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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

Cranial Nerve VI Palsy Emergency

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sábado, 14 de noviembre de 2015

Arteritis de células gigantes

emDocs - November 14, 2015 - Authors: Butterfield M and Jeang L
Edited by: Koyfman A and Long B.
"You wonder: Is there a good way to rule out GCA myself in the ED?
Clinical Bottom Line
Given its protean manifestations, the insufficient sensitivity of biomarkers, and unavailability of highly accurate imaging modalities, GCA will be difficult, if not impossible to rule out in the ED. Emergency physicians should have a low threshold for making a presumptive diagnosis of GCA and managing accordingly. One exception to this rule might be patients under 50 years old with an unconvincing presentation and another plausible reason for abnormal biomarkers (if elevated), as only about 40 cases of GCA have ever been reported in this age group. Another might be patients with an atypical presentation, normal ESR and CRP, who have been counseled on the risks of GCA, and have reliable follow-up (a lot of “ifs” in that statement).
For all others, consultants should be called, and if unavailable, steroid treatment should be started until follow-up. Patients without visual symptoms should be started on 40-60 mg of prednisone daily, while those with visual impairment need to start with 1 g of intravenous methylprednisolone for 3 days, according to the British Society for Rheumatology guidelines."
http://www.emdocs.net/can-giant-cell-arteritis-be-ruled-out-in-the-ed/