- Be prepared to do everything with these cases, if they can’t provide information, dive into their medication list, history, contact whoever you have to to get more information
- Keep differentials wide – then approach these cases with the mindset of focal vs generalized weakness and work from there
- Focal – ask about muscle weakness, bowel and bladder incontinence, perform a complete neuro exam – finger to nose, heel to shin, ambulation, and perform an NIH stroke score
- Generalized – think about cardiac, metabolic, and endocrine causes like myxedema coma, order ALL the tests including a head CT if their baseline is not known
- Don’t forget the toxicology component – is this a medication side effect? Check their medication list!
- Look for objective signs pointing to badness – bladder retention, diaphoresis, decubitus ulcers, pallor, dark stools, purulent urine – they can all help narrow down the list of differentials
REBEL Core Cast – Basics of EM – Weakness
Click here for Direct Download of the Podcast
Co-Host
Jenny Beck-Esmay, MD FACEP
Associate Professor for Emergency Medicine Icahn School of Medicine at Mount Sinai
Assistant Residency Director
Mount Sinai Morningside – Mount Sinai West
New York, NY
Twitter: @jbeckesmay
Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)
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