Ch 18 - Neuro Emergencies - Review

Question 1

Seizure (Causes)

Answer 1

Recent or prior head injury / a brain tumor (structural)
Metabolic problems (Metabolic)
Fever (Febrile)
A genetic disposition (epileptic)

Question 2

Altered Mental Status (Causes)

Answer 2

Intoxication
Head injury
Hypoxia
Stroke
Metabolic disturbances

Question 3

Tension Headach

Answer 3

Caused by muscle contractions in the head and neck
Attributed to stress
Pain is usually described as squeezing, dull, or as an ache. Usually do not require medical attention

Question 4

Sinus Headache

Answer 4

Caused by pressure that is the result of fluid accumulation in the sinus cavities
Patients may also have cold-like symptoms of nasal congestion, cough, and fever.
Prehospital emergency care is not required.

Question 5

Migraines

Answer 5

Thought to be caused by changes in blood vessel size in the base of the brain.
Pain is usually described as pounding, throbbing, and pulsating.
Often associated with nausea and vomiting, and may be preceded by visual changes
Can last for several hours or days

Question 6

Stroke (general info)

Answer 6

Also called a cerebrovascular accident (CVA)
Interruption of blood flow to an area within the brain
Results in the loss of brain function
There are two main types of stroke: ischemic and hemorrhagic.

Question 7

Ischemic Stroke

Answer 7

Most common, accounting for 87% of strokes
Results from thrombosis or an embolus
Symptoms may range from nothing at all to complete paralysis.
Atherosclerosis in the blood vessels is often the cause

Question 8

Hemorrhagic Stroke

Answer 8

Most common, accounting for 87% of strokes
Results from thrombosis or an embolus
Symptoms may range from nothing at all to complete paralysis.
Atherosclerosis in the blood vessels is often the cause. e. Berry aneurysms are a common cause of hemorrhagic strokes in healthy, young people.
i. Presents as the “worst headache of their life”
ii. Causes a subarachnoid hemorrhage

Question 9

Transient Ischemic Attack (TIA)

Answer 9

Stroke-like symptoms go away on their own in less than 24 hours.
May be a warning sign of a larger stroke to come
About one-third of patients who have a TIA will experience a stroke

Question 10

Stroke (S/S)

Answer 10

a. Facial drooping
b. Sudden weakness or numbness in the face, arm, leg, or one side of the body
c. Decreased or absent movement and sensation on one side of the body
d. Lack of muscle coordination (ataxia) or loss of balance
e. Sudden vision loss in one eye, or blurred and double vision
f. Difficulty swallowing
g. Decreased level of responsiveness
h. Speech disorders i. Aphasia: difficulty expressing thoughts or inability to use the right words (expressive aphasia) or difficulty understanding spoken words (receptive aphasia)
j. Slurred speech (dysarthria)
k. Sudden and severe headache
l. Confusion
m. Dizziness n. Weakness
o. Combativeness
p. Restlessness
q. Tongue deviation
r. Coma

Question 11

Focal Onset Seizure (S/S)

Answer 11

No change in the patient’s level of consciousness
May have numbness, weakness, dizziness, visual changes, or unusual smells/tastes
May have some twitching or brief paralysis

Question 12

Generalized Seizure (S/S)

Answer 12

characterized by unconsciousness and a generalized severe twitching of all muscles lasting several minutes or longer Altered mental status
Results from abnormal discharges from the temporal lobe of the brain
Lip smacking, eye blinking, isolated jerking
Unpleasant smells, visual hallucinations, uncontrollable fear, repetitive physical behavior

Question 13

Postictal State

Answer 13

After a seizure, the muscles relax and breathing becomes labored.
May be characterized by hemiparesis
Most commonly characterized by lethargy and confusion

Question 14

Syncope

Answer 14

Does not have a Postictal State

Question 15

BE-FAST Stroke Assessment

Answer 15

Balance, Eyes, Facial Droop, Arm Drift, Speech, Time

Question 16

GCS (Glasgow Coma Scale)

Answer 16

Eye Opening - Spontaneous, in response to sound, in response to pressure, none. Verbal Response - Oriented Convo, confused convo, inappropriate words, incomprhensible sounds, none Motor Function - obeys commands, localizes pressure, withdraws from pressure, abnormal flexion, abnormal extension, none

Question 17

Seizure (Emergency Care)

Answer 17

Supplemental oxygen is strongly advised.
For patients who are having a seizure:
Protect them from harm.
Maintain a clear airway by suctioning.
Provide oxygen as quickly as possible.
If head or neck trauma is suspected, provide spinal immobilization. For patients who continue to have a seizure, as in status epilepticus:
Suction the airway.
Provide positive pressure ventilations.
Transport quickly to the hospital.
Rendezvous with ALS, if possible. If the patient refuses transport after a seizure:
Contact medical control.
Follow local protocols.

Question 18

Headache (Emergency Care)

Answer 18

You should be concerned if the patient complains of:
A sudden-onset, severe headache
A sudden headache with fever, seizures, altered mental status, or following trauma. 2. Migraine
a. Always assess the patient for other signs and symptoms that might indicate a more serious condition.
b. Apply high-flow oxygen, if tolerated.
c. Provide a darkened and quiet environment.
d. Do not use lights and siren during transport.

Question 19

Stroke (Emergency Care)

Answer 19

1. Support the ABCs and provide rapid transport to a stroke center.
2. Maintain a Spo2 level of at least 94%.
3. Routine use of oxygen therapy is not recommended unless the patient is experiencing respiratory distress or is showing signs of hypoxia.
4. Fibrinolytic therapy and methods to mechanically remove the blood clot may reverse stroke symptoms and even stop the stroke if given within 3 hours (drugs) or 6 hours (mechanical methods).
5. If possible, transport to a designated stroke center.