1. Remember to consider spontaneous cervical artery dissection in the differential diagnosis of a headache patient.
2. The majority of patients who develop an spontaneous cervical artery dissection will not develop a stroke.
3. Cerebral ischemia caused by cervical dissection is usually embolic rather than hemodynamic compromise caused by dissection-related stenosis or occlusion.
4. Stroke prevention is with antiplatelet or anticoagulant therapy, with no data supporting improved outcomes with either therapy compared to the other.
5. Endovascular therapy is increasingly being used in the acute treatment of stroke related to spontaneous cervical artery dissection.
- >20 weeks pregnancy with RUQ/epigastric pain, HTN
- Elevated AST/ALT, Low Platelets on CBC/COMP - should trigger diagnosis
- reflex order smear, OB consultation, Heme/Onc consultation
- Fear the Glucose - often neglected portion of HELLP syndrome since it didn't make the cut for the acronym.
- Don’t forget about other causes of abdominal pain, other heme syndromes
- Magnesium sulfate for treatment, Labetalol for blood pressure control, +/- Dexamethasone depending on fetal age
1. Children have fantastic physiologic reserve but will fall off the cliff quick if illness is under appreciated.
2. Listen to parents - even if they are being too persistent, they know their children better than anyone
3. If you think a patient needs a test because you are concerned they have a significant illness, be persistent and willing to make go do what is in the patient's best interest (even if you have to call in specialists from their cozy homes).
4. Always be wary of questionable vaginal bleeding in pregnancy - sometimes you get more than blood when you look.
Consider Ketamine for:
Consider administering zofran concomitantly (NNT=7), but do not prophylactically treat with benzos
· Consider poisoning when confronted with confusing clinical presentations
· Always save and freeze initial urine from suspicious cases
· “Munchausen’s by proxy” is now known as “Factitious disorder imposed on another” or “child abuse” and does not require exotic toxins.