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41 Cards in this Set
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coma
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unconscious state where patient does not respond to painful stimuli
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ras and consciousness
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ras is network of nerve cells in brain stem that constantly transmit environmental and sensory stimuli to and from cerebrum, if damged or dysfunctional patient will lose consciousness, or if both cerbral hemispheres damged or dysfunctional patient will lose consciousness
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cause of altered mental status 2 categories
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stuctural (brain tumor hemmorage etc)
toxic metbolic causes (severe hypoxia, abnormal glucose, liver failur, kidney failure, poisioning) |
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all patients with altered loc must receive
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high flow o2
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blood pressure and loc
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a low bp may represent poor perfusion while a high bp may indicate a stoke causing altered loc
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nuerological deficit
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any deficit in functioning of brain or nervous system
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stroke
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-aha 3rd leading cause of death in adult population
-700,000 a yr suffer 1st stroke, 158000 will die |
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stroke and time
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time is very critical factor
-early recognition allows drug and mechanical devices to be used in certain stoke patients to break up clots -must be delivered within 3 hrs |
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stroke
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-cerbral artery is occluded
-atherosclerosis norm a contributing factor |
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ischemic stoke
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blockage of artery carrying blood to brain
(thrombotic stroke from a clot or embolic stroke-stroke from clot that has traveled from another area that lodges in cerbral artery |
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thrombotic vs embolic
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embolic much quicker has headache seizure activity and breif periods of unresponsiveness more common
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hemorrhagic stroke
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rupture of an artery that cause bleeding in the brain
-hypertensive people high candidates (aneurysm which weakened a dilated area within artery wall is common cause, common cause for stokes in younger healthy adults) |
s/s
-very sudden onset -headache common and severe symptom -seizures and stiff neck also common |
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most likely candidate for stroke
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high bp with breif intermittent stoke like episodes called tia
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s/s of stoke
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-paralysis of one or both extremities on one side
-double or blurred vision -facial drop -speak clearly uttering nonsensical words (aphasia) |
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tia (transient ischemic attack)
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same s/s pf stoke except sign and symptoms of tia typically disappear within 10 to 15 minutes
-tia always resolves within 24 hrs -thrid who suffer tia will eventually suffer stroke |
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Cincinnati prehospital stoke scale
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1. facial droop by having patient smile
2. arm drift by having patient close his eyes and hold both arms straight out in front for 10 seconds 3. abnormal speech pattern (you cant teach an old dog new tricks) (all three abnormal 72 percent prob stoke) |
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LA prehospital stroke screen
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1. age greater than 45
2.history of seizures epilepsy 3.duration of symptoms 4. wheelchair or bedridden 5. bgl assymetry by facial smile, grip, and arm strength (97 percent if any positive findings) |
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most commonly misdiagnosed as stoke
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hypoglycemia
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headache
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may be condition in itself or symptom of stroke, brain tumor, brain infection
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seizure
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sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain.
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convulsion
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jerky muscle like movements
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epilepsy
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common cause of seizures
125,000 new cases a yr |
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primary or secondary seizures
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primary- due to genetic or known cause
secondary-not from genetic cause but from insult to body such as fever, hypoxia, drug withdrawal, eclmapsia, etc ( secondary generalized in nature therefore full convulsive type seizure) |
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generalized verse partial seizures
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-generalized involves both hemispheres of brain and ras, unconsciousness usually results
has rhythmic tonic clonic muscle contractions partial- abnormal activity in one hemisphere, patient remains conscious in simple partial, complex partial may alter loc or unresponsive |
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status epilepticus
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patient who suffers generalized motor seizures that last more than 5 minutes or occur consecutively without period of responsiveness between
(aggressive airway, ppv, and immed transport) |
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(grand mal) generalized tonic clonic seizure
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-affects both hemispheres of brain and ras
-loss of consciosness and jerky convulsive motor like activity six stages-aura, loss of consciosness, tonic phase (muscles contracted and tense with arching of back), hypertonic, clonic phase (musle spasm that alternate with relaxation violent jerky movement) 1to 3 min, postical state (altered loc, weak, exhausted last 10 to 30 mins |
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simple partial seizure
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(jacksonian or focal motor) jerky movement in one area of body, arm, leg, or face
(may spread to others and may progress to grand mal) |
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complex partial seizure
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(psychomotor or temporal lobe)
last 1 to 2 minutes -awake but not aware of surroundings -blank stare followed by random activty such as chewing, lip smacking, rolling fingers |
-care= stay with person until aware of surroundings
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absence (petit mal)
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common in children
-blank stare lasting only a few seconds -rapid blinking, chewing, or lack of attention |
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febrile seizure
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children 6 months to 6 yrs
-high fever caused -very short secondary generalized seizures |
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seizure care
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-open airway if needed
-be prepared to suction vomitus and blood ( do not insert opa) -status epilepticus or severly cyanotic ppv -15 lpm o2 if breathing adequate secondary -palpate extremties bone injuries may result -assess bgl -take history from resp patient or bystander -postical state lateral recumbent |
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syncope
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fainting or sudden loss of consciousness
-common cause is overwhelming influence of parasympathetic nervous system that causes blood vessels to dilate |
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syncope
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-blood vessels suddenly dilate, gravity cause blood to pool in extremities decrease perfusion in brain, then they have a faint, patient recover quickly when placed supine
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insulin
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secreted when blood glucose level is elevated
-pancreas produces insulin -it increases movement of glucose into cells and cause liver to take up glucose out of blood and convert it into glycogen |
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organ that does not need insulin to move glucose into the cells?
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the brain
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glucagon
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hormone that stimulates liver to convert stored glycogen and other substances into glucoes
-raise blood glucose level glycogen stores can last for up to 24-48 hrs |
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normal blood glucose range
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70-120 mg/dl
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hypoglycemia
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low blood sugar
-bgl below 60 with s/s or below 50 without s/s |
s/s of epi release
-epinephrine will be released at higher levels it shuts down secretion of insulin and stimulates secretion of glucagon -diapohresis -tremors -weak -hunger -tachycardia -dizziness -pale, cool, clammy skin -warm sensation s/s associted with brain function -confusion -drowsiness -disorientation -unresponsiveness -seizures stroke like symptoms |
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hyperglycemia
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-high blood glucose level
-can be dka or hhns |
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dka (diabetic ketoacidosis)
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-bgl greater than 350
-brain has suffucient glucose therefore no altered loc but rest of cells starving -frequent urination causes dehydration -cells burning fat causes buildup of ketones which produce a strong acid |
sweet and frutiy odor, abdominal pain (50 percent), three p's, nausea vomiting, tachycardia, kussmaul respirations
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hhns (hyperglycemic hyperomolar nonketottic syndrome
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600 to 1200 bgl
-kidneys spill large amounts of glucose into urine -glucose draws water to it and causes dehydration -more common in type 2 - |
no kussmaul respirations or fruity breath odor
-carries fairly high mortality rate |
