"On Call Neurology" (4th edition, 2020) by Marshall and Mayer is a practical, pocket-sized guide designed for residents managing neurological emergencies, covering 19 common on-call problems with a structured, step-by-step approach. It provides critical, scannable information, including an on-call formulary and anatomic references, aimed at guiding clinicians through high-pressure scenarios. The guide is available in paperback and as an Elsevier eBook on VitalSource Amazon.com On Call Neurology: On Call Series - Amazon.com
This paper serves as a clinical guide for managing common neurological emergencies encountered during "on-call" shifts. It outlines the immediate diagnostic steps and initial management strategies for conditions requiring rapid intervention.
Management of Acute Neurological Emergencies: An On-Call Clinical Guide 1. Introduction
Neurology on-call shifts are characterized by high-pressure decision-making. The primary goal is to distinguish between life-threatening "red flag" conditions and stable presentations. Rapid assessment and stabilization often precede a definitive diagnosis. 2. The Acute Stroke Protocol
Time is the most critical factor in managing suspected stroke patients. Initial Assessment : Perform a rapid NIH Stroke Scale (NIHSS) assessment.
: Order a non-contrast CT head immediately to rule out hemorrhage. Intervention neurology on call pdf
If ischemic and within the 4.5-hour window, evaluate for IV thrombolysis (Alteplase/Tenecteplase).
If large vessel occlusion (LVO) is suspected, coordinate with neurosurgery/interventional radiology for mechanical thrombectomy. 3. Status Epilepticus (SE) Defined as continuous seizure activity lasting is greater than 5
minutes or recurrent seizures without recovery between episodes. Phase 1 (0–5 min)
: Secure airway, check blood glucose, and establish IV access. Phase 2 (5–20 min) : Administer benzodiazepines (e.g., Lorazepam 4mg IV). Phase 3 (20–40 min)
: If seizures continue, load with anti-seizure medications (e.g., Levetiracetam 60mg/kg or Fosphenytoin 20mg PE/kg). 4. Acute Neuromuscular Weakness "On Call Neurology" (4th edition, 2020) by Marshall
Commonly presenting as Guillain-Barré Syndrome (GBS) or Myasthenic Crisis. The "20/30/40" Rule
: Monitor for respiratory failure. Intubation is often required if: Forced Vital Capacity (FVC) is less than 20 Maximal Inspiratory Pressure (MIP) cap H sub 2 cap O Maximal Expiratory Pressure (MEP) is less than 40 cap H sub 2 cap O 5. Altered Mental Status and Coma
A systematic approach is required to identify metabolic, infectious, or structural causes. Mnemonic: AEIOU TIPS
: Alcohol, Epilepsy, Insulin, Oxygen/Opiates, Uremia, Trauma, Infection, Poisoning, Stroke. Herniation Syndromes
: Look for the Cushing triad (bradycardia, hypertension, and irregular respirations) and pupillary changes. Administer Mannitol or hypertonic saline if herniation is suspected. 6. Conclusion Ischemic Stroke: Alteplase (tPA) 0
Navigating neurology on-call shifts requires a structured approach to the "ABC" (Airway, Breathing, Circulation) of acute neurological care. Prioritizing rapid stabilization and time-sensitive interventions like thrombolysis or seizure control remains the cornerstone of effective management. For complex or refractory cases, early consultation with senior specialists and multidisciplinary teams is essential to optimize patient outcomes. Disclaimer:
This document is intended for educational purposes and summarizes general clinical strategies. It does not constitute medical advice. Clinical decisions must always be made by qualified healthcare professionals based on individual patient presentation, institutional protocols, and current medical standards.
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The Golden Rule: Time is Brain. Stabilize the patient first, then localize the lesion.
The "VITAMINS" Mnemonic for Differential Diagnosis: