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Test 6 > Neurological Emergencies > Flashcards

Neurological Emergencies Flashcards

1
Q

Cerebrum

A

2 hemispheres

4 lobes

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2
Q

Frontal Lobe

A
  • Speech (Broca’s area)
  • Abstract thinking
  • Personality
  • Touch (primary sensory center)
  • Voluntary movement (right-left)
  • Primary motor center
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3
Q

Parietal Lobe

A

•Proprioception
-The ability to tell the location of a body part
•Math
•Language processing

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4
Q

Occipital Lobe

A
  • Sight

* Color vision

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5
Q

Temporal Lobe

A

•Hearing and understanding speech

•Wernicke’s
-Behavior and storage of memory

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6
Q

Thalamus

A
  • Relays sensory to cerebral cortex
  • Wakefulness

•Does not relay smell

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7
Q

Hypothalamus

A
  • Temperature
  • Pituitary control
  • Links ANS to Endocrine system
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8
Q

Pituitary

A

Bridge to PNS

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9
Q

Cerebellum

A
  • Movement
  • Fine motor control
  • Coordination
  • Balance
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10
Q

Cerebral Cortex

A 
•Outermost portion of cerebrum 
•Works with RAS= consciousness 
•Distributes impulses to other brain areas
•Interprets sensory from body
 -Afferent
•Motor muscular control 
 -Efferent 
•Aids judgment 
•Concentration 
•Analysis
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11
Q

Limbic System

A 
•Hypothalamus
•Amygdala 
 -Temporal Lobe 
•Hippocampus 
•Limbic cortex 
•Controls-
 -Emotions 
 -Fear
 -Pleasure
 -Mood 
 -Behavior 
 -Long term memory 
 -Motivation
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12
Q

Midbrain

A
  • Hearing and visual reflexes
  • Posture
  • Muscle tone
  • Reticular Activating System (RAS)
  • Consciousness
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13
Q

Pons

A 
•Relays impulses to and from medulla and cerebrum 
•Apneustic and pneumotaxic centers
•Regulating-
 -Respiratory rate
 -Arousal
 -Sleep
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14
Q

Medulla Oblongata

A
  • Heart rate
  • Blood pressure
  • Breathing
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15
Q

Diencephalon

A

Comprised of the Thalamus and Hypothalamus

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16
Q

RAS and Cerebral Cortex

A 
•Work together to maintain consciousness 
•1 disrupted 
 -Altered LOC
•Both disrupted 
 -Unresponsive
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17
Q

Brain Blood Supply

Circle of Willis

A

Ensures blood supply to all parts of the brain if blockages occur

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18
Q

Brain Blood Supply

Blood Brain Barrier

A

Capillaries tightly packed together allowing only certain molecules into brain’s circulation

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19
Q

Ventricles of the Brain

A
  • Space in cerebral hemispheres
  • 2 hemispheres
  • Cerebrospinal fluid is created here
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20
Q

Neurons- Fundamental unit

A 
•Cell body, axon, and dendrites
•Cell body = gray matter
 -Brain, brain stem, cord
•Axons = white matter
 -Myelin- fatty insulation 
 -Increases speed of impulse conduction
•Bundles of neurons = nerve
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21
Q

Anatomy- CNS & PNS

A 
•Central nervous system 
 -Brain and spinal cord
•Peripheral nervous system 
•Spinal nerves- 31 pairs
 -Sensory ➡️ Afferent (arrives)
 -Motor ➡️ Efferent (exits)
 -8 cervical 
 -12 thoracic 
 -5 lumbar 
 -5 sacral
 -1 coccygeal
•Cranial nerves- 12 pairs 
 -Affect SAME side of body as place of origin
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22
Q

CN I

A

Olfactory- smell

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23
Q

CN II

A

Optic- vision

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24
Q

CN III

A
  • ***Oculomotor (part of PNS)
  • Eyeball movement
  • Raising eyelid
  • Pupil constriction
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25
Q

CN IV

A

•Trochlear

-Eye move down / inward

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26
Q

CN V

A

•Trigeminal

  • Sensation forehead to chin
  • Mastication
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27
Q

CN VI

A

Abducens- eye movement outward

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28
Q

CN VII

A
  • Facial expression

* part of PNS

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29
Q

CN VIII

A

•Acoustic-Vestibulocochlear

-Hearing and balance

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30
Q

CN IX

A 
•Glossopharyngeal
 -Swallowing 
 -Gag reflex
 -Speech
•Part of PNS
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31
Q

CN X

A 
•Vagus 
 -Sense hypo pharynx 
 -Throat 
 -Heart rate
 -Respirations 
 -Digestion 
•Part of the PNS
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32
Q

CN XI

A

•Spinal accessory

  • Turn head
  • Shrug shoulders
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33
Q

CN XII

A

•Hypoglossal

-Tongue movements

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34
Q

Dermatones

A 
•Spinal nerves 
•Specific area of skin 
 -Carries sensory impulse to brain 
•Key locations 
 -Collar region: C-3 (turtle neck)
 -Middle finger: C-7
 -Nipple line: T-4
 -Umbilicus: T-10
 -Small toe: S-1
•Sensory assessment findings
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35
Q

Neuro Assessment

A 
•Focal deficit- specific 
 -Part of body
 -Pinpoint damaged area
•General impression 
 -Muscle tone- Posture, facial, extremities 
   •Flacid paralysis= weakness/paralysis with ⬇️ muscle tone 
 -Involuntary movements or tremors 
 -One side or both sides?
 -Facial droop
36
Q

Pupil Eye Exam

A

•Pupils
-Unequal >1 mm - consider ⬆️ ICP
-Dilated = CNS stimulant
-Constricted = CNS depressant
-Aniscoria = Normal difference- pupil size
•PERRLA
-Accommodation- able to focus both eyes as distance changes
-Consensual response- Both eyes react to light
•Eyes
-Nystagmus- smooth eye movement one direction
•Jerky, fast movement in opposite direction
-Dysconjugate gaze- failure of eyes to turn together in same direction
-Diplopia- double vision

37
Q

Posturing

Decorticate

A 
•Flexion
•Cerebral cortex to thalamus 
•Upper arms pulled inward to core
•Flexed elbows
•Flexed wrists
 -Clenched fists
•Extended lower extremities 
 -Toes point down
•GCS of...
38
Q

Posturing

Decerebrate

A 
•Extension 
•Brain stem injury 
•Upper arms pulled inward to side 
•Extended elbows 
•Pronated wrists
 -Turned outward 
•Extended lower extremities 
 -Toes point down 
•GCS of...
39
Q

Meningeal Exam

Brudzinski sign

A
  • Flexion of neck painful
  • Patient will flex hips and knees
  • Meningitis
  • Subarachnoid bleed
40
Q

Meningeal Exam

Kernig’s Sign

A
  • Flex hip to 90 degrees
  • Extend lower leg
  • Causes extreme pain
  • Meningitis
  • Subarachnoid bleed
41
Q

Motor/Sensory Exam

A

Assess both sides at the same time

42
Q

Hemiparesis

A

One sided weakness

  • Strength
  • Grips, pedal
43
Q

Hemiplegia

A

Paralysis one side

44
Q

Paresthesia

A

Abnormal sensation

45
Q

Anesthesia

A

Absence of sensation

46
Q

Babinski

A 
•Stroke lateral, plantar foot 
•Positive 
 -Dorsiflexion great toe
 -May fan toes
•Positive Babinski is bad
•Not for babies 
 -12-18 months
47
Q

Mental status

Level of Consciousness

A

Arousability

Responsiveness

AVPU scale

48
Q

Mental Status

Glasgow Coma Scale

A

Detailed responses

BEST response

Compare to baseline

<8 ➡️ intubate!

49
Q

Retrograde Amnesia

A

Prior to event

50
Q

Antegrade Amnesia

A

After event

51
Q

Coma

A

Absolute unresponsive

52
Q

Confusion

A
  • Memory not correct

* Can’t learn new material

53
Q

Lethargy

A

Slow response to stimuli

54
Q

Reticular Activating System

A 
•Brainstem to cerebral cortex 
•Initiates, maintains arousal &amp; awareness 
•Cerebral cortex &amp; RAS intact 
 -Maintains consciousness 
•If one or other is altered, damaged 
 -Altered mental status 
•If both altered, damaged 
 -Unresponsive 
•ANY ⬇️ LOC at ANY time = HIGH PRIORITY
55
Q

Altered Mental Status- Tx

A 
•ABC’s
•Oxygen; SpO2 monitoring 
•Ventilate prn 
•Vitals; IV; cardiac monitor 
•Check BGL
 -<60 ➡️ D50 or glucagon (Consider thiamine 100mg)
 ->350 ➡️ fluid boluses(unless contraindicated)
•Consider naloxone- suspect what?
•Rapid transport, med control contact
56
Q

Delirium

A 
•Acute
•Temporary
•Confusion 
•Changing LOC
•Possible 
 -Hallucinations- visual or auditory
 -Delusions- false beliefs 
•Causes
 -Illnesses, meds, cardiac, CVA, alcohol
•MADCAP
57
Q

Dementia

A
  • Chronic
  • Progressive
  • Decline mental function
  • Memory
  • Judgement
  • Concentration
  • Bizarre behavior
  • Irrational
  • Violent
  • Neurological cause
58
Q

Seizures

A 
•Temporary 
•Altered LOC or behavior 
•Massive firing of neurons in the brain 
 -Electric storm 
•3 types 
 -Generalized
  •Involves both hemispheres of the brain 
  •Consciousness is involved
 -Focal (partial)
  •Isolated area(s) of one brain hemispheres 
  •Motor or non-motor 
  •May also include consciousness 
 -Unknown onset 
  •Doesn’t fit other categories
59
Q

Seizures

Generalized onset- non-motor

A 
•Absence seizure
•Children = >5 years old; girls 
•Lapse of awareness 
 -Vacant stare
•No loss of muscle tone 
 -Eye blinking or fluttering 
•Sudden onset 
•Duration-30 sec
•NO aura
•NO postictal state
•May progress to Grand Mal Seizures 
 -Adolescence
60
Q

Seizures

Generalized - motor

A 
•Tonic- 15-20 sec
 -Whole body muscle contraction 
 -Stiff, rigid
•Clonic- 90 sec- 2 min
 - Rhythmic jerking 
 -Alternating relaxation 
 -Incontinence urine
 -Ventilations inadequate
•Grand Mal is no longer used
•Sudden 
•4 phases
•Aura- sensation 
•(Actually focal aware seizure)
 -Smell 
 -Taste 
 -Visual- lights 
 -Stomach 
 -Not all patients have auras 
•Postictal-15-30 min or longer
 -Gradual return 
 -Drowsy, confused, combative 
 -Fatigue!
 -Check BGL - high demand glucose 
 -Amnesia 
 -Headache, VOMITING 
•History event 
•Onset 
 -Consider C-spine
 -Tongue biting?
•Appearance
 -Typical or atypical 
•Time and duration 
•Previous Hx
 -Meds? Changes?
•Recent trauma, fever, H/A, stiff neck?
61
Q

Status Epilepticus

A 
•Medical emergency 
•May lead to death!
•Single lasting >5 min
•Recurrent without full recovery and >5 minutes 
 -Brain still seizing!
•Convulsive and non-convulsive 
•Hypoxia Brain cells
 -Acidosis (kind??)
•Postictal without improvement?
 -Brain may still be seizing
62
Q

Tx-Prolonged Status

A
  • Airway-NPA, nasal ETT
  • O2, ventilation, suction
  • Position protect Injury
  • Spinal precautions?
  • IV
  • Benzodiazepines
  • BGL check and treat
  • Thiamine?
  • Transport
63
Q

Benzodiazepines

Diazepam (Valium)

A
  • 5-10 mg IM or slow IV (rectal)
  • IV preferred
  • Repeat 10-15 min
  • Max 30 mg
  • Onset 1-5 min
  • Short duration 20 min
64
Q

Benzodiazepines

Lorazepam (Ativan)

A
  • 4 mg IM or slow IV
  • Dilute with equal mL saline
  • Max 8 mg
  • Onset 1-5 min
  • Duration 6 hours
  • Status Epilepticus
  • Stops a prolonged seizure longer
65
Q

Benzodiazepines

Midazolam (Versed)

A 
•1.0-2.5 mg IV, IO
•Slowly over 2 minutes 
•Repeat in small increments 
 -Max 5 mg
•Elderly, chronic ill
 -Reduce 1.0-1.5 mg
 -Slowly 2 minutes 
•If opiate concurrent 
 -Reduce 50%
•Dose is individualized 
•Allow 2-4 min to gauge therapeutic effects
66
Q

Focal Seizures

Aware

A 
•Old: simple partial 
•Awareness intact 
•Motor or non-motor 
•Twitching rhythmic muscle contractions 
•One part of body 
•Hallucinations 
 -Auditory
 -Visual 
 -Olfactory 
•See note chart
•These may be aura for generalized motor
67
Q

Focal Seizures

Impaired Awareness

A 
•Old: complex partial
•Altered awareness 
•Blank stare
•Automatisms 
 -Lip smacking 
 -Chewing or twitching in face
•Mumbling 
•Dazed, disoriented 
•Oblivious-surroundings
•Violent???
68
Q

Myoclonic Seizures

A
  • Generalized type
  • Sudden, brief jerking both upper arms (typical) or legs
  • After awakening or prolonged sleep deprivation
69
Q

Atonic Seizures (Drop Seizures)

A
  • Generalized type
  • Loss of muscle control
  • Neck ➡️ head falls forward
  • Legs ➡️ body collapses
70
Q

Psychogenic Non-Epileptic Seizures

PNES

A
  • Conversion Disorder (PTSD often)

* Diagnosed by neurologist- rule out epilepsy as cause

71
Q

Febrile Seizures

A 
•Children 3 months to 5 years
 -6-18 months most common 
 -1st relative (parent, sibling) predispose
•Sudden spike in temperature 
•Short duration, frightening to parents 
•Treatment 
 -Supportive 
 -Passive cooling ➡️ no shivering 
 -Antipyretic(Tylenol)
 -Possible benzodiazepine
 -transport, calming, parents
72
Q

Syncope

A 
•Transient loss of consciousness 
•Atony 
•Falling
•Regain consciousness 
 -Supine position 
•Near syncope
 -No LOC
 -Hearing/vision loss
•Vasovagal -Common 
•Stimulate vagus nerve
 -Pain, fright, stress
  •Overcompensation sympathetic stimulation 
 -Needle stick
 -Bearing down abdomen 
 -forceful cough, swallow 
 -Prolonged sitting, then standing 
 -Shaving 
 -Micturition- urination
  •Full bladder
73
Q

Syncope Assessment

A 
•Syncope vs cardiac, seizures, neuro, trauma issues 
•SCENT
 -Before syncope 
 -Supine, no warning 
 -Cardio/neuro
•TIPS
 -During 
•CHAN
 -After
•Treat- underlying cause 
•ABC’s
 -Oxygen, ventilation’s 
•C-spine??
•IV-fluids??
•Cardiac monitor-SpO2
•BGL
•Transport recommended
74
Q

Atony

A

Loss of muscle tone

75
Q

Headache- Vascular Migraine

A 
•Recurrent 
•Nausea/vomiting 
•Photophobia 
•Sound sensitive 
•Throbbing, pulsating 
•One or both sides
•Auras 
•Rest/sleep alleviates
•Family Hx/ Triggers 
 -Tyramine foods
 -Msg
•Medication Rx
 -Beta-blockers 
 -Tricyclic antidepressants 
 -Depakote
 -Topamax
•Other possible causes
 -Neuron hyper-excitability
 -Hypomagnesemia
76
Q

Cluster Headache- Vascular

A 
•Severe stabbing 
 -Eye, temple, forehead, cheek
•One side
•Watery eye, rhinorrhea 
•Rock back and forth
•Pace
•Males > females
77
Q

Rhinorrhea

A

Runny nose

78
Q

Cerebral Vascular Accident- Stoke

A 
•Neurological deficits 
 -Decrease in blood flow to brain 
•Ischemic-80%
 -Blocked artery
 -Thrombus or embolism 
•Hemorrhagic-20%
 -HTN
 -Arteriovenous malformations
  •Abnormal connections-Arteries and veins
  •Congenital 
 -Aneurysm- weaken area
79
Q

Ischemic Stroke - Thrombotic

A 
•Atherosclerotic plaques 
•Bifurcation of arteries
•Slower to develop 
 -Than hemorrhagic 
•Risks
 -HTN
 -Diabetes
80
Q

Ischemic Stroke Findings

A 
•Dysarthria 
 -Slurred speech; lacking muscle control 
•Aphasia 
 -Expressive- understands; unable to verbalize 
 -Receptive- no understanding; verbal response inappropriate 
 -Global- no understanding; unable to verbalize 
•Hemiparesis
•Hemiplegia
•Hemiparesthesia 
 -Abnormal sensation, unilateral 
•Arm drift, facial droop
•Ataxia 
 -Uncoordinated movements 
•Headache 
•Seizures 
•Hypertension 
•Vertigo- dizziness 
•Vision loss 
 -Half sight
 -Left or right
81
Q

Hemorrhagic Stroke

A 
•Morbidity/mortality- often fatal 
•Sudden 
 -“Worse headache of my life”
•⬆️ICP
 -Excessive pressure in cranium 
 -“pushes” brain downward 
 -Herniates into foreman magnum 
•Cushing’s triad
 -High BP w/ wide pulse pressure 
 -Bradycardia 
 -Abnormal, irregular, bradypneic respiration’s 
•Unresponsive 
•Hyperthermia
82
Q

Subarachnoid Hemorrhage

A 
•Cause- aneurysm 
•Sudden onset SEVERE headache 
 -“Thunderclap” headache 
 -To occiput 
•Brief loss of consciousness 
•Forceful vomiting 
•Unilateral pupil dilation 
•Rapid progression 
•Females 20-30 years old 
•Supportive ABC’s, expedite transport
83
Q

Transient Ischemic Attacks

A
  • Cerebral dysfunction lasting from minutes to several hours
  • Return to normal <24 hrs

•No permanent neurological deficit
-Indication of impending stroke

•S/S same as CVA

84
Q

Prehospital Stroke Management

A 
•Rapid transport 
•Determine time of onset
 -Last known normal
 -3 hour window
•Manage airway/ Oxygen 
•Ventilation 
•Monitor vital signs and ECG
•Initiate IV- KVO en route 
•Assess blood glucose 
 -D-50 for low BGL
•Control seizures 
 -Benzodiazepines 
•Supine, head elevated 
•On side
 -Affected side down
•Stroke screen 
•Stroke center
85
Q

Cincinnati Stroke Scale

A 
•Arm drift
 -Both arms out, palms up
 -Close eyes 
 -One arm drifts down
•Speech
 -“The sky is blue in Ohio”
 -“No if’s, ands or but’s”
•Facial droop (CN 7)
 -Smile and show teeth
86
Q

Parkinson’s Disease

A 
•Degeneration or damage to nerve cells within basal ganglia in brain 
•Lack of DOPAMINE
•Leading neurologic disability in persons over 60 years old
•Characterized by:
 -Muscle rigidity 
 -Tremors (start on one side)
 -Weakness 
 -Shuffling gait
 -May lead to dementia
87
Q

Alzheimer’s

A 
•Degenerative 
•Dementia-senile
•Neurons get choked off protein growth
 -Dying brain 
•⬇️ memory, cognition 
•⬇️ ability to care for self
•Personality changes 
 -Combative, hostile, angry
•Supportive care
 -Cautious if combative

Test 6 (3 decks)

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