reversal agent Dabigatran: idarucizumab (Praxbind) initial dose 2.5 g iv, repeat in 20 min, total of 5 g Apixaban,...
Warfarin associated bleeding
For serious bleeding Discontinue Warfarin Vit K 10 mg slow iv over 20-60 minutes may repeat q12 ir inr still high Kcentra: PCC (4 factor prothrombin complex concentrate) – 1500 to 2000 units iv over 10 min...
Neuro Practice
Texas Neuro Society: Medical economic FAQ Neurology Residents: How physicians get paid...
UsefulLinks
Useful links Drug RxList – Drug Information Neurology Reference Handbook – by Ahmed Koriesh, M.D. Good Rx – Drug price Calculators NIH Stroke scale CHA2DS2VASc Stroke Risk Modified Rankin Scale ASPECTS – Alberta Stroke Program Early CT score Phenytoin Correction RASS – Richmond agitation sedation scale Glasgow Coma Scale...
Intracerebral hemorrhage (ICH)
Intracerebral Hemorrhage (ICH) Score Initial care airway cardiovascular support acute stroke care facility, ICU care Reversal of anticoagulation & coagulopathy Stop all anticoagulant and antiplatelet Heparin associated bleed Protamine sulfate: slow IV infusion (< 20 mg/minute and no more than 50 mg over any 10-minute period). Warfarin associated ICH:...
Diener Law
Resumption of anticoagulation after stroke/tia tia: immediate Mild stroke (nihss < 8): 3 to 5 days Moderate stroke (nihss 8-16): 5-7 days Severe stroke (nihss over 16): 2 weeks Reference huisman mv, et al. Thromb Haemost. 2012...