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87 Cards in this Set

  • Front
  • Back
What are some causes of nervous system disorders?
Neoplastic (cancerous)
Degenerative
Developmental causes
Infectious causes
Vascular causes
What else can cause neurologic deficit?
Hypoxemia
Trauma
Toxic substances, poisons, medications and drugs
What are things to consider in the initial assessment?
If no response to verbal stimuli look for abnormal posturing.

Decorticate - may indicate damage to the area below the cerbrum

Decerebrate - More severe damage that is located at or near the brain stem.
What are things to consider in assessment of the airway?
Anything that affects the nerves that control the airway can cause relaxation or constriction.

Trismus - teeth are clenched closed, can indicate a seizure, severe head injury or cerebral hypoxia.
What are things to consider in assessment of breathing?
Need to check the rate and rhythm of breathing. Rhythms can be subtly different to normal or drastically different.
How should circulation be assessed?
Are central and peripheral pulses the same?

Is the patient suffering from ICP?
How is the transport decision determined?
Altered LOC or significant MOI should be transported imediately.
How is the head examined?
Evaluation the LOC is key with NE.

Use the GCS

Changes in the patients mood and state can alert to changes in the neurologic status.

When this happens attempt to determine what is causing the change.

Low O2 or glucose levels can cause frustration or aggression.
What are some signs and questions that can be seen and asked to determine neurologic deficit?
Ask the patient how they feel. Frustration, anger and aggression can be caused by low oxygen levels.

Ask the patient how easy is it for them to think. Patients with decreased blood glucose levels or who are taking narcotics can experience difficultly concentrating.

Some stimulants can increase nervous system activity.
What are important visual findings with neurologic assessments.
Examine the face. Is their obvious facial droop? Are the eyelids even bilaterally. This can indicate a stroke.
What are important speech findings when assessing a pt?
Slurring is a classic finding with strokes.

Focus not only on the quality but the appropriateness of the words.

Pts may be able to speak but have knowledge deficits.
What is Agnosia?
Without Knowledge - Pts will be unable to name common objects due to damage to associations.
What is Apraxia?
Without Movement - Loss of the ability to use a common object.
What is receptive aphasia?
The pt cannot understand speech but is able to speak clearly. Indicated damage to the temporal lobe.
What is expressive aphasia?
The pt can't speak but is able to understand speech. Indicates damage to the frontal lobe.
What is global aphasia?
A combination of expressive and receptive aphasia. Patient can have problems in understanding your speech and speaking.
What is something to bear in mind with global aphasia?
The pt can often think clearly. They will have needs and anxieties. Can be very frightening. Move slowley, make lots of eye contact and use theraputic touch.
What is the relevence of unequal pupil sizes?
Unequal pupil size can be an indication of increased ICP.
How can pupil shape be changed?
Trauma, glaucoma, or increased ICP

Cocaine, Methamphetamine and hallucinogens tend to dilate.

Depressants such as alchohol, narcotics tend to cause constriction.
What is hemiparesis and hemiplegia? What if this is on one side of the body?
hemiparesis - weakness
hemiplegia - paralysis

If on one side of the body it can be a sign of stroke.
How can a stroke be identified?
Hold arms out with eyes closed and look for drift down with one arm.
What is dystonia?
A part of the body contracts and remains contracted. Such as in cramp. An arm or a leg can be become frozen in a contracted position.

Dystonia can be caused by brain injury or medication reactions.
What are rest tremors?
Occur with the patient at rest and not in motion, common in Parkinsons disease.
What are intension tremors?
Occur when the pt tries to reach out and grab an object. Tremors may increase as the pt gets closer to the object. They are common in MS.
What are postural tremors?
Occur when a body part is required to maintain the same position for a long time.
What are the two types of movement that a pt can perform when seizing?
Tonic activity - very rigid contracted body posture. The body will shake slightly from the intensity of the contraction

Clonic Activity - Rhythmic contraction and relaxation of muscle groups. Can appear as bizare and non-purposeful movements. Arms and Legs may flail, teeth clench, torso may move wildly.
What about BGL?
Blood glucose monitoring is standard pre-hospital care for the patient with altered LOC.
What are things to bear in mind with regards to the chest?
Apply a cardiac monitor and evaluate the ECG! Many cardiac arrhythmias can cause neurologic disorders by decreasing the blood supply to the brain.

Perform a 12 lead in all patients with a sudden loss of conciousness.
What are things to bear in mind with the abdomen?
Signs of nausea and vomiting are common with some neurologic conditions such as headaches or increased ICP.
What are things to look for with the pelvis?
Urinary or fecal incontinence are common findings with seizures or syncope. It is an objective marker for the LOC. Ie the LOC has decreased below that of sleep!
What to look for with the extremities?
Look for venipuncture marks which may be a sign of drug use.
What should be performed with ongoing assessment?
Casual conversation will allow you to closely monitor brain function.

Keep an eye on respiratory patterns, eye and body movements and monitor for seizure activity.

Check all interventions vitals and ECG's
What is a stroke?
A serious medical condition where the blood supply to the brain becomes interupted resulting in ischemia.
What is the goal of treatment?
Early recognition and rapid appropriate intervention. Time is Brain.
What are the two basic types of stroke?
Ischemic and hemorrhagic.
What is an ischemic stroke?
Ischemic - A blood vessel is blocked so the tissue distal to the blockage becomes ischemic. The extent and severity of the stroke will be dictated by which artery is involved and which portion of the brain is denied oxygen. IE an ischemic CVA to the brain stem is life-threatening.
Why does an ischemic stroke not worsen over time?
The stroke is limited to the area around the vessel that is occluded. The extent of the severity is limited by the size and location.
What is a hemorrhagic stroke?
Caused by bleeding within the cranium. They tend to worsen over time as the bleeding continues.
What can the bleeding do?
The bleeding can increase ICP and lead to herniation of the brain stem.
What is the hallmark of a hemorrhagic stroke?
The patient complains of the worst pain of their life.
What is pre-hospital care for a stroke?
-Adequate ABC's and blood pressure.
-Establish O2 and glucose levels
-Establish IV access in case medication is needed
-Use a stroke assessment tool
-Try to determine when the stroke took place.
What are Transient Ischemic Attacks?
Episodes of cerebral ischemia that do no do any lasting damage.

Signs and symptoms usually resolve within 24 hours.
What are TIA's a sign of?
A problem with the blood vessels in the brain. Possibly leading to an impending stroke.
What are causes of altered LOC?
Altered mental state has many causes. A good way to remember is with AEIOU-TIPS

A - Alchohol/Acidosis
E - Epilepsy
I - Insulin
O - Overdose
U - Uremia
T - Trauma
I - Infection
P - Phsychosis
S - Stroke
What about the speed of onset?
Very important to evaluate the speed of onset for the altered LOC.
What is prehospital care for altered LOC?
-Support the vital functions.

-Gather information as to the cause of the altered LOC
What are seizures?
Seizures are sudden erratic firing of neurons.
What are some signs and symptoms for seizures?
Seizures can range from one hand shaking or having a strange taste to movement of all limbs or complete loss of conciousness.
What should you try to do with seizures?
Determine the reason for the seizure.

Ask about medications and compliance.
How are seizures classified?
Seizures can be classified as generalized or partial.
What are the phases of a seizure?
Aura - sensation felt before the seizure

Tonic Phase - body wide rigidity

Clonic Phase - Rhythmic contrations

Postictal - Reset period for the brain.
What is an absence seizure?
Most common in children from 4-12.

Typically lasts less than 15 seconds after which LOC back to normal

Staring or absense spells. Loss of motor control is uncommon.
What is a Tonic Clonic seizure?
Loss of conciousness followed by a generalized tonic phase alternating with a clonic phase

Often preceded by an aura or warning that it will occur.

Can occur at any age

Often lasts several minutes and can progress to status epilepticus

Typically is followed by a postictal phase.
What are simple partial seizures?
Also known as focal motor seizures.

Characterized by tonic-clonic activity which may spread to generalized tonic clonic seizure
What are complex partial seizures?
Also referred to as temporal lobe seizures.

Manifests as changes in behaviour (mood changes, abrupt bouts of rage)

Often preceded by an aura.

Usually lasts less than 1-2 minutes.
How are seizures managed?
Most seizures are self limiting so monitor and protect patients from injuring themselves.

Where was the patient before the seizure?

What was the patient doing?

How did the pt get to the current position?

If their is trauma or the situation is unclear perform c-spine immobilization

Provide ventilations only if the seizure is prolonged.
What should you do for pt's you feel could seize?
Establish IV access
Place blankets over the hand rails of the stretcher
Place protection over hard surfaces need the patient
Ensure that the stretcher straps are not too tight.
What is status epilepticus?
A seizure that lasts longer than 4 to 5 minutes. Or consecutive seizures that occur without conciousness returning in between.

Be prepared to control the airway.
What is syncope?
Fainting - the sudden and temporary loss of consciousness with and accompanying loss of postural tone.

This is caused by a brief decrease in cerebral perfusion.

The question is what caused the sudden decrease.
What are some causes of syncope?
Cardiac Rhythms - bradycardia, SVT, Torsade de pointes, Transient asystole, Transient V-Fib, V-Tach.

Cardiac muscle - cardiomyopathy, Myocardial Infarction

Others - Dehydration, Hypoglycemia, Vasovagal
What is a headache?
Headache pain originates from the nerves withing the scalp, face, blood vessels and the muscles of the neck and head.
What are some types of headaches?
Muscle Tension headaches

Migraine headaches

Cluster headaches

Sinus headaches
How can headaches be managed?
Be cautious with headaches. Consider the environment and the context. Ask questions and be observant.

Headaches can be symptomatic of a more serious condition such as hemorrhagic stroke.
What is an abscess?
Body of infection within the brain or the spinal cord.

The body effects a barrier around the area of infection.

This can cause increased ICP

Low grade fever can result as well as headaches and confusion and focal seizures.

Has a gradual onset of symptoms.

Pre-hospital care is supportive, be ready for seizures.
Look for evidence of ICP
What is Multiple Sclerosis?
An autoimmune condition in which the body attacks the myelin sheath of neurons in the brain and spinal column leading to scaring.
How does MS present?
Usually through periods of attack and remission. Attacks can vary in intensity and length.
What are some symptoms of MS?
In the initial attack blurred and double vision are common complaints.

Muscle weakness

Impairment of pain

Pain

Tremors

Fatigue

Speech and vision disturbances

Depression
What is prehospital care for MS?
Prehospital management is supportive.
What is a neoplasm?
Defined as a cancer within the brain or spinal cord.
What are signs and symptoms of neoplasm?
Headache, nausea, vomiting, changes in mental status, stroke like symptoms.

The rate and intensity of the signs depend on the growth rate and location.
What is prehospital care for Neoplasm?
Supportive care

Look out for seizures and treat as such.

Be observant for increased ICP.

Ensure all patients with chronic headaches and new onset seizures are transported to definitive care.
What is Parkinsons Disease?
The area of the brain which produces dopamine become damaged.
How does this affect patients?
Dopamine is the neurotransmitter that ensures smooth muscular contractions.

Symptoms are gradual onset and often begin as unilateral tremors. Over time more body areas become involved.
What is the classic presentation for parkinsons disease?
Four characteristics:

Tremor
Postural Instability
Rigidity
Bradykinesia (slowness in the execution of movement)
What is Encephalitis?
Encephalitis literally means an inflammation of the brain,
but it usually refers to brain inflammation caused by a
virus.
What is Guillain-Barre Disease?
A very rare condition thought to be due to an immune system response. Thought that an infection can cause a response by which the body attacks its own neurons.
How does Guillain-Barre develop?
Begins as weakness or tingling sensation in the legs.

This moves up and begins to affect the thorax and the arms.

Can quickly develop into paralysis. The transition from talking and walking to needing a ventilator can be a matter of hours.

Most patients will experience maximum muscle weakness and paralysis within two weeks.
What is pre-hospital care?
Ensure patient can maintain airway and intervene if necessary.

This can be terrifying for the patient so comformt and touch are very important.
What is poliomyelitis?
It is a viral infection that is transmitted by the fecal oral route.

Very young and older patients are at most risk.

Has been all but eliminated from the world.
What is Alzheimer’s disease?
The most common form of dementia.

It is a progressive organic condition in which neurons die.

There is no treatment for this condition.

Characterized by a progressive deterioration of a persons memory, peronality and ability to think.
What is Amyotriphic Lateral
Sclerosis (ALS)?
Degenerative neuromuscular
disease of the motor neurons, the Amyotriphic Lateral
Sclerosis (ALS) nerves cells of the CNS that control the voluntary muscle movement.

There is no cure for this disease.
What is Bell’s Palsy?
Paralysis of facial nerves resulting in the inability to control the facial muscles on the affected side.
What is pre-hospital care for Bell's Palsy?
Can be confused with a stroke.

Supportive care. Be aware that the patient may not be able to blink.
What is Cerebral Palsy?
A developmental condition in which damage is done to the brain.

Presentation begins in infancy. Milestones may be delayed.

Prehospital management is supportive. Bring along any aids and equipment that they may have.
What is spina bifida?
A portion of the spinal cord is not formed properly.

May be called for seizures, trauma or infections.

Be aware that many SB patients are allergic to latex.
What is Myasthenia Gravis?
The body creates antibodies against acetylcholine receptors. As acetylcholine levels fall muscle weakness begins.

Weakness can affect the facial muscles.

Other patients can have trouble speaking or swallowing.
What is a Myasthenia Crisis?
A sudden increase in the destruction of acetylcholine resulting in weakness of the respiratory muscles.

As a result the patient can become hypoxic.