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EMT > Chapter 18 > Flashcards

Chapter 18 Flashcards

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1
Q

Seizures may occur as a result of

A
  • Recent or prior head injury
  • A brain tumor
  • Metabolic problems
  • Fever
  • A genetic disposition
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2
Q

Possible causes of altered mental status include

A
  • Intoxication
  • Head injury
  • Hypoxia
  • Stroke
  • Metabolic disturbances
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3
Q

The brain is the body’s computer - it controls

A
  • breathing,
  • speech,
  • and all body functions
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4
Q

Three major parts of the brain

A
  • brainstem
  • cerebellum
  • cerebrum

The cerebrum is the largest part

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5
Q

The brainstem controls

A

Most basic functions.
- Breathing
- blood pressure
- swallowing
- pupil constriction

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6
Q

The cerebellum controls

A

muscle and body coordination

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7
Q

The cerebrum

A

The cerebrum is divided into right and left hemispheres.
- Each controls activities on the opposite side of the body.
- The front of the cerebrum controls emotion and thought.
- The middle controls sensation and movement.
- The back processes sight.

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8
Q

speech is controlled

A

In most people, speech is controlled on the left side of the brain near the middle of the cerebrum.

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9
Q

Messages sent to and from the brain travel through

A

nerves

Twelve cranial nerves run directly from the brain to parts of the head.

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10
Q

foramen magnum

A

the opening in the skull where the spine enters

  • The rest of the nerves join in the spinal cord and exit the brain through a large opening in the base of the skull called the foramen magnum.
  • At each vertebra in the neck and back, two nerves branch out (spinal nerves).
  • These carry signals to and from the body.
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11
Q

The spinal cord

A

The spinal cord is the continuation of the
brainstem. It exits the skull at the foramen magnum and
extends down to the level of the second lumbar vertebra.

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12
Q

Many different disorders may cause brain dysfunction, may affect the patient’s level of consciousness

A
  • speech
  • and voluntary muscle control
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13
Q

The brain is sensitive to changes in

A

oxygen,
- glucose,
- and temperature.

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14
Q

Headaches

A
  • One of the most common complaints
  • Can be a symptom of another condition or a neurologic condition on its own
  • Only a small percentage of headaches are caused by a serious medical condition.
  • Tension headaches, migraines, and sinus headaches are the most common.
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15
Q

Tension headaches

A
  • 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
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16
Q

Migraine headaches

A
  • 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
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17
Q

Sinus headaches

A
  • 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.
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18
Q

Serious conditions that include headache as a symptom are

A
  • hemorrhagic stroke (bleeding into the brain by the rupture of a blood vessel)
  • brain tumor (an abnormal mass of tissue in which cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells)
  • meningitis (inflammation of the tissues surrounding the brain and spinal cord)
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19
Q

Stroke

A
  • 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.
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20
Q

Ischemic Stroke

A
  • 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
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21
Q

Atherosclerosis

A

Atherosclerosis can damage the wall of a
cerebral artery, producing narrowing and/or a blood clot.
When a vessel is narrowed or completely blocked, blood
flow to part of the brain may be blocked, causing brain
cells to die because of the lack of adequate oxygenation

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22
Q

Hemorrhagic Stroke

A
  • Accounts for 13% of strokes
  • Results from bleeding inside the brain
  • Cerebral hemorrhages are often fatal.
  • People at high risk include those experiencing stress or exertion.
  • People at highest risk are those who have very high blood pressure.
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23
Q

Aneurysm

A

Swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall

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24
Q

Transient Ischemic Attack (TIA)

A
  • 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.
25
Q

Signs and Symptoms of Stroke

A
  • Facial drooping
  • Sudden weakness or numbness in the face, arm, leg, or one side of body
  • Decreased or absent movement and sensation on one side of the body
  • Lack of muscle coordination (ataxia) or loss of balance
  • Sudden vision loss in one eye
  • Blurred and double vision
  • Difficulty swallowing
  • Decreased level of responsiveness
  • Speech disorders
  • Aphasia
  • Slurred speech (dysarthria)
  • Sudden and severe headache
  • Confusion
  • Dizziness
  • Weakness
  • Combativeness
  • Restlessness
  • Tongue deviation
  • Coma
26
Q

Left Hemisphere

A

A stroke in the left cerebral hemisphere may cause aphasia.
- Inability to produce or understand speech
- Speech problems can vary widely.
- May also cause paralysis of the right side of the body

27
Q

Right Hemisphere

A
  • Stroke may cause paralysis of the left side of the body.
  • Usually, patients can understand language and are able to speak.
  • Patients may be oblivious to their problem (neglect).
  • Neglect and lack of pain cause many patients to delay seeking help.
28
Q

Bleeding in the Brain

A
  • Patients may have high blood pressure.
    – May be the cause of the bleeding
    – May be caused by the bleeding, as a compensatory response
  • Increasing blood pressure is an important sign.
  • Significant drops in blood pressure may occur as the patient’s condition worsens.
29
Q

Conditions That May Mimic Stroke

A
  • Hypoglycemia (a condition in which your blood sugar (glucose) level is lower than the standard range)
  • Postictal state (a period that begins when a seizure subsides and ends when the patient returns to baseline)
  • Subdural or epidural bleeding
30
Q

Bleeding outside the dura and under the skull is called

A

epidural bleeding

31
Q

Bleeding beneath the dura but outside the brain is called

A

subdural bleeding

32
Q

Seizures

A
  • A neurologic episode caused by a surge of electrical activity in the brain
  • Can take the form of a convulsion and/or can be associated with a temporary alteration in consciousness.
  • Two basic groups: generalized and partial (focal)
33
Q

Generalized Seizure

A
  • Results from abnormal electrical discharges from large areas of the brain
  • Typically characterized by unconsciousness and a generalized severe twitching of all muscles lasting several minutes or longer
34
Q

Absence Seizure

A
  • Does not involve any changes in motor activity
  • Characterized by a brief lapse of consciousness in which the patient seems to stare and not respond
35
Q

Partial (Focal) Seizure

A

Focal-onset aware seizure
- 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

Focal-onset, impaired awareness seizure
- 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

36
Q

Aura

A
  • Patients may experience an aura prior to a seizure.
  • Can include visual changes or hallucinations
  • People with a history of seizures recognize their auras and usually take steps to minimize injury.
  • Auras do not occur prior to every seizure, and not all patients with a seizure disorder experience an aura.
37
Q

Generalized Seizure

A
  • Characterized by sudden loss of consciousness, chaotic muscle movement and tone, and apnea.
  • May exhibit bilateral muscle movement characterized by a cycle of muscle rigidity and relaxation
  • Typically lasts less than 5 minutes
  • Followed by a postictal state
38
Q

Absence Seizure

A
  • Formerly called petit mal
  • May last for seconds
  • Patient fully recovers with a brief lapse of memory
39
Q

Status Epilepticus

A
  • Seizures lasting more than 5 minutes are likely to progress to status epilepticus.
  • Seizures that continue every few minutes without the person regaining consciousness or last longer than 30 minutes
40
Q

Epileptic seizures usually can be controlled by medications

A
  • Levetiracetam (Keppra)
  • Phenytoin (Dilantin)
  • Phenobarbital
  • Carbamazepine (Tegretol)
  • Valproate (Depakote)
  • Topiramate (Topamax)
  • Clonazepam (Klonopin)
41
Q

The Postictal State

A

The postictal state is a period that begins when a seizure subsides and ends when the patient returns to baseline

  • After a seizure, the muscles relax and breathing becomes labored.
  • May be characterized by hemiparesis (one-sided of the body muscle weakness)
  • Most commonly characterized by lethargy and confusion
    If the patient does not improve, consider other possible underlying conditions.
42
Q

Syncope

A

a loss of consciousness for a short period of time.

  • Seizures are often mistaken for syncope, or fainting.
  • Fainting typically occurs while the patient is standing.
  • Seizures may occur in any position.
    Fainting is not associated with a postictal state.
43
Q

Causes of AMS (altered mental state)

A
  • Hypoglycemia
  • Hypoxemia
  • Intoxication
  • Delirium
  • Drug overdose
  • Unrecognized head injury
  • Brain infection
  • Body temperature abnormality
  • Brain tumor
  • Overdose and/or poisoning
44
Q

XABC

A

XABC exsanguinating hemorrhage ( It occurs when someone loses enough blood to cause death), ABC

45
Q

Vital signs

A

Significant intracranial bleeding leads to a great deal of pressure in the skull, compressing the brain.
- Slow pulse and erratic respirations
- High blood pressure
- Changes in pupil size

If the patient has an AMS (altered mental state), check the blood glucose level.

46
Q

Stroke assessment

A

Stroke scales evaluate the face, arms, and speech.
- BE-FAST mnemonic
- Cincinnati Prehospital Stroke Scale
- Los Angeles Prehospital Stroke Screen
- 3-Item Stroke Severity Scale (LAG)
- Glasgow Coma Scale (GCS) score

47
Q

BE-FAST mnemonic

A

B - Balance - Watch for sudden loss of balance
E - Eyes - Check for vision loss

F - Face - Look for uneven smile
A - Arms - Check if one arm is weak
S - Speech - Listen for slurred speech
T - Time - Call 911 Right away

48
Q

Cincinnati Prehospital Stroke Scale

A
  • facial droop
  • dysarthria (where you have difficulty speaking because the muscles you use for speech are weak)
  • upper extremity weakness
49
Q

Los Angeles Prehospital Stroke Screen

A
  • unilateral deficit facial paresis
  • hand grip weakness
  • arm drift
50
Q

3-Item Stroke Severity Scale (LAG)

A
  • level of consciousness
  • gaze
  • motor function
51
Q

Glasgow Coma Scale (GCS) score

A

The GCS is scored between 3 and 15, 3 being the worst and 15 the best. It is composed of three parameters: best eye response (E), best verbal response (V), and best motor response (M). The components of the GCS should be recorded individually; for example, E2V3M4 results in a GCS score of 9. A score of 13 or higher correlates with mild brain injury, a score of 9 to 12 correlates with moderate injury, and a score of 8 or less represents severe brain injury.

https://www.uptodate.com/contents/image?imageKey=NEURO%2F81854

52
Q

ED physicians determine if there is bleeding in the brain for patients with a suspected stroke with a CT scan of the head

A

If no bleeding is present, the patient may be a candidate for blood clot dissolving medication.
Notify the hospital regarding the last time the patient was known to be without their current signs and symptoms of stroke.

53
Q

Patients who have had a seizure require definitive evaluation and treatment

A

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.

54
Q

For patients who continue to have a seizure, as in status epilepticus:

A

Suction the airway.
Provide positive pressure ventilations.
Transport quickly to the hospital.
Rendezvous with ALS, if possible.

55
Q

You should be concerned if the patient complains of

A

You should be concerned if the patient complains of:

56
Q

Migraine

A

Always assess the patient for other signs and symptoms that might indicate a more serious condition.
Apply high-flow oxygen, if tolerated.
Provide a darkened, quiet environment.
Do not use lights and siren during transport.

57
Q

Stroke

A

Support XABCs and provide rapid transport to a stroke center.
Maintain a SpO2 level of at least 94%.
Oxygen therapy not recommended unless the patient is in respiratory distress or is hypoxic.
If possible, transport to a designated stroke center.

58
Q

Seizure

A

The patient may be in a postictal state upon your arrival.
The patient may still be having a seizure:
Continue to assess and treat XABCs.
Protect the patient from harm.

If the patient refuses transport after a seizure:
Contact medical control.
Follow local protocols.

59
Q

Altered Mental Status

A

Determine the cause.
Provide spinal motion restriction.
Provide airway and ventilation support.
Transport to the appropriate facility.

EMT (9 decks)

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