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altered mental status loss of function.ppt
 

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    altered mental status loss of function.ppt altered mental status loss of function.ppt Presentation Transcript

    • Altered Mental Status With Loss of Function
    • Neurological Deficit
      • Any deficiency in the functioning of the brain or nervous system
      • Nontraumatic brain injuries
    • Stroke (CVA)/Brain Attack
      • Most common condition causing altered mental status
      • Interruption of blood flow to the brain
      • Aphasia (loss of speech)
      • Anesthesia (loss of sensory function)
      • Plegia (paralysis)(loss of function)
      • Paresis (weakness) (loss of function)
      • Most common cause of death
        • More than half victims die
        • Others suffer permanent neurological damage
    • Stroke (CVA)/Brain Attack Cont..
      • Most often affect the elderly
      • Atherosclerosis
      • Arteriosclerosis
      • Hypertension
      • Episodes of TIA’s
    • Signs & Symptoms
      • Loss of speech, sensory & motor function
      • Decreased LOC.
      • Severe headache
      • Drooping eyelid and mouth on one side
      • Monoplegia (one extremity)
      • Hemiplegia (one side of the body)
      • Dysphasia (difficulty speaking or swallowing)
      • Dyspnea
      • Possible seizures
    • Transient Ischemic Attack (TIA)
      • Mini-stroke
      • Signs & symptoms often disappear within 24 hours with no permanent disability
      • Ischemia - oxygen deficit in the tissues
      • Most commonly signs and symptoms last for approximately 5 to 10 minutes. Unusual to last longer than 30 minutes
      • Approximately 1/3 who suffer TIA will have a stroke
      • Thrombosis
      • Embolism
      Occlusive Strokes
    • Thrombosis
      • Thrombosis - process of clot formation
      • Thrombus - clot at the site of occlusion
        • Atherosclerosis (plaque deposits)
        • Hypertension( wearing out of the walls, plaque)
      • Builds up over a loner period of time
      • Onset of signs and symptoms slower than embolic-type
      • Most common type of stroke
        • Most commonly occurs at night when patient awakens with loss of speech, motor, and sensory functions
    • Embolism
      • Clot travels from one area of the body, usually the neck or heart and lodges in the cerebral artery.
        • Blood clot
        • Air bubbles
        • Tumor fragments
        • Fat particles
      • Most often occurs when patient is awake and active
      • Sudden onset of signs & symptoms
        • Headache, seizure activity, brief periods of unresponsiveness are more common
    • Hemorrhagic Stroke
      • Rupture of an artery causing bleeding within the brain
      • Hypertension - causes wall to weaken(aneurysm)
      • Congenital defect
      • Onset sudden
      • Severe headache (worst headache I ever had)
      • May or may not have mental distortion
      • Seizures and stiff neck are also common
    • Scene Size-up
      • Scan the scene for clues of medical or trauma
      • Look for evidence of drug paraphernalia, alcohol, or prescription drugs.
      • Note patient’s cloths (bed clothes)
      • Look for bucket or ice pack near the bed
        • N&V or headache
    • Initial Assessment
      • Establish airway
      • Suction (lost ability to swallow due to paralysis)
      • Establish positive pressure ventilation with BigO’s
        • NPA or OPA
      • It is possible for patient to feel pain but not be able to move in response to it
    • Focused History/Physical Exam
      • If patient is unresponsive
        • Perform physical exam
        • Obtain baseline vitals
        • SAMPLE history
      • If patient is responsive
        • Perform SAMPLE history
        • Physical exam
        • Baseline vitals
      • Assessment will be rapid rather than focused
      • Assess speech
      • Assess face for drooping and pupils for equality
      • Assess grip strength bilaterally
      • Baseline vitals every 5 minutes & document
        • Remember hypertension is a good indicator
      Focused History/Physical Exam Cont..
    • SAMPLE History
      • Medic alert tags
      • Determine response to commands
        • Blink yes or no
        • Squeeze your finger if patient understands
      • Any recent history of trauma to the head
      • Any history of previous stroke
      • Any seizure activity prior to arrival
      • What was the patient doing at time of onset
      • Any history of diabetes
      • Any complaint of headache or stiff neck
    • Other Questions
      • Any anticoagulant drugs
      • History of hypertension
      • Has patient taken any amphetamines, cocaine, or other stimulant drugs
      • Was onset gradual or sudden
      • Did signs & symptoms get progressively worse or better
      • Any paralysis or weakness progressing to other areas
    • Detailed & Ongoing Assessment
      • Do a detailed exam if time permits
      • Perform ongoing assessment every 5 minutes
      • Document and record any changes and all vitals
    • Emergency Treatment
      • Ensure airway
      • Oxygen therapy NR mask or positive pressure ventilations with Big O’s
      • Position patient
        • Altered mental status left lateral recumbent
        • Responsive supine semi-fowlers or fowlers
      • Protect paralyzed extremities
      • Transport