… is the fifth leading cause of death and the leading cause of adult disability in the US
common in geriatric patients
stroke
… and … are other common neurological emergencies
seizures; altered mental status
the brain controls …, …, and all other body functions
three major parts: …, …, and ..–> … is the largest part
breathing; speech; brain stem; cerebellum; cerebrum; cerebrum
the … controls the most basic functions
the cerebellum controls … and … coordination
brain stem; muscle; body
messages sent to and from the brain travel through nerves:
… nerves run directly from the brain to parts of the head
the rest of the nerves join in the … and exit the brain through the foramen magnum
at each vertebra in the neck and back, two nerves branch out from the …and carry signals to and from the body
twelve cranial nerves; spinal cord; spinal cord
many different disorders can cause brain dysfunction: can affect the patient’s …, …, and …
the brain is sensitive to changes in oxygen, glucose, and …–> significant change in any one of these levels will result in a neurologic change
level of consciousness; speech; voluntary muscle control; temperature
headache is one of the most common complaints and can be a symptom of another condition or a … on its own
only a small percentage of headaches are caused by a serious med condition
neurologic condition
tension headaches: caused by … in the head and neck
attributed to …
pain is usually described as squeezing, dull, or as an ache
usually do not require med attention
muscle contractions; stress
migraine headaches:
thought to be caused by changes in the … size in the base of the brain
pain is usually described as pounding, throbbing, and pulsating
often associated with … and … and may be preceded by … changes
can last for several hours or days
blood vessel; nausea; vomiting; visual
sinus headaches: caused by pressure that results from … in the sinuses
accumulated fluid
serious conditions that include headache as a symptom are …, .., and …
hemorrhagic stroke; brain tumors; meningitis
stroke: also called a …
interruption of .. to an area within the brain
results in the loss of …
cerebrovascular accident (CVA); blood flow; brain function
ischemic stroke:
most common, accounting for more than 80% of strokes
results from … or an …
symptoms may range form nothing to complete ..
… in the blood vessels is often the cause
thrombosis; embolus; paralysis; atherosclerosis
hemorrhagic stroke accounts for 13% of strokes
cerebral hemorrhages are often ..
… are a common cause of hemorrhagic strokes in healthy, young people–> presents as the “worst headache of their life” and causes a … hemorrhage
fatal; berry aneurysms; subarachnoid
transient ischemic attack (TIA): when stroke-like symptoms go away on their own in less than … hrs, the event is called a TIA
may be a warning sign of a … to come and is considered an emergency–> about one third of patients who have a TIA will experience a stroke soon after
all patients with a TIA should be evaluated by a physician
24; larger stroke
signs and symptoms of stroke:
…
sudden … or … in the face, arm, leg, or one side of body
decreased/absent … and … on one side of the body
lack of … (ataxia) or loss of …
sudden … in one eye, blurred or double vision
facial drooping; weakness; numbness; movement; sensation muscle coordination; balance vision loss
signs and symptoms of stroke: difficulty … decreased level of … … disorders difficulty expressing … or inability to use the right … … speech (dysarthria) … and … headache
swallowing; responsiveness; speech; thoughts; words; slurred; sudden; severe
signs and symptoms of stroke cont: .. … … … … .. ...
confusion dizziness weakness combativeness restlessness tongue deviation coma
stroke in the left cerebral hemisphere may cause …–> inability to produce/understand speech
strokes that affect the left side of the brain can also cause paralysis of the … side of the body
aphasia; right
strokes that affect the right side of the brain cause paralysis of the … side of the body. patients can … language and speak, but their words may be …
patients may be oblivious to their problem; this symptom is called …
patients with a problem affecting the back part of the cerebrum may neglect certain parts of their …
neglect and lack of pain cause many patients to delay seeking help
left; understand; slurred; neglect; vision
bleeding in the brain:
patients may have …–> may be the cause of the bleeding or may be caused by the bleeding as a compensatory response
a trend of an … is an important sign
significant drops may occur as the patient’s condition worsens
high blood pressure; increasing blood pressure
conditions that may mimic stroke:
…
…
… or … bleeding
hypoglycemia
postictal state
subdural; epidural
a seizure is a neurologic episode caused by a sure of … activity in the brain
in the US it is estimated that 2 to 3 million people have epilepsy
electrical
generalized (tonic-clonic) seizure: this type of seizure results from abnormal … from large areas of the brain, usually involving both hemispheres
characterized by … and a generalized severe … of all muscles that lasts several mins or longer
electrical discharges; unconsciousness; twitching
absence seizure:
does not involve any changes in .. activity
characterized by a brief … in which the patient seems to … and not respond
motor; lapse of consciousness; stare
partial (focal) seizure:
simple partial seizure: no change in the patient’s level of …
may have .., .., …, … changes, or unusual … and …
may cause some .. or brief …
consciousness; numbness; weakness; dizziness; visual; smells; tastes; twitching; paralysis
partial (focal) seizure
complex partial seizure:
altered …
results from abnormal discharges from the … of the brain
characterized by …, …, …
patients also may experience unpleasant .. or visual …, exhibit … or perform … physical behavior
mental status; temporal lobe; lip smacking; eye blinking; isolated jerking; smells; hallucinations; uncontrolled fear; repetitive
patients may experience an .. prior to a seizure
aura
generalized seizure:
characterized by sudden …, chaotic muscle … and … and …
most seizures last 3 to 5 mins
followed by a … state
loss of consciousness; movement; tone; apnea; postictal
absence seizure:
formerly called petit mal
lasts for …
patient fully recovers with a brief … of the event
seconds; lapse of memory
status epilepticus: seizures that continue every .. without the person regaining … or last longer than .. mins
few minutes; consciousness; 30
causes of seizures: … … … … epileptic seizure can usually be controlled with meds
congenital
structural
metabolic
febrile
recognize when a seizure is occurring and whether this episode differs from ..
identify other problems associated with the seizure
previous ones
postictal state:
following the seizure, a patient’s muscles … and the breathing becomes ..
patients may be present with …, …, or …
if the patient’s condition does not improve, consider other problems such as infection/hypoglycemia
relax; labored; hemiparesis; lethargy; confusion
seizures are often mistaken for …
syncope
aside from stroke and seizures, the most common type of neurologic emergency that you will encounter is a patient with an altered mental status. causes include: … … … .. … unrecognized … injury .. infection … abnormality .. …
hypoglycemia hypoxemia intoxication delirium drug overdose head brain body temp brain tumor poisoning
causes of AMS (altered mental status):
…: patients can have signs and symptoms that mimic stroke and seizures
…: a symptom, not a disease; presents as a new complaint; temporary state often with a physical or mental cause; can be reversed with proper treatment
hypoglycemia; delirium
other causes of AMS: unrecognized … injury severe … … disorders … complications .., particularly those involving the brain/bloodstream
head; intoxication; psychological; medication; infections
all patients with an altered mental status should receive …
hyperventilation may have several negative consequences–> overinflates the lungs, which can impair … to the right atrium and cause a decrease in …
high-flow oxygen; blood return; cardiac output
hyperventilation also increases the risk of … and … and may cause severe injury in patients with … and increased … causing cerebral vasoconstriction, which shunts blood (and oxygen) away from the brain causing further injury to the brain
regurgitation; aspiration; intracerebral bleeding; intracranial pressure
secondary assessment: patients with intracranial bleeding may have increased … compressing the brain
can slow the … and cause … respirations
blood pressure is usually … to compensate for poor perfusion in the brain
changes in … size and reactivity indicate significant bleeding nd pressure on the brain. check … levels
pressure; pulse; erratic; high; pupil; blood glucose
secondary assessment cont: stroke assessment: Cincinnati prehospital stroke scale los angeles prehospital stroke screen … … mnemonic … score
3-item stroke severity scale (LAG)
FAST
Glasgow Coma Scale (GCS)
for suspected stroke patients, physicians in the ED need to determine whether there is … in the brain–> if there isn’t, the patient may be a candidate for … medication
notify the hospital regarding the last time the patient was known to be without their current signs and symptoms of stroke q
bleeding; blood clot-dissolving
patients who have had a seizure require definitive eval and treatment in the hospital
for patients having a seizure:
protect them from harm
maintain a clear airway by ..
provide … as quickly as possible
if head or neck trauma is suspected, provide spinal immobilization
suctioning; oxygen
headache–> you should be concerned if the patient complains of:
a …, severe headache
a sudden headache with .., …, …, or following …
sudden onset; fever; seizures; AMS; trauma
stroke:
support the … and provide rapid transport to a stroke center
maintain a SPO2 level of at least 94%
oxygen therapy is not recommended unless the patient is experiencing … or is showing signs of …
ABCs; resp distress; hypoxia
.. therapy and methods to mechanically remove the blood clot may reverse stroke symptoms and even stop the stroke if given within 3-6 hrs
transport to a designated stroke center
thrombolytic
Seizure and AMS–> the patient may be in a … state on your arrival; care for patients actively seizing
postictal