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17 Objectives

neurologic emergencies

TermDefinition
17-1 anatomy and physiology of brain and spinal cord brain- computer spinal cord- send messages
17-2 types of headaches tension headaches cause -muscle contractions of head + neck due to stress s/s -squeezing, dull, headache
17-2 types of headaches migraine headaches cause -changes of blood vessel size at brain base s/s -pounding, throbbing, pulsating -nausea, vomiting -visual flashing lights or partial vision loss -women 3x greater than men
17-2 types of headaches sinus headaches causes -fluid accumulation in sinus cavities s/s -cold symptoms, increased pain with movement (bending over)
17-2 types of headaches life threat headaches -sudden onset -explosive/ thunderclap -AMS -age >50 -depressed immune system -neurologic deficts -neck stiffness/ pain (rash and fever) -fever -vision changes -hemiparesis
17-3/4 various ways blood flow to the brain may be interrupted and cause a CVA ISCHEMIC- blood clot, 80% of all strokes, atherosclerosis HEMORRHAGIC- bleed, 10-20% of strokes, HTN and aneurysm (berry=subarachnoid) TIA- symptoms resolve within 24 hrs, clot dissolves naturally, warning sign of real stroke or seizure
17-5 signs and symptoms of stroke -facial drooping -hemiparesis -ataxia or loss of balance -vison loss, blurry, double -difficulty swallowing -AMS -receptive/expressive aphasia (L) -dysarthria (R) -sudden headache -dizziness -weakness -combativeness -restlessness -coma
17-5 signs and symptoms of stroke left side and right side -facial droop on one side -hemiparesis on opposite side of brain injury -aphasia (L) -dysarthria (R) -neglect (R) -weakness on one side -tongue deviation on side of brain injury
17-6 name three conditions that mimic stroke - hypoglycemia - postictal state - subdural or epidural bleed **these may all have hemipharesis
16-7 generalized (tonic-clonic) seizures -abnormal electric discharge from layer areas of brain with both hemisphere. - May be proceeded by "aura" -unresponsive, generalized twitching -under 5 minutes -petite mal -> absence seizures -> staring or lip smacking -usually lasts for seconds
16-7 partial (focal) seizures - one area of the brain -simple -> no AMS, numbness, weakness, dizziness, visual changes, unusual smells or tastes -complex -> AMS, temporal lobe, lip smacking, eye blinking, isolated convulsions or jerking of the body or body part, uncontrolled fear
16-7 status epilepticus seizures every few minutes without regaining consciousness or greater than 30 minutes
16-7 febrile seizures -6 months to 6 years - caused by rapidly high fever
16-7 break through seizure seizure while on medication
16-8 stages of seizures -aura -one side of body - can progress to generalized -tonic- usually seconds w/ muscle contractions -postictal state- 5 to 30 mins
16-9 importance of recognizing seizure in EMS EMS must recognize seizure so they can look at underlining serious conditions or life threats
16-10 postictal state interventions -high flow O2, positioning, clearing of airway secretions, prevent aspiration -muscle relax(may be flaccid), breathing becomes labored (fast deep breaths off CO2), body must balance acids
16-11 AMS definition and causes Pt is not thinking clearly or is uncapable of being aroused H factors -head trauma -hypoxia -hypothermia -hypoglycemia
16-12 scene safety considerations with neurogenic emergencies Postictal patients may become violent
16-13 special consideration required for pediatric patients with AMS -strokes-> due to berry aneurysm(hemorrhagic) or sickle cell(ischemia) -seizures-> febrile seizures is most common -hypo or hyperglycemia -infection (meningitis) -poisonings -tumors -watch airwayyyyyyy
16-14 primary assessment steps for neurogenic emergencies and steps to address life threats -ABCs and life threats -rapid exam if unresponsive or trauma -> AVPU - FBAO -treat and manage shock -immediate transport
16-15 steps for Hx taking on neurogenic emergencies -Hx from bystander -look for clues -evaluate speech *when last normal? *is this typical seizure *how long did it last *describe seizure -SAMPLE -taking or stopped taking meds -diabetic and seizure - check BS
16-16 steps for secondary assessment of neurogenic emergencies -stroke assessment -always check the BP manually to get a true reading
16-17 stroke assessment tools to rapid ID a stroke Pt Cincinatti Stroke Scale -smile -arm drift- hold arms out, palms facing up w/ eyes closed-> release support and see if Pt holds arm at same level -speech- THE SKY IS BLUE IN CINCINNATI
16-17 stroke assessment tools to rapid ID a stroke Pt LA Prehospital Stroke Scale -age >45 -Hx of seizures-epilepsy -symptoms <24 -pt not wheelchair bound or bedridden -BG glucose 60-400 mg/dL -obvious asymmetry *facial smile *grip *arm drift
16-17 stroke assessment tools to rapid ID a stroke Pt FAST F-facial droop A- arm drift S- speech T- time pt last normal
16-17 stroke assessment tools to rapid ID a stroke Pt LAG L-LOC normal=0 mild =1 severe (unresponsive)=2 Arm drift normal=0 mild=1 severe(flaccid)=2 Gaze normal=0 mild=1 severe=2
16-17 stroke assessment tools to rapid ID a stroke Pt GLASGOW COMA SCALE Eye(4) Verbal(5) Motor(6)
16-18 stroke alert and timeframe for most successful outcome 3 hr window to admin of Thrombolytics for Ischemic stroke PT- needs CT scan
16-19 obtain and document stroke Pt -time of onset - score on GCS -results from stroke assessment tool -changes noted on reassessment
16-20 care, treatment and transport of headache -Position of comfort -high flow O2 -consider pain management -quite and dark, no sirens
16-20 care, treatment and transport of stoke -manage airway -SatO2>94
16-20 care, treatment and transport of seizures -manage airway with positioning -NPA if needed -suctioning -high flow O2 -immobilize if trauma
16-21 what special considerations for geriatric Pt having neurologic emergencies more likely to experience: -hypoxia -hypotension -cardiac dysrhythmias
Created by: emt2023deal
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