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EMT Key Points > Ch18: Neurologic Emergencies > Flashcards

Ch18: Neurologic Emergencies Flashcards

1
Q

Role of brainstem

A

the most basic functions of body such as breathing, bp, pupil constriction

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2
Q

Role of cerebellum

A

coordinate complex tasks e.g. playing piano, standing on one leg

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3
Q

Role of cerebrum

A

Front: emotions and thought
Middle: senses and movement
–> in most ppl, left and middle = speech
Back: sight

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4
Q

how many pairs of cranial nerves run DIRECTLY from the brain to the rest of the body

A

12

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5
Q

what is the large opening in the base of the skull called

A

foramen magnum

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6
Q

how many spinal nerves per each vertebrae

A

2, one on each side

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7
Q

what 3 changes is the brain most sensitive to?

A

oxygen, glucose and temperature

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8
Q

coma

A

state of unconsciousness where the patient cannot be roused

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9
Q

do the brain and spinal cord sense pain

A

no, they don’t have pain receptors

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10
Q

if the brain and spinal cord do not have pain receptors, what causes the feeling of headaches?

A

scalp
meninges (membrane around brain and SC)
blood vessels
muscles around head, neck & face

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11
Q

what causes tension headaches

A

caused by muscle contractions in the head & neck. caused by STRESS

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12
Q

quality of tension headache pain

A

dull, ache, squeezing

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13
Q

do tension headaches usually require medical attention?

A

no

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14
Q

what causes migraine headaches

A

change in size of blood vessels at the base of the brain

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15
Q

quality of migraine pain

A

pounding, throbbing, pulsating

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16
Q

are men or women more likely to get migraines

A

women by 3x

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17
Q

symptoms associated with migraines

A

nausea
vomiting
visual warning signs like partial vision loss

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18
Q

what causes sinus headaches

A

pressure build up in the sinus cavities

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19
Q

symptoms of sinus headaches

A

Pain, pressure and fullness in the cheeks, brow or forehead.
Worsening pain if you bend forward or lie down.

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20
Q

headache RED FLAGS

A

sudden onset
very severe pain - “worse than anything before”
explosive, thunderclap pain
altered mental status
neurologic deficits
changes in vision
one side paralysis or weakness
age over 50
depressed immune system
fever
stiffness

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21
Q

what is a hemorrhagic stroke?

A

ruptured blood vessel in the brain that causes an increase in intracranial pressure (ICP), hence a headache

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22
Q

early signs of ICP

A

altered mental status
seizures
vomiting
headache

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23
Q

causes of ICP

A

hemorrhagic stroke
tumor
swelling/inflammation from a recent head trauma

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24
Q

bacterial meningitis

A

bacterial infection of the meninges that results in headache, sensitivity to light, stiff neck and fever. CONTAGIOUS

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25
Q

what is a cerebrovascular accident (CVA)

A

stroke - interruption to blood flow in the brain that results in loss of function –> cause ischemia

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26
Q

ischemic stroke

A

caused by a blood clot that obstructs blood flow either a thrombus or embolus

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27
Q

thrombus

A

clot formed right at the site of obstruction

28
Q

embolus

A

clot stuck in a vessel that originated from somewhere else

29
Q

patients with what kind of conditions are more prone to ischemic strokes?

A

atrial fibrillation, they take blood thinners
and coronary artery disease

30
Q

how does atherosclerosis cause ischemic strokes?

A

if the plaque in the carotid vessel wall ruptures, blood clotting processes are stimulated and blood clots form. the clots can obstruct the carotid vessel and prevent blood flow to the brain.

31
Q

hemorrhagic stroke

A

bleeding in the brain because of ruptured vessel

32
Q

transient ischemic strokes

A

mini strokes caused by partial obstruction of vessel that resolves on its own

33
Q

general symptoms of stroke

A

face drooping
one side weakness
neglect - only lifting one arm
slurring (dysarthria)
lack of muscle coordination
loss of balance
aphasia - cannot express thoughts with the right words
severe headache
dizziness
confusion
combativeness
tongue deviation
coma

34
Q

symptoms of stroke in left hemisphere

A

*left, mid hemisphere controls SPEECH

aphasia - can test by asking patient a question
weakness or paralysis on right side

35
Q

symptoms of stroke in right hemisphere

A

slurred
left side weakness, paralysis
neglect - one arm, lack of pain, certain part of vision

36
Q

cerebral hemorrhage

A

bleeding in the brain characterized with high bp (either caused by or compensated with it)

37
Q

big indicator of cerebral hemorrhage

A

increasing blood pressure
followed by decreasing to normal level
and then sudden drops

38
Q

conditions that mimic stroke

A

hypoglycemia
postictal state - for 5-30 mins after a stroke where there is altered mental status and labored respirations
subdural, epidural bleeding

39
Q

bleed above dura of brain

A

epidural bleed

40
Q

bleed below dura of brain, but outside brain

A

subdural bleed

41
Q

what is the period of time between injury and deterioration in someone with epidural bleeding

A

lucid interval

42
Q

seizure

A

an episode of electrical surge that causes convulsions characterized by uncoordinated muscle activity and/or altered LOC

43
Q

generalized seizures

A

electrical surge from large area of the brain that causes generalized twitching and convulsions (generalized motor seizures).

sometimes it only shows as a brief lapse of consciousness (generalized absence seizures).

other symptoms associated w/ generalized seizures:
hyperventilation
tachycardia
sweating
drooling/salivation
incontinence

44
Q

postictal state

A

5 - 30 minutes after a generalized seizure when person might have:

altered LOC
hemiparesis (weakness on one side: stroke-like symptoms)
labored breathing to level hypercapnia

45
Q

focalized seizure

A

electrical surge coming from a particular area of the brain

46
Q

types of focal seizures

A

aware and impaired-awareness

both can either be motor or absence

47
Q

what happens during a focal-onset aware seizure

A

no changes in LOC
possible changes in senses
twitching of muscles that spread to extremities but not as much as generalized seizures
paralysis

48
Q

cause of focal-onset impaired-awareness seizure

A

abnormal discharges from temporary lobe

49
Q

what happens during a focal-onset impaired-awareness seizure

A

lapse of consciousness
isolated twitches e.g. lip smacking, eye blinking
unpleasant smells, visual hallucinations, fear, repetitive physical movements
patients don’t remember the episode

50
Q

aura

A

signs that a seizure is coming. e.g. vision impairment or hallucinations

51
Q

status epilepticus

A

when a seizure recurs every few minutes OR lasts more than 30 minutes

52
Q

what to do with status epilepticus

A

ALS!! need airway mgmt and medication to stop seizures

53
Q

common causes of seizures

A

1) epileptic
2) structural
- tumor
- scar tissue
- infection
- head trauma
- stroke
3) metabolic
- hypoglycemia
- hypoxia
- abnormal chemical values
- poisoning
- overdose
- withdrawal
4) febrile - fever in children

54
Q

seizure medications

A

levetiracetam (Keppra)
phenytoin (Dilantin)
phenobarbital
carbamazepine (Tegretol)
valproate (Depakote)
topiramate (topamax)
clonazepam (klonopin)

55
Q

causes of altered mental status

A

AEIOU TIPS

Alcohol
Epilepsy, Endocrine, Electrolytes
Insulin
Overdose or other drugs
Uremia

Trauma, temperature
Infection
Poisoning, psychogenic causes
Shock, stroke, seizure, syncope, subarachnoid hemorrhage

56
Q

delirium

A

change in mental status characterized by disorganized thoughts, hallucinations, disorientation, memory loss and changes in personality

56
Q

which is worse: seizures in a patient with a Hx of seizures or no Hx

A

no Hx because it indicates a potentially dangerous change in the brain e.g. tumor or intracranial bleeding

57
Q

stroke assessment

A

BE-FAST

Balance
Eyes
Facial droop
Arm lift
Slurring/speech
Time

58
Q

most commonly used pre-hospital stroke screening

A

Cincinnati Prehospital Stroke Scale
Los Angeles Prehospital Stroke Screen

59
Q

Cincinnati Prehospital Stroke Scale

A

FAS

Facial droop
Arm lift
Slurring/speech

60
Q

Los Angeles Prehospital Stroke Screen

A
  1. Age > 45
  2. History of seizures/epilepsy
  3. Symptoms <24h
  4. Patient is not bedridden or wheelchair-bound at baseline
  5. Blood gluc between 60-400 mg/dL
  6. Asymmetry in: face (smile/grimace), arms and grip
61
Q

what stroke scale is used in the hospital

A

NIH Stroke Scale (11 steps)

0 stroke symptoms
1-4 minor stroke
5-15 moderate stroke
16-20 moderate to severe stroke
20-42 severe stroke

62
Q

3-Item Stroke Severity Scale

A

LAG

LOC
0 = normal
1 = mild dysfunction
2 = severe dysfunction e.g. unconscious

Arm drift (hemiparesis)
0 = none
1 = drift
2 = no movement on one side

Gaze
0 = normal gaze
1 = mild dysfunction
2 = severe dysfunction - cannot follow moving objects (fixed gaze)

63
Q

Key information to document for a patient with suspected stroke

A

1) time of onset; sign + symptoms
2) GCS score
3) Stroke scale (NIH, LA, Cincinnati, LAG, BE-FAST)
4) Changes during reassessment

64
Q

within how many hours do fibrinolytic drugs work to reverse the clot of a stroke?

A

3 hours

65
Q

are febrile seizures in children usually benign or life-threatening?

A

benign

EMT Key Points (21 decks)

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