Chapter 13 Neurologic Emergencies 13 Neurologic Emergencies Objectives
Chapter 13 Neurologic Emergencies
13: Neurologic Emergencies Objectives (1 of 4) • Describe the causes of stroke and the three conditions that cause blockages. • Describe the events that occur during a stroke. • Obtain and interpret vital signs in the stroke patient. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 2
13: Neurologic Emergencies Objectives (2 of 4) • State the reason stroke must be treated within the first 3 to 6 hours. • Identify the signs and symptoms of stroke. • Describe the significance of a transient ischemic attack (TIA). Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 3
13: Neurologic Emergencies Objectives (3 of 4) • Define seizure, including the two major types of seizure. • Describe the parts of a seizure. • List possible causes of seizures. • Explain the importance of recognizing seizures. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 4
13: Neurologic Emergencies Objectives (4 of 4) • Describe characteristics of the post-seizure state. • Define altered mental status. • List possible causes of altered mental status. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 5
13: Neurologic Emergencies Brain Structure and Function Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 6
13: Neurologic Emergencies The Spinal Cord Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 7
13: Neurologic Emergencies Common Causes of Brain Disorder • Cerebrovasuclar accident (CVA) • Interruption of blood flow to the brain that results in the loss of brain function • Stroke • The loss of brain function that results from a CVA Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 8
13: Neurologic Emergencies Hemorrhagic Stroke • Results from bleeding in the brain • Arterial rupture • High blood pressure is a risk factor. • Some people are born with aneurysms. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 9
13: Neurologic Emergencies Ischemic Stroke • Results when blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel • Thrombosis • Clotting of the cerebral arteries • Cerebral embolism • Blockage by a clot formed elsewhere in the body Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 10
13: Neurologic Emergencies Transient Ischemic Attack (TIA) • A TIA is a “mini-stroke. ” • Stroke symptoms go away within 24 hours. • Every TIA is an emergency. • TIA may be a warning sign of a larger stroke. • Patients with possible TIA should be evaluated by a physician. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 11
13: Neurologic Emergencies Seizures • Generalized (grand mal) seizure • Unconsciousness and generalized severe twitching of the body’s muscles that lasts several minutes • Petit mal seizure • Seizure characterized by a brief lapse of attention Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 12
13: Neurologic Emergencies Characteristics of Seizures • Seizures may occur on one side or gradually progress to a generalized seizure. • Usually last 3 to 5 minutes, and are followed by postictal state • Seizures recurring every few minutes are known as status epilepticus. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 13
13: Neurologic Emergencies Causes of Seizures • Congenital (epilepsy) • • • High fevers Structural problems in the brain Metabolic disorders Chemical disorders (poison, drugs) Sudden high fever Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 14
13: Neurologic Emergencies Recognizing Seizures • Cyanosis • Abnormal breathing • Possible head injury • Loss of bowel and bladder control • Severe muscle twitching • Post seizure state of unresponsiveness with deep and labored respirations Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 15
13: Neurologic Emergencies Postictal State • Patient may have labored breathing. • May have hemiparesis: weakness on one side of the body. • Patient may be lethargic, confused or combative. • Consider underlying conditions. • Hypoglycemia • Infection Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 16
13: Neurologic Emergencies Altered Mental Status (AMS) • Hypoglycemia • Brain infection • Hypoxemia • Body temperature abnormalities • Intoxication • Drug overdose • Unrecognized head injury • Brain tumors • Glandular abnormalities • Poisoning Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 17
13: Neurologic Emergencies Signs and Symptoms of Brain Disorders • Many different disorders can affect: • Level of consciousness • Speech • Voluntary muscle control Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 18
13: Neurologic Emergencies Signs and Symptoms of Stroke • Left Hemisphere • Aphasia: Inability to speak or understand speech • Receptive aphasia: Ability to speak, but unable to understand speech • Expressive aphasia: Inability to speak correctly, but able to understand speech • Right Hemisphere • Dysarthria: Able to understand, but hard to be understood Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 19
13: Neurologic Emergencies Stroke Mimics • Hypoglycemia • Postictal state • Subdural or epidural bleeding Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 20
13: Neurologic Emergencies Assessing the Stroke Patient • Initial assessment • Check and care for ABCs. • Obtain history if possible. • Administer oxygen and manage airway. • Focused history and physical exam • Perform neurologic exam. • Utilize the Cincinnati Stroke Scale Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 21
13: Neurologic Emergencies Cincinnati Stroke Scale • Facial droop • Abnormal if asymmetrical • Arm drift • Abnormal if arms do not move equally • Speech • Abnormal if words are slurred or confused Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 22
13: Neurologic Emergencies Transport Considerations • Place the patient in a comfortable position. • Usually on one side • Paralyzed side down and well protected • Elevate patient’s head about 6". • Continue giving oxygen and monitor vitals. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 23
13: Neurologic Emergencies Assessing the Seizure Patient • Initial assessment • Focus on ABCs • Expect rapid, deep respirations if the patient is postictal. • Focused history and physical exam • Obtain SAMPLE history. • Observe patient for recurrent seizures. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 24
13: Neurologic Emergencies Assessing a Patient with AMS • • Use AVPU scale to classify severity. Consider underlying conditions. Monitor for depressed respirations. Ensure that basic airway maneuvers are followed. • Provide prompt transport to hospital while monitoring the patient. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 25
13: Neurologic Emergencies Emergency Medical Care for Stroke • Patient needs to be evaluated by computed topography (CT). • Recognizing the signs and symptoms of stroke can shorten the delay to CT. • Treatment needs to start within 3 to 6 hours of onset. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 26
13: Neurologic Emergencies Emergency Medical Care for Seizure • Most patients should be evaluated by a physician after a seizure. • With severe injury, suspect spinal injury. • Attempt to lower body temperature if febrile seizure. • Patient and family may be frightened. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 27
13: Neurologic Emergencies Geriatric Needs • Brain shrinks with age. • Always consider underlying conditions. • Elderly are at higher risk for central nervous system illnesses and injuries. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 28
13: Neurologic Emergencies Pediatric Needs • Children can have AMS caused by: • Strokes • Seizure • Other brain emergencies • Treat in the same way as adults. • Seizures are often febrile. • Transport to the hospital. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 29
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