Neurological Emergencies

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Neurological Emergencies

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  • 03/25/11 Temple College EMS Professions
  • Neurological Emergencies

    1. 1. http://crisbertcualteros.page.tl Neurological Emergencies (Coma, Seizures, Syncope, Stroke)
    2. 2. <ul><li>State of unconsciousness from which patient cannot be aroused </li></ul>
    3. 3. <ul><li>Unconsciousness = Immediate Life Threat </li></ul><ul><ul><li>Loss of airway </li></ul></ul><ul><ul><li>Aspiration </li></ul></ul>
    4. 4. <ul><li>Management of ABC’s must come before investigation of cause </li></ul>
    5. 5. <ul><li>Open, clear, maintain </li></ul><ul><li>If trauma present or no history available, immediately control C-spine </li></ul>
    6. 6. <ul><li>Assess presence, adequacy </li></ul><ul><li>High concentration O 2 immediately on all patients with LOC </li></ul><ul><li>Assist if respiratory rate, tidal volume inadequate </li></ul>
    7. 7. Pulses? Perfusion?
    8. 8. <ul><li>Quickly investigate cause </li></ul><ul><li>DERM </li></ul>
    9. 9. <ul><li>DERM </li></ul>
    10. 10. <ul><li>What does patient respond to? </li></ul><ul><li>How does he respond? </li></ul>
    11. 11. <ul><li>Pupils equal, dilated, constricted, </li></ul><ul><li>Responsive to light? </li></ul><ul><li>How? </li></ul>
    12. 12. <ul><li>Rate? </li></ul><ul><li>Unusually deep or shallow? </li></ul><ul><li>Altered pattern? </li></ul>
    13. 13. <ul><li>Evidence of paralysis? </li></ul><ul><li>Movement on stimulation? </li></ul><ul><li>How? </li></ul>
    14. 14. <ul><li>Shock? </li></ul><ul><li>Increased ICP? </li></ul><ul><li>Arrhythmias? </li></ul>
    15. 15. <ul><li>Injuries causing coma? </li></ul><ul><li>Injuries caused by fall? </li></ul><ul><li>What do the scene, bystanders tell you? </li></ul>
    16. 16. <ul><li>Not enough oxygen </li></ul><ul><li>Not enough sugar </li></ul><ul><li>Not enough blood flow to deliver O 2 , sugar </li></ul><ul><li>Direct brain injury </li></ul><ul><ul><li>Structural (trauma) </li></ul></ul><ul><ul><li>Metabolic (toxins, infections, temperature) </li></ul></ul>
    17. 17. <ul><li>A lcohol </li></ul><ul><li>E pilepsy </li></ul><ul><li>I nsulin </li></ul><ul><li>O verdose </li></ul><ul><li>U remia (and other metabolic causes) </li></ul><ul><li>T rauma </li></ul><ul><li>I nfection </li></ul><ul><li>P sychiatric </li></ul><ul><li>S troke, syncope </li></ul>
    18. 18. <ul><li>Secure airway </li></ul><ul><li>Protective reflexes may be lost </li></ul><ul><li>Immobilize spine unless absolutely certain injury not present </li></ul><ul><li>Spinal injury not suspected - patient on left side </li></ul>
    19. 19. <ul><li>High concentration O 2 </li></ul><ul><li>Assist ventilation as needed </li></ul><ul><li>Monitor neurological/vital signs every 5 minutes </li></ul>
    20. 20. <ul><li>Protect patient’s eyes on long transports (tape shut, moist pads) </li></ul><ul><li>Patient may hear, understand even though unable to respond </li></ul><ul><li>Treat, reassure accordingly </li></ul>
    21. 21. <ul><li>Episodes of uncoordinated electrical activity in brain </li></ul><ul><li>Signs/symptoms depend on area involved </li></ul>
    22. 22. <ul><li>Tendency to have repeated episodes of seizure activity </li></ul>
    23. 23. <ul><li>Grand mal (major motor) </li></ul><ul><li>Petit mal (absence) </li></ul><ul><li>Focal motor (simple partial) </li></ul><ul><li>Psychomotor (complex partial) </li></ul>
    24. 24. <ul><li>Aura </li></ul><ul><ul><li>Sensation coming before convulsion </li></ul></ul><ul><ul><li>Patient may recognize as sign of impending seizure </li></ul></ul><ul><ul><li>May help locate origin of seizure in brain </li></ul></ul>
    25. 25. <ul><li>Convulsion </li></ul><ul><ul><li>Loss of consciousness </li></ul></ul><ul><ul><li>Tonic phase - rigidity </li></ul></ul><ul><ul><li>Clonic phase - rhythmic jerking, incontinence , ineffective breathing </li></ul></ul>
    26. 26. <ul><li>Post-ictal Phase </li></ul><ul><ul><li>Exhaustion </li></ul></ul><ul><ul><li>Drowsiness </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Possible hemiparesis (Todd’s paralysis) </li></ul></ul>
    27. 27. <ul><li>Loss of consciousness </li></ul><ul><li>No loss of postural tone </li></ul><ul><li>More common in children </li></ul>
    28. 28. <ul><li>Rhythmic jerking of limb, one side of body </li></ul><ul><li>No loss of consciousness </li></ul>
    29. 29. <ul><li>Loss of consciousness </li></ul><ul><li>Sterotyped movements (automatisms) </li></ul><ul><ul><li>May look purposeful, but aren’t </li></ul></ul><ul><ul><li>Lip smacking, movements of hands </li></ul></ul><ul><li>May be called in as “drunk”, “O.D.”, “psych patient ” </li></ul>
    30. 30. <ul><li>During seizure </li></ul><ul><ul><li>Remove from potential harm </li></ul></ul><ul><ul><li>Do not forcibly restrain </li></ul></ul><ul><ul><li>Roll on side </li></ul></ul><ul><ul><li>Avoid putting anything in mouth </li></ul></ul>
    31. 31. <ul><li>After seizure ends </li></ul><ul><ul><li>Assess ABC’s </li></ul></ul><ul><ul><li>Clear airway </li></ul></ul><ul><ul><li>Most common cause of seizure deaths is post-ictal airway loss </li></ul></ul>
    32. 32. <ul><ul><li>High concentration O 2 - immediately!! </li></ul></ul><ul><ul><li>Assist breathing if ventilation inadequate </li></ul></ul>
    33. 33. <ul><ul><li>Obtain history/physical </li></ul></ul><ul><ul><ul><li>Trauma that could have caused, been caused by seizure </li></ul></ul></ul><ul><ul><ul><li>Anti-seizure medications </li></ul></ul></ul><ul><ul><li>Neuro/vital signs every 5 minutes </li></ul></ul><ul><ul><li>If patient ventilating adequately, transport on left side </li></ul></ul>
    34. 34. <ul><li>Anything that injures brain can cause seizures (AEIOU/TIPS) </li></ul><ul><li>Do not assume seizures are due to idiopathic epilepsy until proven otherwise </li></ul>
    35. 35. <ul><li>> 2 seizures without intervening conscious period </li></ul><ul><li>Immediate Life Threat </li></ul><ul><li>Management </li></ul><ul><ul><li>Secure airway </li></ul></ul><ul><ul><li>Assist breathing with O 2 </li></ul></ul><ul><ul><li>Transport </li></ul></ul><ul><ul><li>Request ALS intercept </li></ul></ul>
    36. 36. <ul><li>Fainting </li></ul><ul><li>Sudden, temporary loss of consciousness </li></ul><ul><li>Caused by lack of blood flow to brain </li></ul>
    37. 37. <ul><li>Stress, fright, pain (vasovagal syncope) </li></ul><ul><li>Orthostatic hypotension (BP fall on standing) </li></ul><ul><ul><li>Decreased blood volume </li></ul></ul><ul><ul><li>Increased size of vascular space </li></ul></ul><ul><li>Decreased cardiac output </li></ul><ul><li>Prolonged forceful coughing </li></ul>
    38. 38. <ul><li>ABCs </li></ul><ul><li>Keep patient supine, elevate lower extremities </li></ul><ul><li>Oxygen </li></ul><ul><li>Assess underlying cause </li></ul>
    39. 39. <ul><li>Cerebrovascular accident </li></ul><ul><li>Stroke </li></ul>
    40. 40. <ul><li>Damage of portion of brain due to interruption of blood supply </li></ul><ul><li>Mechanisms </li></ul><ul><ul><li>Thrombosis </li></ul></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Embolism </li></ul></ul>
    41. 41. <ul><li>Blockage of vessel by thrombus </li></ul><ul><li>Usually forms at area narrowed by atherosclerosis </li></ul><ul><li>Typically in older persons </li></ul><ul><li>Frequently occurs during sleep </li></ul>
    42. 42. <ul><li>Vessel ruptures </li></ul><ul><li>Associated with hypertension, aneurysms of cerebral blood vessels </li></ul><ul><li>Usually characterized by </li></ul><ul><ul><li>Sudden onset </li></ul></ul><ul><ul><li>Severe signs, symptoms </li></ul></ul>
    43. 43. <ul><li>Blood clots, plaque fragments travel through vessel; lodge, block flow </li></ul><ul><li>Often associated with: </li></ul><ul><ul><li>Atherosclerosis of carotids </li></ul></ul><ul><ul><li>Chronic atrial fibrillation </li></ul></ul>
    44. 44. <ul><li>Alterations in consciousness </li></ul><ul><ul><li>Altered affect </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Coma </li></ul></ul>
    45. 45. <ul><li>Localizing signs </li></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Loss of sensation </li></ul></ul><ul><ul><li>Loss of speech </li></ul></ul><ul><ul><li>Unilateral blindness </li></ul></ul><ul><ul><li>Loss of vision in half of visual field of both eyes </li></ul></ul><ul><ul><li>Unequal pupils </li></ul></ul>
    46. 46. <ul><li>Seizures </li></ul><ul><li>Headache </li></ul><ul><li>Stiff neck </li></ul>
    47. 47. <ul><li>TIAs </li></ul><ul><li>“ Little strokes” </li></ul><ul><li>Produce deficits that resolve completely in <24 hours </li></ul><ul><li>Frequently precede CVA </li></ul>
    48. 48. <ul><li>Assess ABC’s </li></ul><ul><li>Protect airway </li></ul><ul><li>High concentration O 2 </li></ul><ul><li>Vital signs every 5-10 minutes </li></ul><ul><li>Note increased BP, irregular pulse </li></ul>
    49. 49. <ul><li>Nothing by mouth </li></ul><ul><li>Avoid rough handling </li></ul><ul><li>Transport paralyzed side down </li></ul><ul><li>Guard your conversation </li></ul><ul><li>Patients who cannot speak may still understand! </li></ul>
    50. 50. <ul><li>CVAs caused by thrombus, embolus may be reversible with thrombolytics (clot busters) </li></ul><ul><li>Early recognition, rapid transport to appropriate facility is critical </li></ul>

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