Emesis And Lethargy in A Shunted Patient

Walking Thoughts

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  What is the patient’s neurological exam and current vitals?

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  What are the patient’s symptoms? What is the timeline of symptoms?

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  Why does the patient have a shunt?

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  What type of shunt is currently in place?

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  What is the patient’s shunt history?

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    When was the shunt placed?

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    Has the patient ever required a shunt revision and if so, when was the last one?

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    Has the patient ever had a shunt malfunction? If so, what symptoms did the patient have at that time?

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    Was the shunt setting recently changed?

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  Is there prior imaging of the patient’s ventricles? If so, does the patient’s ventricles change in size with prior shunt malfunctions?

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  Does the patient need an urgent bedside procedure (e.g. shunt tap)?

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  Does this patient need to go to the operating room for a shunt revision? If so, what is the timing of surgery?

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  Does the patient have other medical comorbidities?

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  Is the patient on any antiplatelet or anticoagulant medications?