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–Do not routinely obtain lab studies, diagnostic imaging, or electrodiagnostic testing for Bell palsy.
–Consider Lyme disease (neuroborreliosis) testing in children of age < 15 y.
–Do not routinely obtain diagnostic imaging for straightforward Bell palsy.
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–If presenting within 72 h of symptoms, give steroids (prednisone 1 mg/kg PO daily × 7 d), with or without antiviral medications (eg, acyclovir or valacyclovir × 7 d) to patients 16 y and older.
–Do not use antiviral monotherapy.
–Arrange eye protection for patients with incomplete eye closure.
–Do not use physical therapy or acupuncture for Bell palsy.
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Practice Pearls
2019 Cochrane analysis1 found no benefit from adding antivirals to corticosteroids vs. corticosteroid monotherapy.
Antivirals may have a marginal effect on facial nerve recovery when added to steroids, so counsel patients regarding the questionable benefit of antivirals if offered.
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CONCUSSIONS AND HEAD INJURY
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Children, Young Adults, and Adults
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►CDC 2016, ACEP 2016, AAN 2013, NICE 2023
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–Patients should receive medical evaluation for any of the following: loss of consciousness (even if now recovered), amnesia, persistent headache, any emesis, previous brain surgery, history of bleeding/clotting disorder, anticoagulation, antiplatelet therapy (besides aspirin alone), current intoxication (alcohol or other substances), behavioral alterations (ie, inattentive, not acting themselves), or concerns for safety/well-being (ie, vulnerable populations with unclear story).
–Obtain noncontrast CT for loss of consciousness or posttraumatic amnesia. There is no evidence for MRI over CT.
–Use standardized sideline assessment tools to assess athletes with suspected concussions.
–Educate all patients about concussions and postconcussive syndrome. Use tools such as the Acute Concussion Evaluation care plan developed by Gioia and Collins to guide follow-up management.
–Immediately remove from play any athlete with a suspected concussion.
–Do not permit an athlete to return to play until he/she has been cleared to play by a licensed health care professional.
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Adults in Hospital or Long-Term Care Settings
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–Identify risk factors including age ≥ 65, cognitive impairment and/or dementia, hip fracture, and severe illness.
–Minimize movement to new rooms/wards.
–Provide appropriate lighting, clear signage, clock, and calendar.
–Reorient patient by explaining where they are, who they are, and your role.
–Stimulate cognitive activity such as reminiscence.
–Facilitate ...