Neurologic Emergencies Flashcards
name two scales used in neurologic patient assessment
GCS
FOUR coma scale
what is the FOUR coma scale
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.
Neurologic Emergencies
Patient assessment
Double vision cranial nerve __
2
Neurologic Emergencies
Patient assessment
Unequal or dilated pupils cranial nerve __
III
Neurologic Emergencies
Patient assessment
Inability to lift one or both eyelids cranial nerve __
3
Neurologic Emergencies
Patient assessment
Inability for the eyes to track, what are the cranial nerves?
II, IV, and VI
Neurologic Emergencies
Patient assessment
Examine cranial nerves __, __, ,__ and __ for involuntary responses
III, V, IX, and X
Neurologic Emergencies
Patient assessment
cranial nerve __ will demonstrate a facial droop
VII
Headache - can be caused by
12
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
cluster headaches and migraines can be cause by
cerebral vasodilation
what are some environmental triggers that can cause headaches?
lights, noise, medications, stress
Name some examples of Primary headaches (3)
tension, cluster, migraine
Name some examples of secondary headaches
resulting from brain tumors, infections
Assessment - red flag emergencies for headaches
3
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”
these headaches are typically related to physical or emotional stress and last from 30 minutes to a week, more common in women than men
Tension Headache
what are some features of Tension Headaches?
5
Features include Bilateral distribution Non pulsating Mild to moderate intensity Absence of nausea Aggravated by light or sound
what is the usual treatment for Tension Headache?
NASIDS
this type of headache affects more men than women, resulting from vascular dilation that puts pressure on the trigeminal nerve.
cluster headaches
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
cluster headaches
what is the treatment for cluster headaches?
6 medications and 1 other treatment
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
Migraine Headache - almost three times as many ____ than ____
women than men
Before a Migraine Headache, what are two things that can manifest?
Prodromal phase
Aura
Describe the Prodromal phase of a migraine headache
a clear deterioration in function before the active phase of a mental disturbance, that includes visual disturbances
Describe the Aura of a migraine headache
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
Describe the active headache phase of a migraine headache
Unilateral, pulsating head pain Moderate to severe intensity Pain aggravation by routine physical activities Photophobia and phonophobia NV
Describe the recovery phase of a migraine headache
Fatigue
Temporal and cranial sensitivity
Pharmacologic Management for migraines includes
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
Non-Pharmacologic Management for migraines includes
Ice pack, warm blanket, dim lights, quiet room
Phenergan and reglan (are/are not) compatible in the same bag
are
Headache; Temporal Arteritis - also known as ____ ____ ____
Is an inflammation of the ____ arteries and their branches and is a medical emergency.
giant cell arthritis
carotid
Temporal Arteritis most commonly affects this demographic
Most frequently affects women over 50.
Temporal Arteritis Commonly affected arteries include (4)
temporal arteries, vertebral arteries, ophthalmic arteries, and posterior ciliary arteries
Temporal Arteritis - Artery inflammation leads to decreased blood flow and eventually to what? If untreated, can lead to what?
__% experience permanent vision loss.
vessel necrosis and death
vision loss and blindness
20
