ch 18 Flashcards
What is the most common cause of a stroke
Ischemia due to a blockage of blood flow to the brain
What are the two main types of stroke
Ischemic and hemorrhagic
What is an ischemic stroke
A stroke caused by a blockage in a blood vessel in the brain
What is a hemorrhagic stroke
A stroke caused by bleeding into or around the brain
What is a transient ischemic attack (TIA)
A “mini-stroke” where symptoms resolve within 24 hours
Why is a TIA an emergency
It is a warning sign of a possible full stroke
What does the acronym FAST stand for
Face drooping Arm weakness Speech difficulty Time to call 911
What is the Cincinnati Prehospital Stroke Scale used for
Identifying possible stroke in the field
What is a seizure
A sudden surge of electrical activity in the brain
What are the two main categories of seizures
Generalized and focal (partial)
What is a generalized seizure
A seizure that affects both hemispheres of the brain (often with loss of consciousness)
What is a focal (partial) seizure
A seizure that affects only part of the brain; may or may not affect consciousness
What is status epilepticus
A seizure lasting more than 5 minutes or multiple seizures without regaining consciousness
What is postictal state
The period following a seizure (marked by confusion and fatigue)
What is syncope
A temporary loss of consciousness (fainting) due to insufficient blood flow to the brain
What is the most important tool for identifying a stroke
A thorough history and physical exam using stroke scales
What are common causes of altered mental status
Stroke seizure hypoglycemia trauma infection drugs/alcohol
What is the priority treatment for a stroke patient
Rapid recognition oxygen if needed and immediate transport to a stroke center
Should you give anything by mouth to a stroke patient
No due to risk of aspiration
Why is time critical in stroke management
Some treatments like thrombolytics must be given within a few hours of symptom onset
What part of the brain controls movement speech and thought
Cerebrum
What part of the brain coordinates muscle activity and balance
Cerebellum
What does the brainstem control
Basic life functions like breathing heart rate and consciousness
What arteries supply the brain with blood
Carotid and vertebral arteries
What is aphasia
Difficulty in producing or understanding speech
What is expressive aphasia
Patient understands but cannot speak or has difficulty forming words
What is receptive aphasia
Patient speaks clearly but the words do not make sense or they don’t understand others
What is dysarthria
Slurred or poorly articulated speech
What are some signs of stroke
Facial droop arm drift slurred speech confusion vision problems headache weakness
What are common causes of hemorrhagic stroke
High blood pressure aneurysms or trauma
What are common risk factors for stroke
Hypertension diabetes smoking atrial fibrillation age family history
What does “time is brain” mean in stroke care
The longer the brain lacks oxygen the more permanent damage occurs
What should you find out during stroke history
Time of symptom onset (or last known normal) and medications (especially blood thinners)
What is the difference between a simple and complex partial seizure
Simple has no loss of consciousness; complex involves altered mental status
What is an aura
A warning sensation before a seizure such as a smell taste or visual disturbance
What is the priority during an active seizure
Ensure scene safety protect patient from injury and provide oxygen if possible
How should you position a postictal patient
On their side (recovery position) to maintain airway
What should you suspect in any patient with AMS
Hypoglycemia stroke seizure trauma drugs infection
What should you check first in a patient with AMS
Blood glucose level
When should you suspect a structural brain problem
when there is gradual onset of AMS
When should you suspect a metabolic cause of AMS
With more generalized symptoms like confusion shaking or hypoglycemia
What is syncope most often caused by
A temporary drop in blood flow or oxygen to the brain
What distinguishes syncope from seizure
Syncope usually has quicker recovery and no postictal confusion
Most common type of stroke
Ischemic stroke
Primary cause of ischemic stroke
Blood clot blocking cerebral artery
Primary cause of hemorrhagic stroke
Ruptured blood vessel in brain
Key symptom of stroke affecting left hemisphere
Aphasia (speech/language problems)
Key symptom of stroke affecting right hemisphere
Neglect poor awareness movement deficits
Stroke mimic that resolves within 24 hours
Transient Ischemic Attack (TIA)
Stroke scale used in the field
Cincinnati Prehospital Stroke Scale
Aphasia
Inability or difficulty speaking or understanding speech
Treatment priority for stroke
Rapid transport to stroke center
Common cause of seizures in adults
Epilepsy trauma tumors stroke
Common cause of seizures in children
Fever (febrile seizures)
Generalized seizure
Involves entire brain causes loss of consciousness
Tonic-clonic seizure
Full-body stiffening followed by rhythmic jerking
Partial seizure
Affects one part of brain; may not involve LOC
Complex partial seizure
Altered mental status may include automatisms (involuntary repetitive movements)
Postictal state
Recovery period after seizure with confusion and fatigue
What is included in initial seizure care
Protect airway prevent injury administer oxygen
Definition of syncope
Temporary loss of consciousness due to decreased brain perfusion
Common causes of syncope
Vasovagal reaction low blood pressure dehydration arrhythmia
Clues to having syncope not a seizure
No postictal state quick recovery brief LOC
Syncope on exertion may indicate
Cardiac cause (dangerous needs evaluation)
Patient position for syncope recovery
Supine with legs elevated
Key history question for syncope
What were you doing just before it happened?
Why is the “last known well” time important
It determines if the patient is eligible for clot-busting medication
What are clues a patient had a seizure and not syncope
Tongue biting incontinence postictal confusion muscle twitching
What are clues a patient had syncope and not a seizure
Quick recovery pale skin no confusion after brief LOC
What does AEIOU-TIPS stand for
Alcohol Epilepsy/Endocrine/Electrolytes Insulin Overdose Uremia Trauma/Temperature Infection Psychogenic Stroke/Seizure/Shock/Syncope
Name a stroke mimic that looks like facial droop but isn’t a stroke
Bell’s Palsy
Name three stroke mimics
Hypoglycemia postictal state Bell’s palsy
What is CPSS used for
Rapid prehospital stroke identification
What are the three components of CPSS
Facial droop arm drift slurred speech
Why is reassessment critical in neurologic patients
Conditions like stroke or brain bleed can worsen quickly
When should you give oxygen to a stroke patient
Only if SpO2 is below 94% or the patient is in respiratory distress
Why shouldn’t you give high-flow O2 to all stroke patients
It may worsen outcomes unless patient is hypoxic
What should you do during an active seizure
Protect from injury do not restrain monitor airway
How should you protect a seizing patient
Move objects away cushion head place in recovery position after
What are signs of a worsening neurologic emergency
Decreased LOC unequal pupils vomiting new confusion
An elderly woman suddenly develops right-sided weakness and slurred speech. Her symptoms began 30 minutes ago and she’s still alert
Suspected stroke activate stroke alert and transport rapidly
A man had a full-body seizure lasting 3 minutes. He’s now confused sleepy and slow to answer questions
Postictal state following a generalized seizure
A teen collapses while standing in line at a concert. Bystanders report she was pale and regained consciousness quickly
Suspected vasovagal syncope
A child with a high fever begins seizing in front of caregivers The seizure lasts 2 minutes and resolves without meds
Febrile seizure ensure airway and monitor
Your patient presents with stroke-like symptoms that fully resolve within 10 minutes
Transient Ischemic Attack (TIA) still needs rapid transport
A 40-year-old diabetic male is confused combative and sweating. His glucometer reading is 34 mg/dL
Hypoglycemia mimicking stroke treat with oral glucose or IV dextrose
A patient is having repetitive seizures without waking up in between
Status epilepticus
A woman complains of a severe headache neck stiffness and photophobia. Vitals are stable but she seems disoriented
Possible meningitis or brain bleed isolate and transport
A male is found down unresponsive with a history of heroin use. His pupils are pinpoint and respirations are slow
Opiate overdose causing altered mental status
A patient has facial droop and slurred speech but can raise both arms evenly and is alert
Suspected stroke perform full stroke scale and transport to stroke center
A teen stares blankly and smacks his lips for 30 seconds without falling. He is confused afterward
Complex partial seizure
A woman reports dizziness nausea and brief loss of consciousness after getting up quickly
Likely orthostatic syncope evaluate for dehydration or underlying cause
