Chapter 17: Neurologic Emergencies

Question 1

Brain stem

Answer 1

Controls breathing, bp, swallowing, pupil constriction

Question 2

Cerebellum

Answer 2

Behind brain stem, controls fine movements such as writing, walking, and balance.

Question 3

Cerebrum

Answer 3

Divided into hemispheres that control the opposite side of the body. Front part controls emotion and thought, middle controls sensation and movement, back controls sight. Speech is usually controlled on the left side, near the middle of the cerebrum.

Question 4

Foramen magnum

Answer 4

Opening at the base of the skull that cranial nerves exit through.

Question 5

Pathophysiology

Answer 5

1. Brain is most sensitive to changes in oxygen, glucose, or temperature, which will cause neurologic change
2. If problem is with cardio or respiratory system, entire brain will be affected.
3. If problem is primarily with the brain, symptoms will only be experienced on one side.

Question 6

Tension Headaches

Answer 6

Most common. Muscle contractions in neck or head from stress. Squeezing, dull, or aching pain that will resolve on its own.

Question 7

Migraine headaches

Answer 7

3x more common in women. Changes in blood vessel size in the brain. Pounding, throbbing, or pulsating pain that can be accompanied by nausea, vomiting, flashing lights, or vision loss. Can last from hours to days.

Question 8

Sinus Headaches

Answer 8

Pressure from fluid accumulation in the sinus cavities. Cold like symptoms with congestion, fever, or cough. Pain is worse when bending forward.

Question 9

Chief complaint of headache

Answer 9

If sudden onset or severe, could indicate stroke, meningitis, or tumor.

Question 10

Headaches following trauma

Answer 10

Accompanied by fever, stiff neck, seizures, or AMS are serious.

Question 11

Bacterial meningitis

Answer 11

Indicated by headache, stiff neck, fever, and sensitivity to light.

Question 12

Stroke (Cerebrovascular Accident)

Answer 12

Interruption of blood flow to the brain, cells die from lack of oxygen as ischemia occurs. Can be hemorrhagic or ischemic.

Question 13

Ischemic Stroke

Answer 13

1. Most common- blood vessels are blocked by thrombus or embolus.
2. Can be caused by atherosclerosis

Question 14

Hemorrhagic Stroke

Answer 14

1. Bleeding in the brain- blood vessel ruptures, blood accumulates and forms a clot, which compresses brain tissue.
2. Often occurs due to stress or long term elevated bp
3. Indicated by severe headache (“worst pain I’ve ever felt”) is localized and then diffuse. Can be accompanied by seizures and AMS

Question 15

Aneurysm

Answer 15

Swelling of an artery due to defect. Indicated by sudden onset, very severe headache.

Question 16

Transient Ischemic Attack

Answer 16

“Mini Stroke”, stroke like symptoms that resolve within 24 hours.

Question 17

Symptoms of stroke

Answer 17

Facial drooping, sudden weakness or numbness on one side, lack of muscle coordination (ataxia), or loss of balance, sudden vision loss in one eye, blurred or double vision, slurred speech, headache, tongue deviation, aphasia (difficulty expressing thoughts).

Question 18

Left Hemisphere Problem

Answer 18

Exhibits aphasia or paralysis on right side

Question 19

Right Hemisphere Problem

Answer 19

Paralysis on left side, slurred speech. Neglect- forget paralyzed body parts exist. Difficulties with vision.

Question 20

Bleeding in brain

Answer 20

High blood pressure as body tries to force blood to brain.

Question 21

Conditions that may mimic stroke (3)

Answer 21

1. Hypoglycemia- glucose is needed for brain metabolism, causes AMS
2. Postictal state- lasts 5-30 minutes, labored respirations and AMS.
3. Subdural and epidural bleeding- occur due to trauma, may have a period before deteriorating (lucid interval).

Question 22

Seizure

Answer 22

Neurologic episode caused by surges of electrical activity in the brain. Can be convulsions or alteration in consciousness.

Question 23

tonic-clonic/ grand mal seizure

Answer 23

Affects both sides of the brain. Unconsciousness and severe twitching of the muscles. Tonic phase- period of constant muscle twitching and trembling. Incontinence.

Question 24

Petit mal/ absence seizure

Answer 24

Affects both sides of the brain. Patient stares in one direction and doesn’t respond to anyone.

Question 25

Simple Partial/focal seizure

Answer 25

Affects one side of the brain. Muscle twitches that are slow spreading, brief paralysis, visual changes, unusual smells or tastes, numbness or dizziness.

Question 26

Complex Partial seizure

Answer 26

AMS, lip smacking, eye blinking, isolated convulsions.

Question 27

Aura

Answer 27

Warning sign of a seizure. Visual changes (flashing lights, blind spots) or hallucinations.

Question 28

Status epilepticus

Answer 28

Seizures that continue every few minutes without the person regaining consciousness or last longer than 30 minutes. This is life threatening and will most likely require medication. Call ALS.

Question 29

Postictal State

Answer 29

Typically follows a generalized seizure. Patient has AMS, labored breathing, temporary paralysis. Patient can become violent. Lasts 5-30 minutes.

Question 30

Causes of Seizures

Answer 30

1. Congenital, or can occur in young children from a high fever
2. Structural- tumors, infection, (abscess, meningitis), scar tissue, trauma, stroke
3. metabolic- hypoglycemia, poisons, drug overdoses, withdrawal, hypoxia.

Question 31

Syncope vs Seizure

Answer 31

Fainting typically occurs when standing up, seizures occur in any position.

Question 32

Hemiparesis

Answer 32

Weakness on one side, can be experienced by hypoglycemic patients.

Question 33

Delirium symptoms

Answer 33

Confusion, personality changes, hallucinations, disorganized thoughts, decreased level of consciousness.
Delirium is a symptom, not a disease

Question 34

Causes of AMS

Answer 34

Head injury, intoxication, psychological disorders, infection.

Question 35

Patient Assessment- scene size up

Answer 35

1. Call for ALS early

2. Did anyone else witness what happened? When was the last time the patient appeared normal?

Question 36

Patient Assessment- Primary Assessment

Answer 36

1. Assess airway, breathing, circulation
2. Use AVPU scale to determine level of consciousness
3. Might have to provide an airway, suction, position to avoid aspiration.
4. Assess for items in mouth (from bystanders).
5. Patients with AMS should receive oxygen, give at a rate of 10-12 bpm

Question 37

Patient Assessment- History Taking

Answer 37

1. If unresponsive, look for bracelets or ask bystanders
2. Ask responsive patient what happened, evaluate speech, look for symptoms
3. If in postictal state, look for causes of a seizure.
4. Ask for SAMPLE, determine when the patient was last healthy.

Question 38

Patient Assessment- Secondary Assessment

Answer 38

1. Complete set of vital signs
2. For AMS, always check blood glucose
3. High bp or unequal pupils can indicate pressure in the brain (stroke).
4. Use stroke scale and GCS for AMS

Question 39

Status epilepticus care

Answer 39

Suction airway, provide BVM, meet with ALS if possible.

Question 40

Seizure care

Answer 40

Give oxygen, maintain airway, consider spinal immobilization. If they refuse transport, make sure they are completely oriented, has trauma, seizure history, and is being monitored by a physician.

Question 41

Stroke care

Answer 41

Don’t give oxygen. Check blood glucose.