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neuro/defib Flashcards

1
Q

Broca’s area

A

Motor/ expressive speech area that controls the output of words (verbal/written) to ensure they are coordinated/ appropriate

Base of the frontal lobe

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2
Q

Mean arterial pressure (MAP)

A

70-100 mmHg, <60mmHg can be deadly to organs

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3
Q

Main areas of the spine

A

Cervical- C1-C7

Thoracic- T1-T12

Lumbar- L1-L5

Sacral- S1-S5

Coccyx- 4

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4
Q

Why does crushing’s reflexes happen

A

The widening pulse pressure and decreased pulse is from the heart trying to perfuse the brain so the heart must work harder to push past the increased IPC to bring blood to the brain

Irregular respirations are from the pressure being put on the medulla from the ICP which interferes with the respiratory and cardiac centers

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5
Q

major bleeding in neuro pts

A

direct pressure not too excessive if skull fracture present/ suspected, active bleeding worsens hypoxia, active bleeding decreases CPP (less volume needs more pressure to perfuse)

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6
Q

Hemispheres of the brain

A

Two hemispheres- left and right, each with 4 major lobes: frontal, parietal, temporal, occipital

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7
Q

Medical TOR criteria in the ALS

A

Age >16 years old, altered LOA, arrest not witnessed by EMS and no ROSC 20 min of resuscitation and no defibrillation delivered

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8
Q

Parasympathetic nervous system

A

Dominates digestive system and aids in recovery after sympathetic stimulation

Responsible for slowing of RR, HR, constriction of pupils

Largely innervated by the vagus nerve

Active chemical neurotransmitter is Ach

Antagonistic effects that maintain homeostasis (opposite effects- one is dominating other is blocking ability of the other)

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9
Q

Neurons

A

Specialized cells that conduct impulses through CNS/PNS that requires glucose/O2 for metabolism

Parts:

Dendrite- receptor site that conducts impulses towards the cell body

Cell body- contains the nucleus

Axon- conducts impulses away from cell body towards effector site or connecting neuron

Myelin sheath- insulates the fiber and speeds up the rate of conduction

Nodes of ranvier- spaces between the myelin sheaths

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10
Q

Acetylcholine

A

Neurotransmitter present at neuromuscular junctions and in the autonomic nervous system and peripheral nervous system

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11
Q

What are the most common errors in prehospital defibrillation

A

Improper pad placement and poor adhesive contact

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12
Q

5 main uses of ETCO2 in cardiac arrest

A

Verify tracheal tube placement, identify tracheal tube displacement, evaluate CPR quality, identify ROSC, determine when ROSC is unlikely

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13
Q

Ninth cranial nerve

A

Glossopharyngeal- sensory/motor, taste, gag reflux

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14
Q

Serotonin

A

Neurotransmitter for mood, sexual desire/function, appetite, sleep, memory/learning, temperature regulation, and social behavior

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15
Q

ROSC- post arrest care

A

Fluid bolus- >2 years old
Ensure chest is clear and BP is hypotensive, 10 ml/kg, max 1000ml, reassess every 100ml >2-<12 years and reassess every 250ml >12 years
Oxygenation- BVM ventilations are required, titrate SPO2 to 94-98%, avoid hyperventilation (ETCO2 40-40mmHg)

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16
Q

What do you do if you obtain a ROSC

A

Complete assessment of CAB, 12 lead, full set of vitals, continually reassess and treat findings

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17
Q

what changes in vitals would you see with a head injury

A

irregular respirations, decreased GCS, sluggish/unresponsive pupils, cool clammy skin, increased systolic BP that widens until decreased as compensatory mechanisms fail

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18
Q

How to manage airway

A

Airway: suctioning/ positioning

Breathing: IPPV, oxygenation (hyperventilation)

Circulation: monitor BP, ECG, IV

Positioning: supine with head elevated 15 degrees

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19
Q

Tension headaches

A

Muscle contractions of the face, neck, and scalp from stress, persistent noise, poor posture, and eye strain

Most common type of headache

Treatment: analgesics

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20
Q

Ischemic strokes

A

Occlusions of an artery from plaque buildup or an embolus causing sudden obstruction

S&s: hemiparesis/hemiplegia, contralateral numbness/ facial drooping, aphasia, confusion/coma, convulsions, incontinence, diplopia, dysarthria, headache, dizziness

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21
Q

Cluster headaches

A

Occurs in short lasting bursts on repeat for days or months (half/two hours) often during sleep due to abnormalities in biological clock (hypothalamus) causing severe pain around one eye, tearing and nasal congestion

Treatment: antihistamines, corticosteroids, calcium channel blockers, analgesics

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22
Q

What are the signs of an obviously dead patient

A

Decapitation, transection, visible decomposition, putrefaction, absence of vital signs and grossly charred body, an open head/torso wound with gross outpouring of cranial or visceral contents, gross rigor mortis, or dependent lividity

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23
Q

Pia mater

A

Inner most layer of connective tissue that adheres closely to the convolutions on the brain

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24
Q

Complex partial seizure

A

Arise from focal seizures in the temporal lobe (psychomotor) that manifest as changes in behavior and present as abnormal repetitive motor behavior and a period of amnesia with a brief duration

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25
Migraines
Severe headaches preceded by visual/ GI disturbances with onset of an intense throbbing pain unilaterally accompanied by nausea and vomiting, constriction and dilation of blood vessels, sensitivity to light, sound or smell
26
Autonomic nervous system
Branch of the PNS that acts as the involuntary control and has two further branches: SNS (sympathetic nervous system) and PNS (parasympathetic nervous system)
27
What are the causes of PEA
Hypovolemia, hypoxia, hyper/hypokalemia, hypothermia, H+ (acidosis), trauma, tension, tamponade, toxins, thrombosis
28
Petit mal
Generalized Absence seizures around kids 4-12 with a lapse of consciousness, no loss of posture or motor activity, isolated clonic activity for a short period then return to normal.
29
Pregnancy in cardiac arrest
Pregnancy presumed to be >20 weeks' gestation Run as regular medical arrest and consider very ealy transport after a minimum 1 analysis and egress plan is organized TOR contraindicated
30
Airway obstruction in cardiac arrest
High instances in children, focus on high-quality CPR, consider very early transport (after 1 analysis and egress plan is organized), transport to closest ER since PT is CTAS 1 If airway obstruction is relieved prior to early transport, consider running a longer arrest on scene TOR is contraindicated
31
Where should the pt be during cardiac arrest
Hard flat surface with enough space- possibly stretcher and plan extrication Move pt only if necessary and notify PD and document and do not move pt back
32
Status epilepticus
prolonged seizure activity that is reoccuring seizures before regained consciousness
33
Third cranial nerve
Oculomotor- motor, eye movements including eyelids
34
Spinal cord makeup
Starts at the medulla and ends at L1 (after L1 spinal cord is called cauda equina “horse tail”) and is protected by vertebral column, meninges, and CSF Consists of nerves that innervate the skeletal muscles with ascending/ descending tracts (afferent/efferent pathways)
35
What are the signs of a ROSC
Sudden increase in ETCO2, spontaneous respirations, palpable pulses, change in colour, spontaneous movement
36
Fifth cranial nerve
Trigeminal- sensory/motor, general sensory- eye, nose, face or oral cavity, teeth, speech muscles
37
Tenth cranial nerve
Vagus- sensory/motor, external ear, parts of taste, heart and lung smooth muscle, glands of GI system, diaphragm
38
Cerebellum
Coordinates movement, maintain posture and equilibrium from taking impulses from visual pathways, vestibular pathways, and proprioceptors in joints and muscles
39
Stroke test
B- balance: loss of balance, headache, or dizziness E- eyes: blurred vision F- face: one side of face is drooping A- arms: arm or leg weakness S- speech: speech difficulty T- time: all for an ambulance immediately
40
Trauma TOR conditions
>16 years, no palpable pulses and no defibrillation delivered and rhythm asystole or no signs of life at any time since fully extricated, or signs of life when fully extricated with the closest ED >30 min transport time away, or rhythm PEA with the closest ED >30 min away
41
Fourth cranial nerve
Trochlear- motor, eye movements
42
Brainstem
Pons: contains afferent (incoming) and efferent (outgoing) fibers Medulla: vital control to regulate respiratory and cardiovascular function RAS (reticular activating system): determines degree, arousal, awareness of cerebral cortex (decides what sensory impulses brain ignores/notices)
43
Multiple sclerosis (MS)
Progressive autoimmune disease of the CNS that causes patches of the myelin in brain/spine to be destroyed causing issues in nerve conduction and message impulse S&s: physical/mental problems, muscle weakness, sensation troubles, vision issues (double/ blindness) No cure- meds slow progression
44
Subdural hematoma
Bleeding between the dura and the arachnoid from injury to underlying brain tissues where blood accumulates slowly so diagnosed hours to days later Tear in the arachnoid can cause loss of CSF in subdural space increased ICP High risk: alcoholics, people on blood thinners S&s: headaches, changes in LOC, slurred speech
45
conditions in medical cardiac arrest
CPR- LOA altered, 2 min intervals Defib- >24 hours, VF/ pulseless VT Epi- >24 hours, anaphylaxis as causative event
46
How does the blood brain barrier work
Cells are tightly joined together to form a barrier that limits the passage of damaging materials into the brain to control balance of electrolytes, glucose, and proteins Lipid soluble substances can still pass through
47
How do neurons work
Impulses are transmitted from cell to cell by neurotransmitters involving presynaptic and postsynaptic synapses Axon and receptor are separated by a synaptic cleft and for impulses to travel the chemical flows a crossed the cleft to the receiving receptor that are specific for each chemical type
48
what do sluggish pupils indicate
cerebral hypoxia or increased ICP
49
Hemorrhagic stroke
Hemorrhage in cranial vault from aneurysms, malformations, hypertension, stress/ exertion, cocaine with a sudden onset accompanied by headache, nausea, vomiting, quick deterioration
50
Basilar skull fracture
A fracture involving the base of the skull
51
frontal lobe functions
conscious thought and voluntary motor action
52
TIA (transient ischemic attack)
Focal cerebral dysfunction (temporary reduction in blood flow) that lasts minutes to hours then the patient returns to normal with no permanent damage Indicate obstruction related to atherosclerosis, can be from spasm of arteries and loss of autoregulation
53
Pre-arrival interventions with respect to TOR
Consult with BHP and advise them of interventions done by FD/other PTA and discuss
54
Advanced airways in cardiac arrest
Dont rush into advanced airways is BLS airways are adequate King LT/ I Gel
55
Norepinephrine/epinephrine
Neurotransmitter in the SNS that causes vasoconstriction and increase HR and stimulate alpha and beta receptors
56
Simple skull fracture
Linear crack or cracks with no displacement
57
Sympathetic nervous system
Increases level of activity like cardio, respiratory and neurological functions, flight/fight (Ach) and stress (epi/norepi) Antagonistic effects that maintain homeostasis (opposite effects- one is dominating other is blocking ability of the other)
58
Tonic phase
extensor muscle tone, apnea, tongue biting, incontinence, short duration
59
After 20 mins what do ETCO2 levels indicate
ETCO2 levels <10mmHg are associated with futility (exceptions include hypothermia) ETCO2 levels >25mmHg are associated with survival
60
Defibrillation in cardiac arrest
Heart is quivering but no blood is pumping so defib stuns heart muscles to allow the normal conduction to resume control If not defibbed, VF/VT will deteriorate to asystole Pt must be >24hrs
61
CNS breakdown
Made up of the brain and spinal cord. The brain receives, processed, and responds to sensory information and sends it to the spinal cord to be sent to the PNS
62
signs of basiliar skull fracture
raccoon eyes (bilateral periorbital ecchymosis), ottorhea (CSF from ears), rhinnorhea (CSF from nose), mastoid bruising (battles sign)
63
Joule settings >8 years
Zoll: 120J, 150J, 200J Lifepack: 200J, 300J, 360J
64
90-90-9 rule
double chance of death when SaO2 is below 90%, systolic BP <90mmHg, GCS <9
65
Second cranial nerve
Optic- sensory, vision
66
Somatic nervous system
Has sensory nerves and motor nerves Stretches to every part in the body to deliver information from your senses to your brain to carry out commands from brain to muscles for movement
67
Arachnoid mater
Middle layer that's a loose and web like covering
68
ACR documentation for a cardiac arrest
CPR, PPV (BVM/rate), OPA (size/toleration), suction (how much/response), rhythm interpretations, advanced airway if placed (size/ tolerated), BHP patch (orders received), extrication (what was used), delays to CPR, scene delays, anything of note on scene, pt movement
69
Causes of cardiac arrest
Atherosclerosis or underlying cardiac diseases, genetic disorders, cardiomyopathies, can occur after electrocution, drowning, trauma, drug overdose
70
Dopamine
Neurotransmitter that regulates impulses for mood
71
PNS breakdown
Is made up of the autonomic nervous system and the somatic nervous system
72
Cerebral perfusion pressure (CPP)
70-80 mmHg with no less of 60mmHg
73
Eighth cranial nerve
Vestibulocochlear- sensory, hearing and balance
74
Hematomas
Increased ICP as bleeding puts pressure on the tissues and when blood slowly accumulates blood cells undergo hemolysis (destruction of RBCs) and fluid in the area of accumulation exerts osmotic pressure and draws water to the area increasing size/pressure exerted by the mass
75
Grand mal
Preceded by an aura with a sudden onset with loss of organized muscle tone Tonic phase, clonic phase, postictal phase, status epilepticus
76
Parkinsons disease
Degeneration/damage to nerve cells in basal ganglia (voluntary motor movements) from a lack of dopamine which effects the nerve pathways controlling muscle contraction S&s: tense muscles, tremors, joint rigidity, slow movement
77
Depressed skull fracture
Part of the skull is indented posing a high risk for infection, CSF leaks, profuse bleeding, damage to brain tissue S&s: raccoon eyes, CSF from ears/nose, mastoid bruising
78
First cranial nerve
Olfactory- sensory, smell
79
Assessments for stroke
Facial droop (smile/raise eyebrows), arm/ leg weakness/ drift, slurred speech, inappropriate words, mute, pupils (assessed but not deciding factor of a stroke)
80
Sinus headaches
Pain in forehead, nasal area, eyes or pressure behind face due to buildup in sinuses from infection/ inflammation of membranes Treatment: analgesics, antihistamines, antibiotics
81
Meningitis
Bacterial infection of the meninges of the brain from microbes via the blood that can result from head trauma/ surgery or secondary to other infections like sinusitis or an abscess where the infection can spread through the bone S&s: headache, back pain. Nuchal rigidity, vomiting, irritability lethargy, fever, chills, rash
82
Non-opioid drug cardiac arrest
Prioritize scene safety, determine ingested substance used and dose, consider early transport (min 1 analysis and exit plan is organized), transport to closest ER since pt is CTAS 1 TOR is contraindicated
83
Clonic phase
rigidity, convulsions, ANS discharge, hyperventilation, salivation, tachycardia, 1-3 min
84
What are the reasons to prioritize an advanced airway
Vomit or airway full of secretions Prolonged resuscitation or extrication Poor seal with OPA/BVM
85
What is the life saving measures that are classified in a DNR in the BLS
Chest compressions, defibrillation, artificial ventilation, insertion of oropharyngeal/supraglottic airway, endotracheal tube, transcutaneous pacing, advanced resuscitation drugs- vasopressors, antiarrhythmic agents, and opioid antagonists
86
Simple partial seizures
Motor seizures clonic activity to one specific body part and sensory seizures are tingling, numbness, visual, auditory, and taste symptoms Jacksonian seizure: seizure activity involving a brief alteration in movement, sensation or nerve function
87
occipital lobe function
vision
88
parietal lobe function
body awareness
89
LAMS test
Facial droop: 0- absent, 1- present Arm drift: 0- absent, 1- drifts down, 2- falls rapidly Grip strength: 0- normal, 1- weak grip, 2- no grip Add score is >4 or equal to then having a stroke
90
Interventions prior to EMS arrival
Pre-arrival interventions are not counted into patient care- it can be considered and documented
91
Eleventh cranial nerve
Spinal accessory- motor, voluntary muscle of pharynx, head movements
92
How to confirm cardiac arrest
Assess C-A-B to determine if pt is in cardiac arrest due to many presentations appearing initially as cardiac arrest Check carotid/radial pulses and breathing in >10 seconds Is suspected apply pads immediately over chest leads
93
Types of strokes (CVAs)
Ischemic- 80-85%, rarely lethal in the first hour, conscious w/ alterations Hemorrhagic- less common and rapidly fatal, unconscious w/ no ability to perform testing
94
Types of seizures
Generalized- no definable origin where the entire brain is involved Partial- known focus
95
Cushing's reflex
Caused from cerebral ischemia, where to increase blood supply to the brain, the heart will increase systolic pressure to widen pulse pressure, decreasing pulse, and irregular respirations.
96
Pulse checks in cardiac arrest
Every 2 minutes and done in the last 15 seconds of the CPR cycle Do not delay time off chest if unable to palpate pulse/ unsure of pulse presence Also done if obvious signs of life is present
97
CSF
Clear colorless liquid used for a cushion for brain and spinal cord that is formed in the ventricles in the brain and flows into the subarachnoid space 500mls a day
98
Sub arachnoid hemorrhage
Bleeding between arachnoid and Pia from traumatic bleeding from blood vessels at the base of the brain (aneurysms) that causes CSF to mix with blood and prevents a hematoma formation (blood clots)
99
neurogenic shock
bradycardic response to BP, warm and dry skin, no significant blood loss, paralysis and loss of spinal reflexes
100
temporal lobe function
hearing
101
Subarachnoid space
Lies below the arachnoid and contains CSF, cerebral arteries and veins
102
Medical TOR conditions
>16 years, LOA altered, arrest not witnessed by medic and no ROSC after 20 min of resus and no defib delivered
103
medical cardiac arrest Epi contraindications
allergy or sensitivity to epinephrine
104
What is a vector change
Pads change from the front of the chest to the back
105
Efferent pathways
Descending tract that sends signals from the brain to the muscles for movement
106
Postictal phase
drowsiness, unconsciousness, min to hours, confusion, fatigue, transient neurological deficits
107
Airway management of cardiac arrest
OPA and BVM (15 LMP) ventilations, ETCO2 applied and aim for 45mmHg, suction as needed, SPO2 of 94-96 When advanced airway is placed compressions become asynchronous at a rate of 1 every 6 seconds (10 bpm)
108
Subdural space
Normally empty but can fill with blood after an injury
109
Sixth cranial nerve
Abducens- motor, eye movement
110
Limbic system
Responsible for emotional reactions and feelings- linked to the hypothalamus responsible for autonomic response associated with emotions
111
Inter cranial pressure (ICP)
5-15 mmHg
112
hypovolemic shock
tachy in response to BP, cool pale diaphoretic skin, evident blood loss, not associated with paralysis
113
manual defib contraindications- medical cardiac arrest
rhythms other than VF or pulseless VT
114
Dura mater
Outer later that forms dural sinuses that collect venous blood and CSF to return to circulation
115
Monitoring CPR quality with ETCO2
Higher ETCO2: higher cardiac output (good CPR) Lower ETCO2: change compressions or improve CPR quality ETCO2 decreasing observe for chest compressor fatigue, hyperventilation, airway obstruction, or tracheal tube displacement ETCO2 increasing: CPR is likely effective and ventilation appropriate; substantial rise can indicate ROSC
116
Seventh cranial nerve
Facial- sensory/motor, taste, muscles of facial expression, scalp muscles
117
Joule settings >24 hours to <8 years
Initial dose: 2J/kg Subsequent doses: 4J/kg Interval: 2 min
118
Afferent pathways
Ascending tract that relays information from the skeletal muscles to the brain
119
Diencephalon
Contains thalamus/ hypothalamus Thalamus- nerve bodies serve to sort/relay incoming sensory impulses Hypothalamus- maintains homeostasis- regulates temp, intake of food/fluids, regulates sleep cycle, regulates libido
120
Trauma TOR contraindications
Age <16, defibrillation delivered, signs of life at any time since fully extricated medical contact, rhythm PEA and closest ED <30min transport time, patients with penetrating trauma to the torso/neck/ and lead trauma hospital <30min transport time
121
medical TOR contraindications
known reversible cause of arrest unable to be adressed, pregnancy >20 weeks gestation, suspected hypothermia, airway obstruction, non opioid drug overdose
122
Hypothermia in cardiac arrest
Consider environment and exposure time (remove pt from cold environment), consider early transport to closest ER as pt is CTAS 1 TOR contraindicated Pulse checks every 10 sec Focus on passive rewarming and gentle handling (excessive handling can cause lethal arrhythmias) and minimize movement of pt Manage airways as needed (OPA/BVM over ETT)
123
Signs and symptoms of a sub arachnoid hemorrhage
sudden severe headache, localized but then becomes diffuse from meningeal irritation, as bleeding continues ICP makes decreased LOC, pupil changes, posturing, vomiting, and seizures
124
CPR contraindications- medical cardiac arrest
obviously dead per BLS, meets conditions of BLS DNR
125
Wernicke's area
Integration center that comprehends language receive (written/spoken) with connective fibers to visual/ auditory areas Located in the posterior temporal lobe
126
ROSC summary
A- Advanced airway if needed B- provide optimal ventilation with waveform capnography (ETCO2 35-40 mmhg and O2 sat 94-98%) C- provide optimal perfusion what SBP >90 mmHg and treat hypotension with IV crystalloids, 12 with signs of ST elevation D- consider raising the head of the bed by 30 degrees
127
Twelfth cranial nerve
Hypoglossal- motor, muscles of the tongue
128
Intracerebral hemorrhage
Bleeding in the brain tissue from blunt or penetrating trauma most common in frontal/temporal lobes S&s: alterations in LOC, similar patterns to CVA, high mortality rate
129
Bell's palsy
Temporary paralysis/weakness of the facial muscles on one side of the face from inflammation of the 7th cranial nerve S&s: severe headache. Lower face paralysis (mouth, cheek, eye), upper face paralysis (eyebrow, forehead)
130
Epidural hematoma/ extradural hematoma
Bleeding between the dura and the skull from a tear in the middle meningeal artery in the temporal region from a linear fracture with a quick onset and a deadly outcome S&s: head trauma w/ LOC, rapid death, Lucid interval then signs of increased ICP within min to hours
131
What is the blood brain barrier
A protective mechanism provided by a relatively impermeable membrane capillaries in the brain

AEMCA prep (4 decks)

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