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

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  • 1. Altered Mental Status With Loss of Function
  • 2. Neurological Deficit
    • Any deficiency in the functioning of the brain or nervous system
    • Nontraumatic brain injuries
  • 3. 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
  • 4. Stroke (CVA)/Brain Attack Cont..
    • Most often affect the elderly
    • Atherosclerosis
    • Arteriosclerosis
    • Hypertension
    • Episodes of TIA’s
  • 5. 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
  • 6. 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
  • 7.
    • Thrombosis
    • Embolism
    Occlusive Strokes
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14.
    • 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..
  • 15. 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
  • 16. 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
  • 17. Detailed & Ongoing Assessment
    • Do a detailed exam if time permits
    • Perform ongoing assessment every 5 minutes
    • Document and record any changes and all vitals
  • 18. 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

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