Neurology

Back to Basics: Infantile Botulism

This post was inspired by a recent clinical case in our department. A 7 week full term infant s/p spontaneous vaginal delivery with a normal maternal prenatal screen and course presents to your ED for not eating x 12 hours. On exam, you note decreased spontaneous movements, a weak suck and a weak cry noted. Vitals are normal. What's the diagnosis? 

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Advanced Practice: Use of Ultrasound for Infant Lumbar Punctures

Modern immunizations in conjunction with better CT imaging has likely led to declining need for lumbar puncture in the emergency department to evaluate for meningitis and subarachnoid hemorrhage. This may contribute to physician discomfort with the procedure and lower likelihood of first attempt success. This study evaluated whether the addition of ultrasound guidance could increase first attempt success on infant lumbar puncture in the Emergency Department.

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Back to Basics: Dizziness & the HINTS exam

HINTS Testing: series of three physical exam maneuvers to differentiate peripheral and central causes of vertigo

Head Impulse test: tests vestibulo-ocular reflex

• Patient focuses on visual spot directly in front of them

• Rotate patient’s head rapidly from center to 40 degrees to the left and back again to center, repeat on the right

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Advanced Practice: Pearls for Myasthenia Gravis Intubations

Whereas the dosing of sedative medications is usually unaffected, the chief concern is whether there should be changes for neuromuscular blockade – will your patient with myasthenia gravis require a higher or lower dose of your selected paralytic?

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