Aemt Neurologic Emergencies (Mwn)

Front 1

Seizures may occur as the result of:

Back 1

Recent or old head injury
Brain tumor
Metabolic problem
Genetic disposition

Front 2

Three major parts of brain and what they control:

Back 2

Brain stem - Controls most basic functions
Cerebellum - Controls muscle and body coordination
Cerebrum, Largest part Divided into right and left hemispheres
Each controls activities on opposite side of body.
Front controls emotion and thought.
Middle controls touch and movement.
Back processes sight.

Front 3

________ (#) cranial nerves run directly from the brain to parts of the head. The rest of the nerves join in the spinal cord and exit the brain through the ___________

Back 3

Twelve

foramen magnum

Front 4

S&S Migraine headaches

Back 4

Thought to be caused by changes in the blood vessel size in the base of the brain.
Patient may experience aura and unilateral, focused pain that spreads over time.
Pain is usually described as pounding, throbbing, and pulsating.
Nausea, vomiting, photophobia also occur.
Can last for several days

Front 5

Dead brain cells are called

Back 5

infarcted cells

Front 6

Interruption of cerebral blood flow may result from:

Back 6

Thrombus
Arterial rupture
Cerebral embolism

Front 7

There are two main types of stroke:

Back 7

Ischemic - From embolism or thrombus
Hemorrhagic - From arterial rupture

Front 8

S&S Ischemic Stroke

Back 8

Loss of movement on opposite side of body, confusion, and inability to speak
Patient may experience anything from a few symptoms to complete paralysis.

Front 9

Preventing Hemorrhagic Stroke

Back 9

People at high risk include those with chronic, poorly controlled hypertension.
Cerebral hemorrhages are often fatal.
Proper treatment of hypertension can prevent long-term damage to blood vessels

Front 10

When a hemorrhagic stroke occurs in an otherwise healthy young person, it is likely caused by

Back 10

a berry aneurysm= Subarachnoid hemorrhage
Surgical repair possible if care is immediate
Can result in bizarre vital signs, other findings
Continued bleeding will lead to death

Front 11

With increased ICP, the brain may:

Back 11

Become ischemic due to lack of blood
Herniate

Front 12

Prehospital treatment to decrease ICP

Back 12

is not effective. Also, do not treat high blood pressure in stroke patients in field.

Front 13

Signs and Symptoms of Stroke - Left hemisphere problems

Back 13

Aphasia - Inability to produce or understand speech, Speech problems can vary widely.
Paralysis on right side of body
Right hemisphere problems
Paralysis on left side of body
Dysarthria - Understand language and are able to speak; Their words are slurred and hard to understand.

Front 14

"Neglect" in stroke Pt=

Back 14

Neglect= Patient is oblivious to problem.

Patients with problem affecting occiput may neglect certain parts of vision.

Try to sit or stand on patient’s unaffected side. Patient may delay seeking help.

Front 15

Conditions That May Mimic Stroke

Back 15

Hypoglycemia - Not enough blood glucose, Check blood glucose level. Find out if patient is diabetic.

Postictal state - Reset period of brain after a seizure
Nonstroke patients will recover spontaneously.

Subdural or epidural bleeding - Blood within the skull compresses the brain. Usually result of trauma Symptoms may be subtle, patient may not remember injury.

Front 16

Steps of a Tonic-Clonic Seizure

Back 16

Aura - Sensation before seizure occurs
Loss of consciousness
Tonic phase - Body-wide rigidity
Hypertonic phase - Arched back and rigidity
Clonic phase - Rhythmic contraction of major muscle groups
Postseizure - Major muscles relax
Postictal - Rest period of the brain

Front 17

Characteristics of "Absence Seizures"

Back 17

Present with little or no movement
Child is typical patient- Child will stop moving, but will rarely fall.
Last for no more than several seconds
No postictal period and no confusion
May be brought on by flashing lights or hyperventilation

Front 18

characteristics of Partial Seizures

Back 18

Simple partial seizure - Movement or sensations of one part of the body when originating in the frontal lobe. Altered sensations in one part of the body when originating in the parietal lobe. May spread from one part to another in a wave
Complex partial seizure - Subtle changes in LOC
Patient may become confused, lose alertness, have hallucinations, or be unable to speak. Eyes or head may make small movements. Patient usually does not become unresponsive.

Front 19

Characteristics of Status Epilepticus

Back 19

Seizures lasting more than 4 or 5 minutes
Time frame is arbitrary.
Refer to local protocols for guidelines on how long a seizure can continue before you intervene.
During seizure, neurons are in a hypermetabolic state.
For a short period, seizure does not produce long-term damage. If seizure continues, neurons will be damaged or killed.
Goals of prehospital care - Stop the seizure. Ensure adequate ABCs.

Front 20

Epileptic seizures usually can be controlled by

Back 20

Most seizures are the result of medication noncompliance.
Phenytoin (Dilantin) is used to control seizures, but can cause them if patient takes too much.

Front 21

Characteristics of Febrile Seizures

Back 21

Result from sudden high fevers, usually in infants and small children. Transport child for evaluation in the hospital. Not how high the fever goes, but how quickly it gets there

Front 22

Describe the Postictal State

Back 22

-After a seizure, the muscles relax, becoming almost flaccid, and breathing becomes labored.
-Breathing pattern helps body balance acidity.
-With normal circulation and liver function, the patient will begin to breathe more normally within minutes.
In some situations, postictal state may be characterized by hemiparesis.
-Lethargy. AMS and confusion are common.
-Be prepared; the patient may be combative.
-If the patient’s condition does not improve, consider other conditions, such as:Hypoglycemia, Infection

Front 23

Causes of Altered Mental Status

Back 23

Hypoglycemia
Hypoxemia
Intoxication
Drug overdose
Unrecognized head injury
Brain infection
Body temperature abnormalities
Psychological problems
Infections
Drug overdose and poisonings
Uncommon conditions, such as: Brain tumors, Glandular abnormalities

Front 24

Syncope can be caused by a ___ second loss in blood flow and can result from:

Back 24

3- to 5-second

Problems with cardiac rhythm, conduction, or muscle
Myocardial infarction
Dehydration
Hypoglycemia
Vasovagal episode

Front 25

The ______ is the organ that is most sensitive to fluctuating levels of oxygen, glucose, and temperature.

Back 25

Brain

Front 26

Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score?

Back 26

The Glasgow Coma Scale gives a score of 3 to a patient who opens his or her eyes in response to speech. “Incomprehensible sounds” has a score of 2, and “withdraws to pain” has a score of 4. When added together, this patient’s GCS score is 9.

Front 27

The name for a seizure that lasts for longer than 4 to 5 minutes or consecutive seizures that occur without the return of consciousness between seizure episodes is

Back 27

status epilepticus

Front 28

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as

Back 28

Dysarthria - defined as slurred, poorly articulated speech; it is common in stroke patients.

Dysphasia is defined as difficulty speaking; the patient’s speech may or may not be slurred. Aphasia is the inability to speak. Dysphagia is defined as difficulty swallowing.

Front 29

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is

Back 29

hemorrhagic stroke

Front 30

A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the

Back 30

brain stem

Front 31

Be alert for the Cushing reflex, as it indicates

Back 31

increased ICP

Front 32

decorticate posturing

Back 32

curls arms towards chest, points toes

Front 33

decerebrate posturing

Back 33

points toes, extends arms out & rotates palm palms down (severe finding)

Front 34

trimus

Back 34

clenching teeth

Front 35

ICP in infant is characterized by

Back 35

cat eyes and cat cries

Front 36

Tx stroke

Back 36

Administer 100% supplemental oxygen.
Obtain IV access.
Transport patient.
Most treatments must be started as soon as possible.
Do not give aspirin.

Front 37

Tx seizures

Back 37

Administer 100% supplemental oxygen.
Gain IV access.
Note medications, seizure history.
Depending on protocols and the situation:
-Assess for trauma.
-Treat for hypoglycemia.
-Manage the airway.
Be professional, compassionate.

Front 38

Tx Syncope

Back 38

Begin with standard care.
Determine whether patient experienced trauma during fall.
Take cervical spine precautions as needed.
Focus on blood glucose level, likely cardiac causes.
Obtain orthostatic vital signs.
Provide supplemental oxygen; gain IV access.
Provide emotional support.
Syncope can be a sign of life-threatening medical conditions. Call for paramedic backup if needed.

Front 39

aphasia

Back 39

inability to produce or understand speech (sign of left hemisphere stroke)

Front 40

clonic phase

Back 40

rhythmic contraction of major muscle groups, lip smacking, biting

Front 41

tonic phase

Back 41

body-wide rigidity

Front 42

hypertonic phase

Back 42

arched back and rigidity

Front 43

A Pt who answers "What day is today?" with "Green" is likely having s stroke in which hemisphere?

Back 43

Left

Front 44

S&S of a right hemisphere stroke

Back 44

can't move muscles on Left side of body. Can understand language and speak but words are slurred. May be oblivious to the problem.

Front 45

dysarthria

Back 45

slurred speech

Front 46

Characteristics of absence seizures

Back 46

starring episodes or "absence spells";

most common in children 4-12

lip smacking;

Front 47

Grand Mal seizure

Back 47

now called - Tonic-Clonic

loss of consciousness, can occur at any age.