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EMT Key Points > Ch18: Neurologic Emergencies > Flashcards

Ch18: Neurologic Emergencies Flashcards

1
Q

Role of brainstem

A

the most basic functions of body such as breathing, bp, pupil constriction

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2
Q

Role of cerebellum

A

coordinate complex tasks e.g. playing piano, standing on one leg

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3
Q

Role of cerebrum

A

Front: emotions and thought
Middle: senses and movement
–> in most ppl, left and middle = speech
Back: sight

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4
Q

how many pairs of cranial nerves run DIRECTLY from the brain to the rest of the body

A

12

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5
Q

what is the large opening in the base of the skull called

A

foramen magnum

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6
Q

how many spinal nerves per each vertebrae

A

2, one on each side

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7
Q

what 3 changes is the brain most sensitive to?

A

oxygen, glucose and temperature

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8
Q

coma

A

state of unconsciousness where the patient cannot be roused

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9
Q

do the brain and spinal cord sense pain

A

no, they don’t have pain receptors

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10
Q

if the brain and spinal cord do not have pain receptors, what causes the feeling of headaches?

A

scalp
meninges (membrane around brain and SC)
blood vessels
muscles around head, neck & face

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11
Q

what causes tension headaches

A

caused by muscle contractions in the head & neck. caused by STRESS

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12
Q

quality of tension headache pain

A

dull, ache, squeezing

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13
Q

do tension headaches usually require medical attention?

A

no

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14
Q

what causes migraine headaches

A

change in size of blood vessels at the base of the brain

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15
Q

quality of migraine pain

A

pounding, throbbing, pulsating

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16
Q

are men or women more likely to get migraines

A

women by 3x

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17
Q

symptoms associated with migraines

A

nausea
vomiting
visual warning signs like partial vision loss

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18
Q

what causes sinus headaches

A

pressure build up in the sinus cavities

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19
Q

symptoms of sinus headaches

A

Pain, pressure and fullness in the cheeks, brow or forehead.
Worsening pain if you bend forward or lie down.

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20
Q

headache RED FLAGS

A

sudden onset
very severe pain - “worse than anything before”
explosive, thunderclap pain
altered mental status
neurologic deficits
changes in vision
one side paralysis or weakness
age over 50
depressed immune system
fever
stiffness

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21
Q

what is a hemorrhagic stroke?

A

ruptured blood vessel in the brain that causes an increase in intracranial pressure (ICP), hence a headache

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22
Q

early signs of ICP

A

altered mental status
seizures
vomiting
headache

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23
Q

causes of ICP

A

hemorrhagic stroke
tumor
swelling/inflammation from a recent head trauma

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24
Q

bacterial meningitis

A

bacterial infection of the meninges that results in headache, sensitivity to light, stiff neck and fever. CONTAGIOUS

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25
what is a cerebrovascular accident (CVA)
stroke - interruption to blood flow in the brain that results in loss of function --> cause ischemia
26
ischemic stroke
caused by a blood clot that obstructs blood flow either a thrombus or embolus
27
thrombus
clot formed right at the site of obstruction
28
embolus
clot stuck in a vessel that originated from somewhere else
29
patients with what kind of conditions are more prone to ischemic strokes?
atrial fibrillation, they take blood thinners and coronary artery disease
30
how does atherosclerosis cause ischemic strokes?
if the plaque in the carotid vessel wall ruptures, blood clotting processes are stimulated and blood clots form. the clots can obstruct the carotid vessel and prevent blood flow to the brain.
31
hemorrhagic stroke
bleeding in the brain because of ruptured vessel
32
transient ischemic strokes
mini strokes caused by partial obstruction of vessel that resolves on its own
33
general symptoms of stroke
face drooping one side weakness neglect - only lifting one arm slurring (dysarthria) lack of muscle coordination loss of balance aphasia - cannot express thoughts with the right words severe headache dizziness confusion combativeness tongue deviation coma
34
symptoms of stroke in left hemisphere
*left, mid hemisphere controls SPEECH aphasia - can test by asking patient a question weakness or paralysis on right side
35
symptoms of stroke in right hemisphere
slurred left side weakness, paralysis neglect - one arm, lack of pain, certain part of vision
36
cerebral hemorrhage
bleeding in the brain characterized with high bp (either caused by or compensated with it)
37
big indicator of cerebral hemorrhage
increasing blood pressure followed by decreasing to normal level and then sudden drops
38
conditions that mimic stroke
hypoglycemia postictal state - for 5-30 mins after a stroke where there is altered mental status and labored respirations subdural, epidural bleeding
39
bleed above dura of brain
epidural bleed
40
bleed below dura of brain, but outside brain
subdural bleed
41
what is the period of time between injury and deterioration in someone with epidural bleeding
lucid interval
42
seizure
an episode of electrical surge that causes convulsions characterized by uncoordinated muscle activity and/or altered LOC
43
generalized seizures
electrical surge from large area of the brain that causes generalized twitching and convulsions (generalized motor seizures). sometimes it only shows as a brief lapse of consciousness (generalized absence seizures). other symptoms associated w/ generalized seizures: hyperventilation tachycardia sweating drooling/salivation incontinence
44
postictal state
5 - 30 minutes after a generalized seizure when person might have: altered LOC hemiparesis (weakness on one side: stroke-like symptoms) labored breathing to level hypercapnia
45
focalized seizure
electrical surge coming from a particular area of the brain
46
types of focal seizures
aware and impaired-awareness both can either be motor or absence
47
what happens during a focal-onset aware seizure
no changes in LOC possible changes in senses twitching of muscles that spread to extremities but not as much as generalized seizures paralysis
48
cause of focal-onset impaired-awareness seizure
abnormal discharges from temporary lobe
49
what happens during a focal-onset impaired-awareness seizure
lapse of consciousness isolated twitches e.g. lip smacking, eye blinking unpleasant smells, visual hallucinations, fear, repetitive physical movements patients don't remember the episode
50
aura
signs that a seizure is coming. e.g. vision impairment or hallucinations
51
status epilepticus
when a seizure recurs every few minutes OR lasts more than 30 minutes
52
what to do with status epilepticus
ALS!! need airway mgmt and medication to stop seizures
53
common causes of seizures
1) epileptic 2) structural - tumor - scar tissue - infection - head trauma - stroke 3) metabolic - hypoglycemia - hypoxia - abnormal chemical values - poisoning - overdose - withdrawal 4) febrile - fever in children
54
seizure medications
levetiracetam (Keppra) phenytoin (Dilantin) phenobarbital carbamazepine (Tegretol) valproate (Depakote) topiramate (topamax) clonazepam (klonopin)
55
causes of altered mental status
AEIOU TIPS Alcohol Epilepsy, Endocrine, Electrolytes Insulin Overdose or other drugs Uremia Trauma, temperature Infection Poisoning, psychogenic causes Shock, stroke, seizure, syncope, subarachnoid hemorrhage
56
delirium
change in mental status characterized by disorganized thoughts, hallucinations, disorientation, memory loss and changes in personality
56
which is worse: seizures in a patient with a Hx of seizures or no Hx
no Hx because it indicates a potentially dangerous change in the brain e.g. tumor or intracranial bleeding
57
stroke assessment
BE-FAST Balance Eyes Facial droop Arm lift Slurring/speech Time
58
most commonly used pre-hospital stroke screening
Cincinnati Prehospital Stroke Scale Los Angeles Prehospital Stroke Screen
59
Cincinnati Prehospital Stroke Scale
FAS Facial droop Arm lift Slurring/speech
60
Los Angeles Prehospital Stroke Screen
1. Age > 45 2. History of seizures/epilepsy 3. Symptoms <24h 4. Patient is not bedridden or wheelchair-bound at baseline 5. Blood gluc between 60-400 mg/dL 6. Asymmetry in: face (smile/grimace), arms and grip
61
what stroke scale is used in the hospital
NIH Stroke Scale (11 steps) 0 stroke symptoms 1-4 minor stroke 5-15 moderate stroke 16-20 moderate to severe stroke 20-42 severe stroke
62
3-Item Stroke Severity Scale
LAG LOC 0 = normal 1 = mild dysfunction 2 = severe dysfunction e.g. unconscious Arm drift (hemiparesis) 0 = none 1 = drift 2 = no movement on one side Gaze 0 = normal gaze 1 = mild dysfunction 2 = severe dysfunction - cannot follow moving objects (fixed gaze)
63
Key information to document for a patient with suspected stroke
1) time of onset; sign + symptoms 2) GCS score 3) Stroke scale (NIH, LA, Cincinnati, LAG, BE-FAST) 4) Changes during reassessment
64
within how many hours do fibrinolytic drugs work to reverse the clot of a stroke?
3 hours
65
are febrile seizures in children usually benign or life-threatening?
benign

EMT Key Points (21 decks)

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