Neuro

Question 1

RASS

Answer 1

4 Severely agitation overtly combative, violent, immediate danger or threat
3 Very agitated Aggressive behaviour, unreasonable
2 Agitated Frequent, excessively anxious, loud outbursts
1 Restless Mildly anxious, non aggressive, talkative
0 Alert and calm
-1 Drowsy Sustained awakening to voice >10
-2 Light sedation awakens briefly to voice with eye contact <10
-3 Moderate sedation Movement or eye opening to voice. No eye contact
-4 Deep sedation Movement or eye opening response to physical stimulus
-5 Cannot be roused Unresponsive to voice or physical stimulus

Question 2

Sedation warnings

Answer 2

• Sedation is high risk, must only be carried out after careful deliberation and must not be based primarily at request or influence of others
• Positive RASS does not automatically infer need to sedate
• Age <16 ASMA consult
• Pregnant STORC consult must be initiated prior to sedating any known or suspected pregnant patients
• ETOH/intoxication caution
• Repeat & maintenance doses low threshold to consult
• Monitoring
• Positioning, do not transport in supine position
• Airway & breathing, prepare to support
• Restraint, prone and/or handcuffed to rear carries excessive risk and must not occur
• RASS score must be agreed and documented
• Weight agreed and documented
• Final decision to sedate is on the most senior clinician on scene

Question 3

Treatment of disturbed and abnormal behaviour

Answer 3

• De escalation techniques adopted first
• Restrain only if necessary to protect self and patient
• Monitor and transport per warnings
• Do not allow handcuffing to stretcher
• Never transport prone
• Consider organic causes
• Olanzapine RASS 1-2
• Droperidol RASS 2-3
• Ketamine RASS 4+
• Midazolam only second line maintenance

Question 4

Syncope cause and presentation

Answer 4

Fairly brief with an associated loss of postural tone. Usually full recover after few minutes. Not confused with seizures, shock or any other cause of loss of consciousness. Vasovagal syncope most common type can be caused by prolonged periods of standing, pain, illness, fatigue, fear or emotional distress
Presentation:
* Dizziness or lightheadedness
* Brief but sudden loss of consciousness
* Vertigo
* Pallor
* Diaphoresis
* Anxiety and or restlessness
* Nausea
* Rapid return of consciousness once lying flat
* Chest or abdominal pain
* Palpitation
* Full recovery after few minutes
* Signs of trauma
Head, heart, vessels
Brain injury can occur if kept upright, abnormal vitals may indicate other cause of syncope, faint when lying down usually cardiac, confusion >30 seconds post ictal state, BL drops
Serious causes = cardiac arrhythmia, severe or sudden blood loss, postural hypotension, hypoglycaemia, CVA or TIA

Question 5

Syncope treatment

Answer 5

• Lateral position
• Oxygen if needed
• Manage vitals
• Immediate hx
• 12 lead
• Stroke assessment
• IV access
• Fluid therapy

Question 6

Seizure presentation

Answer 6

Abnormal paroxysmal discharge of cerebral neurons which manifests clinically as changes in motor, sensory, behavioural or autonomic function.
Presentation:
* Generalised seizure activity emergency if = >5 minutes, multiple seizures, doesn’t regain consciousness
* Focal seizure where prolonged >5 minutes with GCS <12

Question 7

Treatment

Answer 7

• Protect from dangers where possible
• Airway
• Do not actively cool febrile child
• Suction
• NPA if trismus
• Midazolam
• Glucose
  Complications =incontinence, secondary injury, aspiration, hypoxia, hyperthermia, dysrhythmia, brain damage and death

Question 8

Stroke treatment and criteria

Answer 8

• FAST neg, but history suggests TiA still at risk and meets stroke criteria
• FAST pos, stroke is likely conduct RACE
• IV access
• Aim for scene time <15 minutes
  Stroke criteria:
• Onset <9 hours
• Possesses full ADLs
• BGL 4-22
• Stroke centre = TIA, FAST+ & RACE <4, Charlie’s Fiona Royal midland and Joondalup
• Neurological unit = FAST + & RACE >5 Charlie’s 24/7, Fiona 8-5m-f

Question 9

Aeioutips

Answer 9

A Alcohol/abuse of substances, acidosis
E Environmental, epilepsy, electrolytes, encepathlopathy, endocrine
I Infection
o Overdose, oxygen deficiency
U Under dose, uraemia
T Trauma, tumour
I Insulin
P Psychogenic, poisons
S Stroke, shock

Question 10

Treatment of unconscious

Answer 10

• C-spine consideration
• Haemorrhage control
• Suction and airway management
• Lateral position
• Oxygen
• Secondary survey
• 12 leads
• Vascular access
• Opioid OD = naloxone
• Hypogylcaemia = glucose 10%
• Fluid therapy
• Consider atropine