Neurologic Emergencies

Question 1

name two scales used in neurologic patient assessment

Answer 1

GCS

FOUR coma scale

Question 2

what is the FOUR coma scale

Answer 2

The 4 components of the FOUR score (eye response, motor response, brainstem reflexes, and respiration pattern) are equally weighted. This scale is easy to remember because it contains 4 components, each with a maximal score of 4. Brainstem reflexes are included for a full and accurate assessment of the depth of coma.

Question 3

Neurologic Emergencies
Patient assessment
Double vision cranial nerve __

Answer 3

2

Question 4

Neurologic Emergencies
Patient assessment
Unequal or dilated pupils cranial nerve __

Answer 4

III

Question 5

Neurologic Emergencies
Patient assessment
Inability to lift one or both eyelids cranial nerve __

Answer 5

3

Question 6

Neurologic Emergencies
Patient assessment
Inability for the eyes to track, what are the cranial nerves?

Answer 6

II, IV, and VI

Question 7

Neurologic Emergencies
Patient assessment
Examine cranial nerves __, __, ,__ and __ for involuntary responses

Answer 7

III, V, IX, and X

Question 8

Neurologic Emergencies
Patient assessment
cranial nerve __ will demonstrate a facial droop

Answer 8

VII

Question 9

Headache - can be caused by

12

Answer 9

Dehydration, hypoglycemia, infections such as flu, glaucoma, refractory errors such as nearsightedness, toxins, dental pain, hormonal shifts, cerebral vasodilation as in cluster headaches and migraines, temporal arteritis, hydrocephalus, increasing ICP

Question 10

cluster headaches and migraines can be cause by

Answer 10

cerebral vasodilation

Question 11

what are some environmental triggers that can cause headaches?

Answer 11

lights, noise, medications, stress

Question 12

Name some examples of Primary headaches (3)

Answer 12

tension, cluster, migraine

Question 13

Name some examples of secondary headaches

Answer 13

resulting from brain tumors, infections

Question 14

Assessment - red flag emergencies for headaches

3

Answer 14

The patient has never had a headache before
The pain or symptoms are different from the patients usual headache pattern
The patient states “worst HA of my life”

Question 15

these headaches are typically related to physical or emotional stress and last from 30 minutes to a week, more common in women than men

Answer 15

Tension Headache

Question 16

what are some features of Tension Headaches?

5

Answer 16

Features include
Bilateral distribution
Non pulsating
Mild to moderate intensity
Absence of nausea
Aggravated by light or sound

Question 17

what is the usual treatment for Tension Headache?

Answer 17

NASIDS

Question 18

this type of headache affects more men than women, resulting from vascular dilation that puts pressure on the trigeminal nerve.

Answer 18

cluster headaches

Question 19

what type of headache causes
Intense, one sided orbital or temporal
Ipsilateral nasal congestion and rhinorrhea
Ipsilateral lacrimation and conjunctival injection, facial swelling or ptosis, pupillary constriction on the painful side

Answer 19

cluster headaches

Question 20

what is the treatment for cluster headaches?

6 medications and 1 other treatment

Answer 20

O2, high flow with NRB, will be effective in 10 minutes if it is going to be successful
Medications
Imitrex, calcium channel blockers, depakote, topamax, Zomig, Migranal

Question 21

Migraine Headache - almost three times as many ____ than ____

Answer 21

women than men

Question 22

Before a Migraine Headache, what are two things that can manifest?

Answer 22

Prodromal phase

Aura

Question 23

Describe the Prodromal phase of a migraine headache

Answer 23

a clear deterioration in function before the active phase of a mental disturbance, that includes visual disturbances

Question 24

Describe the Aura of a migraine headache

Answer 24

a sensation of light, warmth, or emotion (such as fear) that may precede an attack of migraine or seizure
Numbness or tingling in the extremities
Unilateral weakness
Dysphasia or other language problems

Question 25

Describe the active headache phase of a migraine headache

Answer 25

Unilateral, pulsating head pain
Moderate to severe intensity
Pain aggravation by routine physical activities
Photophobia and phonophobia
NV

Question 26

Describe the recovery phase of a migraine headache

Answer 26

Fatigue

Temporal and cranial sensitivity

Question 27

Pharmacologic Management for migraines includes

Answer 27

Zofran, phenergan (dilute in 10-20 ml NSS), compazine, reglan (dilute doses more than 10mg in 50ml NSS)
NSAIDS, Migranal, serotonin inhibitors such as Imitrex, steroids, opioids
Non pharm management

Question 28

Non-Pharmacologic Management for migraines includes

Answer 28

Ice pack, warm blanket, dim lights, quiet room

Question 29

Phenergan and reglan (are/are not) compatible in the same bag

Answer 29

are

Question 30

Headache; Temporal Arteritis - also known as ____ ____ ____

Is an inflammation of the ____ arteries and their branches and is a medical emergency.

Answer 30

giant cell arthritis

carotid

Question 31

Temporal Arteritis most commonly affects this demographic

Answer 31

Most frequently affects women over 50.

Question 32

Temporal Arteritis Commonly affected arteries include (4)

Answer 32

temporal arteries, vertebral arteries, ophthalmic arteries, and posterior ciliary arteries

Question 33

Temporal Arteritis - Artery inflammation leads to decreased blood flow and eventually to what? If untreated, can lead to what?
__% experience permanent vision loss.

Answer 33

vessel necrosis and death
vision loss and blindness
20