10 - Nuerological Emergencies

Question 1

Name the three major parts of the brain.

Answer 1

Brain stem: Breathing

Cerebrum: Thought

Cerebellum: Muscles

Question 2

Neurological complications will result with significant changes in levels of:

Answer 2

Blood glucose,
Oxygen levels
Temperature

Question 3

A 9 year old is showing symptoms of ALOC and is not interacting normally with their family. There is lip smacking that comes then goes away. These S/S are a result of what condition?

Answer 3

Focal Onset - Impaired Awareness Seizure

S/S: ALOC, Lip smacking, eye blinking, isolated convulsions, do not recall events during seizure

NOTE: Focal Onset Aware Seizure: S/S - No ALOC, numbness, weakness, dizziness, unusual smells

(732)

Question 4

What is the most common type of headache? What causes them?

Answer 4

Tension headache.

Caused by muscle contractions in the head and neck attributed to stress

(726)

Question 5

A 37 year old complains of a headache and fever. The patient is alert and oriented, skin is normal, RR IS 18, HR is 80 and BP 132/82 and the SPo2 is 98%. During your secondary assessment you find the patient is also complaining of a stiff neck and sensitivity to light. What is the most likely cause of these S/S? Describe your continued assessment and treatment for this patient.

Answer 5

Meningitus

Apply surgical mask to patient

Apply N95 Respirator to myself

Rapid transport to hospital with infectious disease department

Question 6

What is the most common type of stroke? How does it occur?

Answer 6

Ischemic stroke (87% of the population)

Blood clot reducing blood flow to the brain (Embolus)

(728)

Question 7

Describe what happens to a patient who experiences a TIA?

Answer 7

Patient will exhibit the same signs and symptoms of a stroke, but they will usually clear fully within 24 hours.

(730)

Question 8

A patient who suffers a stroke in the left hemisphere of the brain may experience a speech disorder called:

Answer 8

Aphasia

(730)

Question 9

What is the difference between a focal-onset aware seizure and a focal-onset impaired awareness seizure?

Answer 9

Focal Onset Aware: patients are fully aware of their surroundings with no change to LOC. S/S - No ALOC, numbness, weakness, dizziness, unusual smells

Focal Onset Impaired-Awareness: have ALOC and do not interact normally. S/S: ALOC, Lip smacking, eye blinking, isolated convulsions, do not recall events during seizure

Question 10

A 32 year old patient is semi-conscious and incontinent. The patient has tachypnea with deep breathing and is regaining consciousness slowly. The current symptoms are MOST likely caused by what condition? What is the cause of their rapid breathing?

Answer 10

Postictal State

Breathing becomes labored (fast and deep) to compensate for the buildup of acids in the bloodstream

(735)

Question 11

A 43 year old is lying in bed and complains of a sudden and severe headache. The patient has slurred speech, has vomit on their shirt and is not able to answer most of your questions. The RR is 20, HR is 66, BP is 188/96, and the SPo2 is 95%. These S/S are commonly seen in what condition? What is your treatment for this patient?

Answer 11

Hemorrhagic Stroke.

Treatment: Support XABCs, rapid transport to a stoke center

(729, 748)

Question 12

You decide to perform a Cincinnati Stroke Scale on a patient. Describe how you explain to your patient on how to perform the arm drift procedure.

Answer 12

Ask the patient to extend both arms fully in front of them with the palms facing upward. Ask them to close their eyes as you count down.

(742)

Question 13

You are assessing a 39 year old patient who is actively seizing. Coworkers state the patient has been seizing on and off for over 10 minutes and has not regained consciousness. Your treatment for this patient should include what? What is your working diagnosis for this patient?

Answer 13

Status epilepticus

Call for ALS. Restrain the patient from self-harm.
Manage patients ABCs.

Administer high flow O2 using a NRM and check patients SPo2 levels.

Obtain Blood glucose levels to rule out hypoglycemia as a cause of the seizure.

Rapid transport to a hospital, preferably one with a Stroke / Nuerological center.

Question 14

Febrile seizures are common in what segment of the population?

Answer 14

Children between 6 months to 5 years old

Question 15

What is the most appropriate initial question to ask the family of a patient showing S/S of a stroke?

Answer 15

When was the last time you saw the patient in a normal and symptom free state?

Question 16

You are assessing a semi-conscious patient with incontinence present. The airway is patent, RR is 34, HR is 112, BP is 142/88, SPo2 is 93%, blood glucose is below normal at 32mg/dl. What is your diagnosis for this patient? What is the appropriate treatment plan?

Answer 16

Hypoglycemia.

Supply supplemental O2 via nasal cannula. Give patient oral glucose immediately. Immediately transport to ER while monitoring patients vitals, especially Blood Glucose Level

Question 17

In the scenario above, after the treatment the patient is A&Ox4 and does not want to go to the hospital. How do you proceed with the management of this patient?

Answer 17

Explain to the patient the risk of not going to the hospital

Have patient sign a release document

Let patient go

Question 18

A 48 year old patient presents signs of acute AMS. List all appropriate assessments for the patient.

Answer 18

Glasgow coma scale
Blood Glucose Level (BGL)
Cincinnati stroke scale
LA stroke scale

Question 19

The brain stem controls most basic functions. List three of these functions as described in the textbook.

Answer 19

Breathing, swallowing, blood pressure

Question 20

What is thought to be the cause of migraine headaches?

Answer 20

Change of blood vessel size in the brain

Question 21

A 58-year-old is c/o a sudden onset of a headache, the worst they have ever felt. The patient is alert and oriented, skin is normal, RR is 24, HR is 104 and BP is 168/110 and the SpOz is 98%. What is the most likely cause of these S/S? What is the treatment for this patient?

Answer 21

Hemorrhagic stroke

Treatment: is rapid transport

Question 22

You are dispatched to a residence for a patient who has AMS. Upon arrival, the patient appears normal and is answering all of your questions appropriately. The family states that the patient was staring straight ahead but would not respond when spoken to. They also state that the patient’s mouth was drooping to the right and the right arm appeared to be limp. What is the treatment for this patient? What is your working diagnosis for this patient?

Answer 22

Transient Ischemic Attack (TIA)

Treatment: Rapid transport

Question 23

The highest risk factor for a hemorrhagic stroke is what condition?

Answer 23

Chronic High Blood Pressure

Question 24

A patient who suffers a stroke in the right hemisphere of the brain may experience a speech disorder called:

Answer 24

Dysarthria: Slurred speech

Question 25

A 71-year-old patient who appears to be awake and alert is suffering from an acute onset of AMS. When you ask the patient’s name they are unable to speak. What is the medical term for this finding? What is the most likely cause of this sign? (be very specific)

Answer 25

Aphasia

Left hemisphere stroke

Question 26

You are assessing an unconscious patient who bystanders say was having a seizure. The patient’s muscles are now relaxed, and the breathing is fast and deep. These current signs and symptoms are most likely due to what condition? (for extra credit, explain why the breathing is fast and deep)

Answer 26

Postictal stage of seizure

Release of excess acid / co2 buildup in the blood stream

Question 27

What two signs typically characterize a generalized seizure?

Answer 27

Unconscious

Full body muscle twitching
(732)

Question 28

A 7-year-old patient presents with AMS and is not interacting normally with their environment. You notice the eyes are fluttering, and the lips are smacking; both episodes are repeatedly present and then go away. These S/S are most likely a result of what condition?

Answer 28

Focal onset impaired seizure

(732)