Ashley Strobel
丁香诊所 美国马里兰大学
丁香诊所全科培训课程 08:头晕的诊断与分类

丁香诊所全科培训课程 08:头晕的诊断与分类
  • 头晕
  • 眩晕

采集一个简短、有利的病史可以帮助更多的病人做好体检、鉴别良性、恶性和收住院的指征、进行进一步的检查。良性患者可以回家,但是急性则需要收住院。

眩晕曾经分为外周和中枢性眩晕,外周和中枢性眩晕的区别:外周内耳迷路由 3 个半规管组成,包括椭圆囊和球囊,可以传递声音和保持平衡,迷路传递的信号由第 VIII 对脑神经-前庭窝神经传导;中枢包括脑桥、脑干、延髓以及小脑。其他导致眩晕的原因可能与脊髓有关,无眩晕这种疾病,而叫做「急性前庭综合征」。

遇到周围性眩晕病人时可通过 HINTS 检查先帮助他们消除恐惧感,该方法优于 MRI,敏感度 100%,特异性 96%,是诊断卒中的金标准,但要在 72 h 后检查。HINTS 检查有两种口诀:H 和 I 是头是否有冲动,N 是眼震颤,TS 是倾斜实验,还可以加上听力测试,可确诊缺血性后颅窝的卒中;另一个口诀为 I 和 N 为头摆动实验,A 为眼震颤快向变化,RCT 为遮住眼睛时向上看不好。当病人以眩晕就诊,H 和 I 不正常,单向性眼震,倾斜实验阴性时可慢性处理,不收住院。HINTS 检查正常,Romberg 步态不稳也要收住院。

在丁香诊所「全科医生强化培训班」中,来自美国马里兰大学的急诊和儿科医学讲师 Ashley Strobel 与大家一起分享《头晕的诊断与分类》。

更多精彩内容请点击此处观看丁香公开课全部课程。

封面图片来源:shutterstock 网站

Ashley Strobel

丁香诊所 美国马里兰大学

Ashley M. Strobel, 美国马里兰大学急诊和儿科医学讲师。MD, University of Maryland Upper Chesapeake Health


Postgraduate Education and Training:
2010‒2015 Combined Emergency Medicine and Pediatrics Residency
University of Maryland Medical Center
Baltimore, Maryland

2014-2015 Chief Resident
Combined Emergency Medicine and Pediatrics Residency

Education:
2006‒2010 Doctor of Medicine (magna cum laude)
St. George’s University School of Medicine
Grenada, West Indies

2001‒2005 Bachelor of Science (majors: Spanish and Biology)
University of Wisconsin-Madison
Madison, Wisconsin


Foreign Language: Fluent in Spanish

Certifications:
March 28, 2014 Neonatal Resuscitation Program
August 13, 2014 Pediatric Advanced Life Support
September 3, 2014 Basic Life Support
July 17, 2015 Advanced Cardiac Life Support
April 22, 2010 ECFMG Certification


Medical Licensures:
2015 Maryland (active)
2015 Minnesota (pending)

Clinical Employment History:
2015 – present Assistant Professor, Department of Emergency Medicine
Director of Pediatric Emergency Medical Education
Hennepin County Medical Center and University of Minnesota Masonic Children’s Hospital
Minneapolis, MN

2015- present Pediatric Emergency Medicine Physician
University of Maryland Upper Chesapeake Health
Bel Air, MD


Other Employment History
April 2010‒present Interviewer and Representative, Interview Committee,
St. George’s University


Professional Memberships:
2010‒2015 Emergency Medicine Residents Association (EMRA)
2010-2015 American College of Emergency Physicians (ACEP)
2010-2015 American Academy of Pediatrics (AAP)
2010-2015 American Academy of Emergency Medicine (AAEM)
2013‒2015 American Medical Society for Sports Medicine (AMSSM)

Honors and Awards:
2015 University of Maryland Department of Pediatrics, Carol Carraccio Service Award
2010 Gold Humanism Honor Society, St. George’s University
2010 Magna Cum Laude, St. George’s University
2007‒2010 Iota Epsilon Alpha Honors Society, St. George’s University

Institutional Service:
2014-2015 EM-Pediatrics Residency Curriculum Development
March 2014 ED Optimization QI Project, Cannon Design, University of Maryland Medical Center
September 2011 Medical Team, Baltimore Grand Prix, with Dr. Benjamin Lawner and Dr. Wade Gaasch

National Service:
2015-2016 Chair, Pediatric Emergency Medicine Division, Emergency Medicine Residents Association
2014‒2015 Pediatric Section Editor, EMResident
2013‒2015 Vice Chair, Pediatric Emergency Medicine Division, Emergency Medicine Residents Association

Teaching Service:
Invited Lectures
July 8, 2015「High Yield Pediatric Orthopedic Emergencies」, University of
Maryland Emergency Medicine Pediatrics Grand Rounds [CME].

Lectures:
January 2012「From the Rock to Charm City,」IEA Honors Society Lecture, St. George’s University, Grenada, West Indies
February 2013「Neonatal Seizures Secondary to Transient Hypoparathyroidism: A Review of Neonatal Seizure,」Hotbox Case Presentation, Department of Pediatrics, University of Maryland Medical Center
March 2013 Instructor, EMT-1 Cadaver Airway Course, Community College of Baltimore Country, Baltimore MD
June 2013「Pediatric Electrocardiograms: The Math and the Mystery,」Junior Lecture, Emergency Medicine Residency, Pediatric Emergencies Conference, University of Maryland Medical Center
July 2013 Instructor, Emergency Medicine Student Cadaver Lab, University of Maryland School of Medicine, Baltimore, MD
March 2014「Here’s Looking at You, Kid: Pediatric Ophthalmologic Emergencies」Senior Lecture Conference, Emergency Medicine Residency, University of Maryland Medical Center
May 2014「Anaphylaxis: Pediatric versus Adult,」Division of Pediatric Allergy and Immunology Elective, University of Maryland Medical Center
September 2014「Hematuria: A Case of Adenovirus Cystitis,」Hotbox Case Presentation, Department of Pediatrics, University of Maryland Medical Center
October 2014「Fever and Abdominal Pain Presenting as Right Tibial Osteomyelitis: A Review of Osteomyelitis,」Hotbox Case Presentation, Department of Pediatrics, University of Maryland Medical Center
February 2015「Picking out a Cardiac Infant in the ED: MISSION IMPOSSIBLE?」Senior Presentation, Department of Emergency Medicine, University of Maryland Medical Center

Simulation Education Sessions, Instructor, Pediatric Residency:
May 2013 Pediatric Supraventricular Tachycardia
July 2014 Pediatric Lumbar Puncture and Intraosseous Access Skills
July 2014 Laceration, Bite, and Abscess I&D Skills
August 2014 Pediatric Respiratory Distress: Part I
August 2014 Pediatric Respiratory Distress: Part II
August 2014 Intravenous Access and Phlebotomy Skills
August 2014 Laceration Repair and Abscess I&D Skills
January 2015 Airway, Laceration, and LP Refresher Skills Lab
January 2015 Pediatric Supraventricular Tachycardia
February 2015 Pediatric Septic Shock
February 2015 Pediatric Nursing Intravenous Access and Phlebotomy Skills

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