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EMT Class > Chapter 18: Altered Mental Status, Stroke, and Headache > Flashcards

Chapter 18: Altered Mental Status, Stroke, and Headache Flashcards

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1
Q

reticular activating system (RAS)

A

one of two components necessary for a patient to be awake/conscious, the network of nerve cells in the brain stem that constantly transmit environmental and sensory information to and from the cerebrum

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2
Q

altered mental status

A

significant indication of injury or illness in a patient, can range from simple disorientation to complete unconsciousness in which the patient is not responsive, even to painful stimuli

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3
Q

coma

A

an unconscious state in which the patient does not respond to painful stimuli

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4
Q

structural causes of altered mental status

A
  • brain tumor
  • hemorrhage in the cranium but outside of the brain
  • hemorrhage in the brain tissue
  • direct brain tissue damage from trauma to the brain
  • degenerative disease of the brain
  • brain abscess or infection
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5
Q

toxic-metabolic causes of altered mental status

A
  • severe hypoxia or anoxia
  • abnormal blood glucose conditions
  • liver failure
  • kidney failure
  • poisoning
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6
Q

other causes of altered mental status

A
  • shock
  • drugs that depress the central NS
  • post seizure
  • infection
  • cardiac rhythm disturbance
  • stroke
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7
Q

physical exam for altered mental status

A
  • head
  • pupils
  • mouth and oral mucosa
  • chest
  • breath sounds
  • abdomen
  • lower and upper extremities
  • lower extremities (peripheral edema)
  • posterior body
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8
Q

signs and symptoms of altered mental status commonly associated with trauma

A
  • obvious signs of trauma
  • abnormal respiratory pattern
  • increased or decreased HR
  • unequal pupils
  • high or low BP
  • Battle’s Sign
  • Raccoon eyes
  • pale, cool, moist skin
  • flexion or extension
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9
Q

Battle’s Sign

A

discoloration around eyes, late sign of altered mental status associated with trauma, suggests basilar skull fracture

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10
Q

signs and symptoms of altered mental status commonly associated with a non-traumatic or medical condition

A
  • abnormal respiratory pattern
  • dry or moist skin
  • cool or hot skin
  • pinpoint, midsize, dilated, or unequal pupils
  • stiff neck
  • lacerations to the tongue indicating seizure activity
  • high systolic BP and low HR
  • loss of bowel or bladder control
  • abnormally high or abnormally low blood glucose reading
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11
Q

AEIOU-TIPPSS

A

mnemonic for common causes of altered metnal status
A: Alcohol intoxication
E: Epilepsy (seizure)
I: Insulin (diabetic emergency)
O: Oxygen (hypoxia)
U: Uremia (toxic from kidney failure
T: Trauma
I: Infection
P: Psychiatric
P: Poisoning (including drug overdose)
S: Shock
S: Stroke

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12
Q

emergency medical care for altered mental status

A

along with care for the other injuries/conditions
1) consider spine motion restriction precautions
2) maintain a patent airway
3) suction any secretions, vomitus, or blood
4) maintain adequate oxygenation
5) be prepared to assist ventilation
6) position the patient: lateral recumbent position or supine (if ventilation needed)
7) transport

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13
Q

neurologic defecit

A

any deficiency in the functioning of the brain or nervous system

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14
Q

stroke/non-traumatic brain injury

A

a medical injury to the brain that is not related to trauma

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15
Q

AHA/ASA stroke chain of survival

A

1) rapid recognition of stroke signs and symptoms by the public and immediate access to EMS through 911
2) 911 call taker recognition of the signs and symptoms leading to rapid EMS dispatch
3) rapid EMS response, assessment, recognition of stroke, and transport while providing pre-arrival notification of a stroke patient to include the results of a verified stroke scale to the receiving medical facility
4) rapid diagnosis and treatment by the medical facility

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16
Q

F.A.S.T mnemonic for public stroke recognition

A

F: Facial droop
A: Arm weakness
S: Speech difficulty
T: Time to call 911 (if any sign or symptom found)

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17
Q

more subtle signs/symptoms of stroke

A
  • sudden onset of numbness or weakness to the face, arm, or leg, especially on one side of the body
  • sudden onset of confusion
  • sudden slurring of speech or trouble speaking or the ability to understand
  • sudden onset of blurred vision, double vision, or other vision disturbance in one or both eyes
  • sudden onset of dizziness, lack of balance or coordination, or trouble walking
  • sudden onset of a severe headache with no other known cause
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18
Q

collateral circulation

A

blood supply from the smaller arteries surrounding an occluded artery, to make up for the occluded artery

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19
Q

“electrically silent” cells

A

cells that do not get enough ATP to run their normal functions so they cannot produce or send out electrical impulses

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20
Q

ischemic penumbra

A

the area of ischemia during the stroke where the brain cells are electrically silent from lack of ATP but are still alive, aka ischemic shadow, it is possible to salvage these cells

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21
Q

infarct zone

A

the area of dead tissue due to a complete absence of blood flow

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22
Q

ischemic stroke

A

stroke caused by a blockage

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23
Q

hemorrhagic stroke

A

stroke causes by rupture and bleeding

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24
Q

thrombus

A

a clot that developed at the site of occlusion

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25
Q

thrombosis

A

the process of clot formation

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26
Q

thrombotic stroke

A

a stroke resulting from thrombus formation, severe headache not usually seen, typically has slower onset of symptoms

27
Q

embolus

A

a clot or other matter that has traveled from another area of the body

28
Q

cerebral embolism

A

when the emolys occludes the cerebral artery

29
Q

embolic stroke

A

stroke resulting from cerebral embolism, sudden onset of symptoms, usually when patient is awake and active

30
Q

types of ischemic strokes

A

thrombosis, embolism, atrial fibrillation and stroke

31
Q

aneurysm

A

a ballooning of a weakened area within an artery wall

32
Q

arteriovenous malformation (AVM)

A

a tangle of abnormally formed blood vessels in the brain or on its surface, divert blood directly from the artery to the vein and bypass capillaries

33
Q

hemorrhagic stroke symptoms

A

sudden onset, headache is common and often severe, rapid deterioration, seizures, stiff neck

34
Q

intracerebral hemorrhage stroke symptoms

A
  • headache
  • nausea and vomiting
  • weakness to one side of body
  • decreased consciousness
35
Q

subarachnoid hemorrhage stroke symptoms

A
  • worst headache
  • intolerance to light
  • vomiting
  • decreased consciousness
36
Q

anterior circulation stroke

A

occurs from the blockage of a cerebral artery that perfuses the cerebrum and cerebral cortex

37
Q

signs and symptoms of an anterior circulation stroke

A
  • paralysis and motor deficits
  • numbness, tingling, loss of sensation
  • language disturbance
  • vision disturbance
  • eye gaze
38
Q

aphasia

A

communication disorder from damage to language areas in the brain

39
Q

expressive aphasia

A

non-fluent, the patient knows what they want to say but cannot form the words

40
Q

receptive aphasia

A

fluent, the patient has difficulty understanding what you are asking or telling, but can form fluent words

41
Q

global aphasia

A

most severe, patient cannot understand or speak

42
Q

posterior circulation

A

perfuses the brainstem and cerebellum (only 1/5 of brain)

43
Q

signs and symptoms of a posterior circulation stroke

A
  • paralysis and motor deficits
  • numbness, tingling, loss of sensation
  • language disturbance (not usually aphasia, usually dysarthria)
  • vision disturbance
  • ataxia and vertigo
44
Q

dysarthria

A

slurred or difficult-to-understand speech caused by weakness or paralysis of the muscles used to form words

45
Q

transient ischemic attack (TIA)

A

“mini strokes,” cerebral artery blockage is temporary or transient, signs and symptoms disappear without any obvious permanent neurologic deficits

46
Q

cryptogenic stroke

A

a stroke that cannot be conclusively attributed to an embolism from the heart, thrombosis in the artery, or small artery disease

47
Q

Cincinnati prehospital stroke scale (CPSS)

A

tests for facial droop, arm drift, abnormal speech

48
Q

Los Angeles prehospital stroke screen (LAPSS

A

gathers info of: age greater than 45 years, history of seizures/epilepsy, duration of symptoms, wheelchair or bedridden status, blood glucose level, test asymmetry of strength

49
Q

Miami emergency neurologic deficit (MEND) scale

A

takes about 3 minutes to complete, more comprehensive, has CPSS elements as well as elements from NIHSS

50
Q

large vessel occlusion (LVO)

A

aka emergent large vessel occlusion (ELVO), a stroke caused by blockage of a large cerebral artery, has the highest mortality rate and worst patient outcomes

51
Q

rapid arterial occlusion evaluation (RACE) scale

A

enables prehospital providers to perform a quick assessment that can both predict the stroke and identify an LVO
- facial palsy
- arm motor function
- leg motor function
- head and gaze deviation
- aphasia (right side deficit)
- agnosia (left side deficit)

52
Q

questions to ask a stroke patient for a history

A
  • when did the symptoms begin
  • is there any recent history of trauma to the head
  • does the patient have a history of a previous stroke
  • was there any seizure activity noted prior to arrival
  • what was the patient doing at the time of onset of the signs and symptoms
  • does the patient have a history of diabetes
  • has the patient complained of a headache or a stiff neck
  • has the patient complained of dizziness, nausea, vomiting, or weakness
  • has the patient experienced any slurred speech
53
Q

other helpful questions to get info for hospital staff

A
  • does the patient take any oral anticoagulant drugs
  • does the patient have a history of hypertension
  • has the patient taken amphetamines, cocaine, or some other stimulant drug
  • was the onset of signs and symptoms gradual or sudden
  • did the signs and symptoms get progressively worse or better
  • did the paralysis or weakness affect one part of the body first and then progress to other areas
  • does the patient have a history of atrial fibrillation or irregular heartbeat
54
Q

emergency medical care for strokes

A

1) maintain a patent airway
2) suction secretions and vomitus
3) be prepared to assist ventilation
4) maintain adequate oxygenation
5) position the patient: left lateral recumbent (unresponsive), semi-fowlers less than 30°, supine position if spinal injury suspected
6) check blood glucose level if protocol permits
7) protect any paralyzed extremities
8) rapid transport

55
Q

vascular headache

A

due to dilation or distention of vessels or inflammation within the cranium

56
Q

migraine headaches

A

caused by spasm of vessels followed by vasodilation and a change in the chemicals that transmit nervous impulses in the brain. throbbing, generalized or localized, photosensitivity, nausea, vomiting, sweating

57
Q

cluster headaches

A

occur repetitively in clusters, similar to migraines, pain usually found only on one side of head or face in the temporal region or around the eye, typically excruciating

58
Q

tension headaches

A

caused by contractions of the muscles of the neck and scalp, tight or viselike pain, throbbing, aching, squeezing pain in frontal, temporal, occipital regions with radiation to neck and shoulders

59
Q

organic headaches

A

aka traction or inflammatory headaches, symptoms of another condition

60
Q

if called to a headache, these symptoms suggest a serious underlying condition

A
  • altered mental status
  • motor or sensory deficit
  • behavior change
  • seizure
  • first experience of this type of headache with an abrupt onset
  • worsening of pain with coughing, sneezing, or bending over
  • fever of stiff neck
  • change in the quality of a chronic headache
61
Q

emergency medical care for a headache

A

1) establish and maintain an adequate airway
2) be prepared to suction
3) assess and maintain adequate ventilation
4) maintain adequate oxygenation
5) place the patient in a position of comfort
6) always be prepared to treat for seizures and transport to a medical facility

62
Q

serious causes of a headache

A
  • tumor
  • bleeding within brain
  • bleeding around brain
  • meningitis
  • hypertension
  • hypoglycemia
  • carbon monoxide poisoning, other toxic inhalation
  • fever
  • hypoxia
  • stroke
  • depression
  • cyanide poisoning
63
Q

stroke

A

a sudden disruption in blood flow to the brain that results in brain cell damage

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