Neurological Emergencies Flashcards
What is Neurological Emergencies
Sudden, transient loss of consciousness and postural tone with spontaneous recovery
- Often caused by loss of cerebral oxygenation and perfusion
- If they dont wake up quickly be alarmed though
Why does it occur
and can often be a sign of another underlying condition
Most commonly associated with a stressful condiion. such as?
Local anesthia
Not waking up quickly could be many underlying conditons
Who does it affect?
- Common medical problem affecting all age groups
- Children (dehydration), pregnant women (hormones, lying on back), and elderly (medications) are most susceptible
- Macho men?- can be higher risk for syncope
#Laying on back cuts vena cava Orthostatic hypotension Correlated with medications
Why do we care?
Most common medical emergency in the dental office
Most syncopal episodes occur during the administration of local anesthetics, the sight of blood, or associated with a stressful situation
3 Types of Syncope
***Neurocardiac syncope
Associated with noxious
stimuli- Most common
Cardiac syncope
Inadequate cardiac output- most dangerous
Noncardiac syncope
Seizures
Orthostatic hypotension
Associated with noxious stimuli- pain, fear, anxiety, exhaustion.
Sympathetic division of the autonomic nervous system
Release of epi and norepi into system = increase of blood flow to peripheral skeletal muscle = Fight or flight…
When we run or fight we have circulation and getting to brain…. But when blood is pooling we don’t have brain
Neurocardiac Syncope-Most common
inadequate cardiac output and usually occurs as a result of serious underlying heart disease.
Arrythmias- electrical impulses to heart; Obstructive- mechanical- heart attack
Treated with pacemakers!
Cardiac Syncope
Noncardiac Syncope
Wide scope which includes
Seizures Orthostatic hypotension-typically with med side effects Situation occurrences (holds breath and tightens muscles with strenuous effort)- or bowl movement Hyperventilation- cerebral cortext and system constrict Metabolic diseases (hypoglycemia)-
Early Signs and Symptoms of Pre-Syncope
50-70% decrease in blood flow to the brain Feeling of warmth Pallor Diaphoresis Excitation of piloerector muscles Nausea Weakness, vertigo Feel bad, faint Tachycardia
Late Signs and Symptoms of Pre-Syncope
Pupil dilation Yawning Blurred vision or seeing spots Rapid respirations Cold hands and feet Hypotension Bradycardia
TRUE Signs and Symptoms of Syncope
Pallor
Unconsciousness
Weak, slow pulse
Med Emerg Manag Acronym(s)!
P- Position A- Airway B- Breathing C- Circulation D- Definitive Tx
Treatment of Syncope
S/S: Pale, sweaty, yawning, pupil dilation, piloerection, dizziness, loss of consciousness and weak slow pulse
P: Swupine feet elevated
ABC: Airway breathing circulation ***take vital signs
D:
-Untighten clothing
- Provide oxygen 4-6L/min
-Provide cold compress to act as a stimulate
- Find escort for patient who recovers
- Activate EMS if the patient doesnt respond in 15-20 seconds **continue to monitor vital signs every 5 minutes
HOW to prevent
Awareness of possible syncope tendency/history elimination of predisposing factors - Proper positioning anxiety relief stress reduction protocols early apt times use of nitrous oxide during apt oral sedation with benzodiazepine prior to appointment
Shock
Condition produced when the cardio-vascular pulmonary system fails to deliver enough oxygenated blood to body tissues to support metabolic needs
Tissues start to use anaerobic metabolic processes
Produces acidosis and harmful toxins
Stages of Shock
initial
- cells deprived of oxygen
- cells not functioning properly
Compensatory
- body performs physiological adaptations in an attempt to overcome shock
- Reduced blood supply to peripheral organs to improve blood supply to brain
Progressive- Compensatory mechanisms begin to fail
- vital organs compromised and not functioning appropriatley
Stages of Shock Refractory-Failure of vital organs -irreversible cell death and brain damage have occured death will occur in a few hours
Hypovolemic Shock-TEST
Most Common Form of shock Caused by inadequate venous return Etiologies: Hemorrhage or dehydration (vomiting or diarrhea)
Cardiogenic & ObstructiveShock
Reduction in perfusion due to decreased cardiac output -Etiologies Myocardial infarction (MI)-heart attack Cardiac arrhythmias Cardiac dysfunction
Indirect heart pump failure- heart can’t function and circulate blood Etiologies arterial stenosis pulmonary embolism cardiac tamponade
3 types of distributive shock
Anaphylactic shock
Sudden, massive vasodilation and circulatory collapse following exposure to an allergen
Septic shock
Vasodilation occurring from certain bacteria (gram neg bacilli) invading the bloodstream
Neurogenic shock
Loss of sympathetic nerve activity from the brain due to a disease, injury/trauma, or emotional trauma
3 types of distributive shock
-Anaphylactic shock
Sudden, massive vasodilation and circulatory collapse following exposure to an allergen
-Septic shock
Vasodilation occurring from certain bacteria (gram neg bacilli) invading the bloodstream
-Neurogenic shock
Loss of sympathetic nerve activity from the brain due to a disease, injury/trauma, or emotional trauma
Shock Management
S/S
P: Supine
ABC-Take vital signs
D Administer o2 4-6L minute, activate EMS-patient in need of IV fluids or surgical intervention
Hyperventilation
A condition whereby rapid, deep breathing occurs, thus eliminating more carbon dioxide than is produced
Lack of carbon dioxide leads to respiratory alkalosis (increase in the pH of blood)
More common in females age 30 – 40
Normal respiration rate??? 12-20
Hyperventilation rate???25-40
Common to hyperventilate when exposed to
High altitudes Pregnant CNS stimulant Experience aspirin toxicity Extremely anxiousl
Clinical Manifestations
- Anxious patient
- Shortness of breath
- Palpations
- Tachycardia
- Lightheadedness
- ***Circumoral paresthia
- ***Carpopedal tetany
Hyperventilation Management
SS: Abnormal prolonged rapid and deep breathing, light headedness, dizziness, tetany, circumoral paresthesia and in extremities and possible unconciousness
P: Upright position
ABC: Airwy, breathing, circulation, take vital signs
D- Calm the patient and have them breath into
their cupped hands. Slow breath- count to 10 in 1 breath. monitor vital signs
If condition doesn’t improve a benzodiazepine can be given to relax the patient
Activate EMS if pulmonary embolism is suspected
