Chapter 18: Neurologic Emergencies Flashcards
What are the main neurologic emergencies?
Seizure-surge of electrical activity in brain, stroke (or Cerebrovascular Accident “CVA”)-interruption of blood flow to brain, and AMS- AEIOUTIPS
What are the different types of strokes?
Ischemic: (87% of strokes) blood flow block via thrombosis/embolus
symptoms: loss of body function
causes/concerns: coronary artery disease, atherosclerosis, atrial fibrillations, blood thinners
Hemorrhagic: (13% strokes) bleeding in brain
causes/concerns: stress, exertion, hypertension {most sig risk factor}, weakened blood vessels, aneurysm
symptoms: sudden onset, SEVERE headache
Transient Ischemic Attack (TIA)
Resolves on own w/i 24 hours
May be a warning sign for a stroke. All TIAs should be examined by physician
What are the signs and symptoms of CVA and what are its mimics?
Facial drooping, sudden weakness/numbness in face arm, leg or one side of body, ataxia (lack muscle coordination)/loss of balance, sudden vision loss in one eye/blurred/double vision, abnormal eye movements, difficulty swallowing, decreased level of responsiveness, speech disorders, aphasia, (LH), slurred speech (RH), sudden/severe headache, confusion, dizziness, weakness combativeness, restlessness, tongue deviation coma.
Mimics: Hypoglycemia (low BGL, diabetes history), postictal state (recover within minutes), subdural/epidural bleeding: Trauma, alcohol,
What is important to remember in stroke Patient assessments?
ABCs, rapid transport, suction, O2 saturation
PA: D) Rapid transport is critical for prompt treatment
SA: Evaluate speech, Use stroke scale, Glasco coma scale
Transport: Protect paralyzed limbs
Reassessment: closely monitor changes in pulse, bp, respirations and GCS
What are the stroke scales?
BE-FAST: Balance, Eyes, Face, Arms, Speech, Time of onset, Cincinnati Prehospital Stroke Scale- Simple sentence, smile, hold arms out in front. S-LAMS-Cincinnati plus grip strength, LVO- facial droop, arm drift, grip strength
What is the Glasco Coma Scale?
EVM: 4, 5, 6,
Eye opening: None-1, Pressure-2. Sound-3, spontaneous-4
Verbal response: None-1, incomprehensible-2, inappropriate-3, confused conversation-4, orientated conversation-5
Motor response: None-1, abnormal extension-2, abnormal flexsion-2, withdraw from pressure-4, localizes pressure-5, obeys commands-6
What are the different kinds of seizures?
Generalized (tonic-clonic, gran mal): abnormal electrical discharges from large areas of the brain
-Characteristics: unconscious and generalized severe twitching ++ min or longer,
Focal (partial, petit mal): begins in one extremity
-Aware (no change in LOC), numbness, weakness, dizziness, change in vision, unusual smells/ tastes, no twitching or paralysis
-Impaired awareness: AMS and not interact normally,
–abnormal discharges from temporal brain lobe
–lip smacking, eye blinking, isolated convulsions/jerking, unpleasant smell, visual hallucinations, uncontrollable fear, repetitive physical behavior,
What is an aura?
It is a warning sign, it may be a change in vision or a hallucination
What are the causes of a seizure?
Congenital, high fever, brain structural problem metabolic, chemical problems in the brain, idiopathic (unknown)
Hypo/hyperglycemia, poisons, drug overdose, sudden withdrawal, phenytoin
What are common seizure medications?
Levetivacam (Keppra), Phenytoin (Dilantin), Phenobarbital, Carbamazepine (Tegretol), Valproate (Depakote), Topiramate (Topamax), Clonazepam (Klonopin)
What can an EMT do about a seizure?
Identify if it is the same as previous seizures, learn how seizure progressed, if the seizure has caused a lack of O2, a decrease in BGL, or an injury. Note if it caused incontinence.
monitor ABCs, provide emotional support, encourage seen by Dr, assess ability to refuse treatment
What is a postictal state?
It is the 5-30 minutes following a tonic-clonic seizure. Characterized by floppy muscles (which may cause a need for airway management), faster and deeper breathing, possible hemiparesis, may cause a patient to be combative.
What is AEIOUTIPS?
Causes of AMS
Alcohol
Epilepsy, endocrine, electrolytes
Insulin
Opiates & other drugs
Uremia
Trauma and temperature
Infection
Poisons, psychiatric
Shock, stroke, space-occupying lesion, subarachnoid hemorrhage.
What treatment can ease a migrane?
A dark and quiet environment. High flow O2
What is Emergency Medical Care for AMS?
AMS requires IMMEDIATE attention, what is the cause, is there a need for spine restriction, does the patient need airway and ventilation support?
