Neurologic Emergencies Flashcards
Central Nervous System
Responsible for thought, perception, feeling and autonomic body functions
(Brain, brainstem, spinal cord)
Peripheral Nervous System
Responsible for transmitting commands from the brain to the body and receiving feedback from the body
(Cranial Nerves, peripheral Nerves)
Efferent Nerves
Leave the brain and convey commands to other parts of the body
Afferent Nerves
Send signals to the brain
Diencephalon
Filters unneeded information before reaching cerebral cortex
Midbrain
Responsible for regulating LOC, including patterns of sleep and wakefulness
Brainstem
Controls pulse, pressure, and respiratory rate and pattern
Pons
Controls respiratory rate and depth
Medulla Oblongata
Controls pressure and pulse rate
Limbic System
Where rage and anger are generated
Hypothalamus
Where pleasure, thirst and hunger are found
Pituitary Glands
Receives information from the hypothalamus and then sends chemical to the adrenal glands to release epi and norepi
Adrenal Glands
Release epinephrine and norepinephrine
Cerebellum
Manages complex motor activity unconsciously (tree of life)
Synapse
Connects to the cell by chemicals called neurotransmitters. Doesn’t physically touch the nerve cell
Neurotransmitter
Dopamine, acetylcholine, epinephrine, serotonin
These chemicals send signals from one nerve cell to the other
Axon
Bridge that connects the synapse to the nucleus
Myelin
A sheath that surrounds the nerve cell allowing the cell to transmit its signal consistently without “shorting out”
Vitals for Increased Intercranial Pressure
Decreased HR, Decreased RR, Increased BP
Trismus
Clenched teeth
Ptosis
Drooping, sagging, or prolapse of a part of the body
Bell palsy, stroke
Coma
State where patient does not respond to painful stimuli
Supra orbital Foramen
Notch near bridge of nose used to elicit pain
Decorticate Posturing
Contractions of arms towards their chest and point their toes
Indicative of damage directly below cerebral hemisphere
Decebearate Posturing
Contract arms and wrists outwards and point their toes
Indicative of damage near the brainstem
GCS
Eyes Opening- 4 Spontaneous 3 Voice 2 Pain 1 None Verbal- 5 Oriented 4 Disoriented 3 Innapropiate Words 2 Incompetent 1 None Motor- 6 Obeys 5 Localizes 4 Withdraws 3 Decorticate 2 Deceberate 1 None
Hallucinations
Hear voices, see snakes, feel insects, all that are within their mind
Delusions
Thoughts or perceived abilities that are not based on reality
Psychosis
Patient can not tell what is real or inside his mind
Corneal Reflex
Tap between the eyes to determine gag reflex
Pupillary Response
Shine from 45 degree angle Thickness of dime is about a millimeter Dialated with adrenaline Constricted when relaxed <1mm is not abnormal
Agnosia
Unable to tell you names of an object
Apraxia
Unable to use a common object
Receptive Aphasia
Unable to understand speech, but able to speak clearly
Expressive Aphasia
Unable to speak clearly, but understand speech
Global Aphasia
Unable to talk or understand
Hemiparesis
Weakness of one side of the body
Hemiplegia
Paralysis of one side of the body
Gait
Walking pattern
Parkinson’s is abnormal
Ataxia
Unable to perform coordinated motions such as walking
Myoclonus
Rapid, jerky, muscle contraction that occurs involuntarily
Dystonia
Part of body contracts and remains contracted
Use diphenhydramine for cure
Tonic
Rigid, contracted body posture
Hypertnic
Rigid, ARCHED back
Clonic
Rhythmic contraction with tonic and hypertonic phases
Paresthesia
Numbness or tingling
Anesthesia
Complete block of feeling or sensation
Strokes
Ischemic (75%) & Hemmorrhagic (25%)
Ischemic Stroke
Occlusion or blockage within the brain
Thrombus or embolus
Tissue begins to die but the brain does not become worse, just that isolated area
Hemorrhagic Stroke
Tend to get worse over time due to increased pressure and brain herniation
“Worse headache of my life”
Assessment of Stroke
Language- slurred speech, Aphasia, ptosis, apraxia
Movement- Hemiparesis, hemiplegia, arm drift, facial droop, ataxia
Sensory- headache, blindness
Cognitive- LOC, seizures, coma
Cardiac- hypertension
Management of Stroke
- No atropine. The ICP is causing the bradycardia
- maintain BP at least 110-120
- slight hyperventilate at 16-20bpm
- etCO2 high 20’s low 30’s
Ischemic Stroke Fibrinolytic times
Less than 3 hours
Transient Ischemic Attack
Episodes of cerebral ischemia without permanent damage
Symptoms relieved within 24 hours
Coma
Use mnemonic AEIOUTIPS Alcohol, acidosis Epilepsy. Benzodiazepines Insulin. D50 or glucagon Overdose. Romazicon, narcan, glucagon Uremia. Temp, glucose, oxygen Trauma. Spine, pressure Infection. Pressure Psychosis. Oxygen, glucose, temp Stroke. Oxygen, glucose, temp
Seizures
Sudden, erratic firing of neurons
Tonic/Clonic Seizures
"Grand mal" Aura LOC Consider ventilation, airway Tonic and IM benzo Hypertonic Clonic Postictal
Absence Seizures
“Petit mal”
Little or NO movement (eyelids, finger shaking, stop walking)
Last several seconds
Pseudoseizures
Psychological “fake” seizure
Jacksonian March
Spreading of localized seizure and spreading through the body
Partial Seizure
Localized to one part of the body
Status Epilepticus
A seizure that lasts longer than 4 to 5 minutes or consecutive seizures without return of consciousness between seizures
Prodromal
Signs or symptoms following and event
Fall- dizziness, weakness
Management of migraine headaches
Toradol 30mg Demrerol 25mg Morphine 2-4mg Fentanyl 25mcg Zofran 4mg Phenegran 12.5-25mg
Demntia
Chronic deterioration of memory, personality, language skills, perception, reasoning, or judgement with no LOC
-check BGL,
Wernicke encephalopathy dementia
Mostly reversible
Lack of vitamin B1 from malnourishment administer thiamine 100-200mg IVP
before any glucose
May have hypo or hyper deficiencies
Neoplasms
Growths within the body
Benign or malignant
Metastasis
Process by which cancerous cells move from their site of origin
Assessment of Neoplasm
May have months of headaches and suddenly have a seizure
MS (Multiple Sclerosis)
Autoimmune disorder in which the body attacks the myelin sheath of brain and spinal cord
Assessment of MS
Nystagmus, involuntary movement of the eyes
Impairment of pain, touch and sensory
Lhermitte Sign- experiencing electrical sensation when head is flexed forward
Management of MS
Administering anti-inflammatory can decrease length of attack
Gillian-Barré Syndrome
Immune system attacks portions of the Nervous System
Begins in the feet and works up towards the head
ALS (Lou Gehrig Disease)
Disease that strike voluntary motor neurons
Assessment- fatigues, general weakness, difficulty doing daily activities. Destruction of neurons eventually stop the patient from breathing
Parkinson’s Disease
Past injuries to the brain have influence.
Assessment- tremors, postural instability, ridgidity, bradykinesia
Bradykinesia
When patient takes small steps when turning with abnormal gait
Dystonia
Severe muscle cramps that cause bizarre contortions or postures
Assessment- usually take antipsychotic medications
Management- diphenhydramine 25-50mg
Trigeminal Neuroglia
Stabbing or shock pain in the face
Involves cranial Nerve V
Ménière Disease
Increased fluid within the ear
Tinnitus, dizziness, hearing loss, can cause permanent deafness
Encephalitis
Caused from herpes simplex virus
Stiff neck, fever, malaise, vomiting, confusion and seizure
Meningitis
Inflammation of meninges
KernignSign- unable to straighten leg when hips flexed
BrudzinskiSign- flexed knees when neck flexed
Poliomyelitis
Viral infections caused by fecal-oral route
Virus attacks motor neurons in brain
Peripheral Neuropathy
Group of conditions in which Nerves leaving spinal cord are damaged
Assessment- as BGL rises, damages occurs to peripheral nerves
Hydrocephalus
Hydro- means water
Cephalosporins- means head
Only 120ml of CSF is present in CNS
OUR BODIES PRODUCE .3ml/min
Hydrocephalus is the body’s ability to produce adequate amounts of CSF but does not ride body of it fast enough
Assessment- lethargy, irritiability, vomiting, sun-setting eyes
Management- a shunt is placed in ventricle in brain. Drains CSF from brain to the abdomen. Be prepared for seizures with complications of shunt.
Spine Bifida
Part of spine remains outside of the body.
Cerebral Palsy
Damage done to the brain (frontal lobe).
