Neurological Emergencies

Question 1

What is Neurological Emergencies

Answer 1

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

Question 2

Why does it occur

and can often be a sign of another underlying condition

Answer 2

Most commonly associated with a stressful condiion. such as?
Local anesthia

Not waking up quickly could be many underlying conditons

Question 3

Who does it affect?

Answer 3

• 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

Question 4

Why do we care?

Answer 4

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

Question 5

3 Types of Syncope

Answer 5

***Neurocardiac syncope
Associated with noxious
stimuli- Most common

Cardiac syncope
Inadequate cardiac output- most dangerous

Noncardiac syncope
Seizures
Orthostatic hypotension

Question 6

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

Answer 6

Neurocardiac Syncope-Most common

Question 7

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!

Answer 7

Cardiac Syncope

Question 8

Noncardiac Syncope

Wide scope which includes

Answer 8

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)-

Question 9

Early Signs and Symptoms of Pre-Syncope

Answer 9

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

Question 10

Late Signs and Symptoms of Pre-Syncope

Answer 10

Pupil dilation
Yawning 
Blurred vision or seeing spots
Rapid respirations
Cold hands and feet
Hypotension 
Bradycardia

Question 11

TRUE Signs and Symptoms of Syncope

Answer 11

Pallor
Unconsciousness
Weak, slow pulse

Question 12

Med Emerg Manag Acronym(s)!

Answer 12

P- Position
A- Airway
B- Breathing
C- Circulation
D- Definitive Tx

Question 13

Treatment of Syncope

Answer 13

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

Question 14

HOW to prevent

Answer 14

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

Question 15

Shock

Answer 15

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

Question 16

Stages of Shock

Answer 16

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

Question 17

Hypovolemic Shock-TEST

Answer 17

Most Common Form of shock
Caused by inadequate venous return
Etiologies: 
 Hemorrhage or dehydration (vomiting or   
   diarrhea)

Question 18

Cardiogenic & ObstructiveShock

Answer 18

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

Question 19

3 types of distributive shock

Answer 19

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

Question 20

3 types of distributive shock

Answer 20

-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

Question 21

Shock Management

Answer 21

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

Question 22

Hyperventilation

Answer 22

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

Question 23

Common to hyperventilate when exposed to

Answer 23

High altitudes
Pregnant
CNS stimulant
Experience aspirin toxicity
Extremely anxiousl

Question 24

Clinical Manifestations

Answer 24

• Anxious patient
• Shortness of breath
• Palpations
• Tachycardia
• Lightheadedness
• ***Circumoral paresthia
• ***Carpopedal tetany

Question 25

Hyperventilation Management

Answer 25

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