Altered Mental Status  With Loss of Function
Neurological Deficit <ul><li>Any deficiency in the functioning of the brain or nervous system </li></ul><ul><li>Nontraumat...
Stroke (CVA)/Brain Attack <ul><li>Most common condition causing altered mental status </li></ul><ul><li>Interruption of bl...
Stroke (CVA)/Brain Attack Cont.. <ul><li>Most often affect the elderly </li></ul><ul><li>Atherosclerosis </li></ul><ul><li...
Signs & Symptoms <ul><li>Loss of speech, sensory & motor function </li></ul><ul><li>Decreased LOC. </li></ul><ul><li>Sever...
Transient Ischemic Attack (TIA) <ul><li>Mini-stroke </li></ul><ul><li>Signs & symptoms often disappear within 24 hours wit...
<ul><li>Thrombosis  </li></ul><ul><li>Embolism </li></ul>Occlusive Strokes
Thrombosis <ul><li>Thrombosis - process of clot formation </li></ul><ul><li>Thrombus - clot at the site of occlusion </li>...
Embolism <ul><li>Clot travels from one area of the body, usually the neck or heart and lodges in the cerebral artery. </li...
Hemorrhagic Stroke <ul><li>Rupture of an artery causing bleeding within the brain </li></ul><ul><li>Hypertension - causes ...
Scene Size-up <ul><li>Scan the scene for clues of medical or trauma </li></ul><ul><li>Look for evidence of drug parapherna...
Initial Assessment <ul><li>Establish airway </li></ul><ul><li>Suction (lost ability to swallow due to paralysis) </li></ul...
Focused History/Physical Exam <ul><li>If patient is unresponsive </li></ul><ul><ul><li>Perform physical exam </li></ul></u...
<ul><li>Assessment will be rapid rather than focused </li></ul><ul><li>Assess speech </li></ul><ul><li>Assess face for dro...
SAMPLE History <ul><li>Medic alert tags </li></ul><ul><li>Determine response to commands </li></ul><ul><ul><li>Blink yes o...
Other Questions <ul><li>Any anticoagulant drugs </li></ul><ul><li>History of hypertension </li></ul><ul><li>Has patient ta...
Detailed & Ongoing Assessment <ul><li>Do a detailed exam if time permits </li></ul><ul><li>Perform ongoing assessment ever...
Emergency Treatment <ul><li>Ensure airway </li></ul><ul><li>Oxygen therapy NR mask or positive pressure ventilations with ...
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altered mental status loss of function.ppt

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

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