Chapter 17: Neurologic Emergencies Flashcards
Brain stem
Controls breathing, bp, swallowing, pupil constriction
Cerebellum
Behind brain stem, controls fine movements such as writing, walking, and balance.
Cerebrum
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.
Foramen magnum
Opening at the base of the skull that cranial nerves exit through.
Pathophysiology
- Brain is most sensitive to changes in oxygen, glucose, or temperature, which will cause neurologic change
- If problem is with cardio or respiratory system, entire brain will be affected.
- If problem is primarily with the brain, symptoms will only be experienced on one side.
Tension Headaches
Most common. Muscle contractions in neck or head from stress. Squeezing, dull, or aching pain that will resolve on its own.
Migraine headaches
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.
Sinus Headaches
Pressure from fluid accumulation in the sinus cavities. Cold like symptoms with congestion, fever, or cough. Pain is worse when bending forward.
Chief complaint of headache
If sudden onset or severe, could indicate stroke, meningitis, or tumor.
Headaches following trauma
Accompanied by fever, stiff neck, seizures, or AMS are serious.
Bacterial meningitis
Indicated by headache, stiff neck, fever, and sensitivity to light.
Stroke (Cerebrovascular Accident)
Interruption of blood flow to the brain, cells die from lack of oxygen as ischemia occurs. Can be hemorrhagic or ischemic.
Ischemic Stroke
- Most common- blood vessels are blocked by thrombus or embolus.
- Can be caused by atherosclerosis
Hemorrhagic Stroke
- Bleeding in the brain- blood vessel ruptures, blood accumulates and forms a clot, which compresses brain tissue.
- Often occurs due to stress or long term elevated bp
- Indicated by severe headache (“worst pain I’ve ever felt”) is localized and then diffuse. Can be accompanied by seizures and AMS
Aneurysm
Swelling of an artery due to defect. Indicated by sudden onset, very severe headache.
Transient Ischemic Attack
“Mini Stroke”, stroke like symptoms that resolve within 24 hours.
Symptoms of stroke
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).
Left Hemisphere Problem
Exhibits aphasia or paralysis on right side
Right Hemisphere Problem
Paralysis on left side, slurred speech. Neglect- forget paralyzed body parts exist. Difficulties with vision.
Bleeding in brain
High blood pressure as body tries to force blood to brain.
Conditions that may mimic stroke (3)
- Hypoglycemia- glucose is needed for brain metabolism, causes AMS
- Postictal state- lasts 5-30 minutes, labored respirations and AMS.
- Subdural and epidural bleeding- occur due to trauma, may have a period before deteriorating (lucid interval).
Seizure
Neurologic episode caused by surges of electrical activity in the brain. Can be convulsions or alteration in consciousness.
tonic-clonic/ grand mal seizure
Affects both sides of the brain. Unconsciousness and severe twitching of the muscles. Tonic phase- period of constant muscle twitching and trembling. Incontinence.
Petit mal/ absence seizure
Affects both sides of the brain. Patient stares in one direction and doesn’t respond to anyone.
Simple Partial/focal seizure
Affects one side of the brain. Muscle twitches that are slow spreading, brief paralysis, visual changes, unusual smells or tastes, numbness or dizziness.
Complex Partial seizure
AMS, lip smacking, eye blinking, isolated convulsions.
Aura
Warning sign of a seizure. Visual changes (flashing lights, blind spots) or hallucinations.
Status epilepticus
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.
Postictal State
Typically follows a generalized seizure. Patient has AMS, labored breathing, temporary paralysis. Patient can become violent. Lasts 5-30 minutes.
Causes of Seizures
- Congenital, or can occur in young children from a high fever
- Structural- tumors, infection, (abscess, meningitis), scar tissue, trauma, stroke
- metabolic- hypoglycemia, poisons, drug overdoses, withdrawal, hypoxia.
Syncope vs Seizure
Fainting typically occurs when standing up, seizures occur in any position.
Hemiparesis
Weakness on one side, can be experienced by hypoglycemic patients.
Delirium symptoms
Confusion, personality changes, hallucinations, disorganized thoughts, decreased level of consciousness.
Delirium is a symptom, not a disease
Causes of AMS
Head injury, intoxication, psychological disorders, infection.
Patient Assessment- scene size up
- Call for ALS early
2. Did anyone else witness what happened? When was the last time the patient appeared normal?
Patient Assessment- Primary Assessment
- Assess airway, breathing, circulation
- Use AVPU scale to determine level of consciousness
- Might have to provide an airway, suction, position to avoid aspiration.
- Assess for items in mouth (from bystanders).
- Patients with AMS should receive oxygen, give at a rate of 10-12 bpm
Patient Assessment- History Taking
- If unresponsive, look for bracelets or ask bystanders
- Ask responsive patient what happened, evaluate speech, look for symptoms
- If in postictal state, look for causes of a seizure.
- Ask for SAMPLE, determine when the patient was last healthy.
Patient Assessment- Secondary Assessment
- Complete set of vital signs
- For AMS, always check blood glucose
- High bp or unequal pupils can indicate pressure in the brain (stroke).
- Use stroke scale and GCS for AMS
Status epilepticus care
Suction airway, provide BVM, meet with ALS if possible.
Seizure care
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.
Stroke care
Don’t give oxygen. Check blood glucose.
