a network of specialized nerve cells within the brainstem that controls states of arousal and consciousness including wakefulness, attentiveness, and sleep
reticular activating system (RAS)
an unconscious state in which the Pt does not respond to painful stimuli is referred to as a ______.
coma
______ causes of AMS
brain tumor
hemorrhage in the cranium but outside of the brain
hemorrhage in the brain tissue
direct brain tissue damage from trauma to the brain
degenerative disease of the brain
brain abscess or infection
structural causes of AMS
\_\_\_\_\_\_ causes of AMS severe hypoxia or anoxia (reduced or no 02) abnormal BGL liver failure kidney failure poisoning
toxic-metabolic
S/S obvious signs of trauma: DCAP-BTLS abnormal resp pattern increased or decreased HR unequal pupils high or low BP discoloration around eyes (late sign) discoloration behind ears (late sign) pale, cool, clammy decorticate or decerebrate
AMS - trauma
S/S abnormal resp pattern dry or moist skin cool or hot skin pinpoint, midsize, dilated, or unequal pupils stiff neck lacerations to the tongue - seizure bite high systolic BP and low HR loss of bladder/bowel abnormally high or low BGL
AMS - nontraumatic or medical condition
any deficiency in the nervous systems functioning, typically exhibited as a motor, sensory, or cognitive deficit
neurological deficit
S/S slurred speech absent speech paralysis weakness numbness
neurological deficit
a sudden disruption in blood flow to the brain that results in brain cell damage. blood flow might be interrupted by a ruptured artery or blocked by a clot or other foreign matter in an artery that supplies the brain
stroke or cerebrovascular accident or CVA
“brain attack”
a stroke caused by a cot obstructing a blood vessel in the brain, resulting in an inadequate amount of blood being delivered to a portion of the brain distal to the blocked vessel
ischemic stroke
a stroke caused by rupture of a blood vessel in the brain that allows blood to leak and collect in or around the brain tissue
hemorrhagic stroke
a clot that develops at the site of occlusion
thrombus
the process of clot formation is called
thrombosis
a type of ischemic stroke caused by a stationary clot that forms in and blocks a cerebral artery
thrombotic stroke
a type of ischemic stroke caused by plaque or other material that lodges in and blocks a cerebral artery
embolic stroke
bleeding on the surface of the brain
subarachnoid
bleeding within the brain
intracerebral
brief, intermittent episode with stroke-like symptoms that typically disappear within minutes, but usually last no longer than 1 hr., caused by an oxygen deficit in the brain tissue and are often a precursor to a stroke
transient ischemic attack
S/S scale:
facial droop by having Pt show teeth
arm drift (closed eyes supine arms out)
abnormal speech (you cant teach an old dog new tricks)
cincinnati prehospital stroke scale CPSS
S/S scale: age>45 history of seizures or epilepsy duration of symptoms wheelchair or bedridden pt BGL
LA prehospital stroke scale LAPSS
stroke pt physical assessment considerations
1
2
3
look up, smile, and show teeth
compare grip strength of upper extremities
assess arm strength for drift weekness
S/S
possible seizures
loss of bowel or bladder
arm drift
paralysis or weakness to one or both sides of body
drooping eyelid and mouth on one side of face
severe headache
decreased consciousness
change in personality
pupils unequal in size
loss of vision, dimness, or double vision
difficulty speaking or slurred speech
inability to speak
nausea or vomiting
sudden weakness or paralysis of face, arm, or leg
stroke