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EMT Knowledge > Chapter 15: Neurologic Emergencies > Flashcards

Chapter 15: Neurologic Emergencies Flashcards

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1
Q

Discuss

How many cranial nerves are there?

A

12

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2
Q

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What environmental factors is the brain sensitive to?

A

O2, glucose, temperature

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3
Q

Discuss

Possible causes of headache

A
  • Not life threatening: Tension (stress), migraines (changes in blood vessel size in brain), sinus headaches
  • Serious causes:
  • hemorrhagic stroke
  • brain tumors
  • meningitis
  • Beware sudden onset
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4
Q

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…the two types of CVA?

A

Ischemic and hemorrhagic.

  • Ischemic: blockage of blood flow due to thrombosis or embolus. This is 80% of strokes, often associated with atherosclerosis.
  • Hemorrhagic results from ruptured blood vessel causing intracranial pressure and brain damage. Compressed tissue loses blood supply. Commonly with stress or exertion, with chronic high BP.
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5
Q

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Subarachnoid hemorrhage

A

Results in sudden severe headache, “worst ever”

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6
Q

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TIA

A

Transient ischemic attack: when stroke symptoms go away in <24 hrs. All should be evaluated by physician since a TIA indicates stroke risk.

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7
Q

Discuss

CVA/TIA S/S

A

Ataxia, dysphasia (speech disorder), expressive aphasia (difficulty expressing thoughts), dysarthria (slurred speech), receptive aphasia (difficulty understanding others)

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8
Q

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What are indicators of the location of the CVA?

A

Left hemisphere: aphasia (inability to produce/understand speech), paralysis of right side. Right hemisphere: Left side paralysis, may be oblivious to their problem “Neglect”

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9
Q

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What would suggest hemorrhagic stroke over ischemic?

A

Increasing BP as the body compensates for perceived lack of pressure to perfuse brain

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10
Q

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Conditions mimicking stroke

A

Hypoglycemia, postictal state, subdural (slow onset of AMS because usually a vein) or epidural bleeding (fast onset of AMS because usually an artery)

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11
Q

Discuss

Components of the Cincinnati Stroke Scale

A
  1. Facial droop (“smile!”);
  2. Arm drift (“close your eyes and hold both arms out with palms up”);
  3. Speech (“Say, ‘the sky is blue in Cincinnatti’”). DOCUMENT TIME OF ONSET AND GET GCS score
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12
Q

Discuss

Generalized seizure

A

Unconciousness and twitching of body. From abnormal discharges from large areas of the brain (grand mal) OR a brief lapse of consciousness (petite mal)

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13
Q

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Partial seizure

A

Begins in one part of the brain and can be simple or complex.

  • Simple: no change in LOC, just weakness or dizziness or numbness. May involve senses. May involve extremity twitching.
  • Complex: AMS, isolated convulsions, repetitive physical behavior like lip smacking and eye blinking (automatisms), smells and hallucinations,
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14
Q

Discuss

Aura

A

A feeling a patient may get that warns them a seizure is coming

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15
Q

Discuss

Tonic-clonic seizure

A

Bilateral muscle rigidity and relaxation 1-3 minutes, rhythmic back and forth motion of extremity, with tachycardia, hyperventilation, sweating, salivation

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16
Q

Discuss

Typical time progress of seizure

A

Seizures last 3-5 minutes followed by 5-30 minute postictal state

17
Q

Discuss

Postictal state

A
  • Floppy muscles
  • slowly regaining LOC
  • labored breathing, fast and deep to combat acidosis
  • Occasional hemiparesis.
  • Sometimes combative.
18
Q

Discuss

Hemiparesis

A

Weakness on one side of body. Can occur in postictal state and mimick stroke.

19
Q

Discuss

Status epilepticus

A

Seizures that continue every few minutes without regaining consciousness OR seizures lasting longer than 30 minutes. POTENTIALLY LIFE THREATENING. Pt needs ALS for medication and advanced airway management.

20
Q

Discuss

Causes of seizures

A
  • Epileptic: congenital.
  • Structural: tumor, infection, scar tissue, head trauma, stroke.
  • Metabolic: hypoxia, hypoglycemia (monitor blood glucose closely after seizure since the seizure can dramatically lower levels), poisoning, drugs, withdrawal, chemical imbalance (eg electrolytes).
  • Febrile: sudden high fever. Usually well tolerated by child, but needs evaluation.
21
Q

Discuss

Seizure meds

A

Dilantin, phenobarbital

22
Q

Discuss

Seizure treatment

A

Encourage pt to see physician, package softly, do not restrain, give O2 and consider NPA in pt having a seizure

23
Q

Discuss

What are possible causes of AMS?

A
  • T: Trauma
  • I: Infection
  • P: Psychogenic
  • S: Seizure/syncope
  • A: Alcohol
  • E: Electrolytes
  • I: Insulin
  • O: Opiates
  • U: Uremia
24
Q

Discuss

How to distinguish hypoglycemia from stroke and seizure

A

Hypoglycemia almost always has altered LOC. Pt’s will have meds that lower blood glucose level. If pt has hypoglycemic seizure, their mental status may not improve during the postictal state

25
Q

Discuss

Glasgow Coma Scale

A
  • Eye opening
    • 4: Spontaneous
    • 3: In response to speech
    • 2: In response to pain
    • 1: None
  • Best Verbal Response
    • 5: Oriented conversation
    • 4: Confused conversation
    • 3: Inappropriate words
    • 2: Incomprehensible sounds
    • 1: None
  • Best Motor Response
    • 6: Obeys commands
    • 5: Localizes pain
    • 4: Withdraws to pain
    • 3: Abnormal flexion
    • 2: Abnormal extension
    • 1: None
26
Q

Discuss

Significance of GCS scores

A

13-15: Mild dysfunction to none. 9-12: Moderate dysfunction. <8: Severe dysfunction

27
Q

Discuss

Questions to ask when postictal pt refuses transport

A

Awake and completely oriented (GCS of 15?). No indication of trauma or complications? Has patient had seizure before? Was this seizure the “usual” seizure in every way? Pt currently being treated with meds and receiving regular evaluations? If yes to all, consider agreeing to refusal to transport

28
Q

Discuss

Aneurysm

A

Swelling or enlargement of part of blood vessel –> weakening of vessel wall

29
Q

Discuss

Aphasia

A

Inability to understand/produce speech

30
Q

Discuss

Coma

A

State of profound unconsciousness from which one cannot be roused

31
Q

Discuss

Thrombosis

A

Clotting of cerebral arteries that may result in the interruption of cerebral blood flow

EMT Knowledge (22 decks)

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