Neurologic Emergencies Flashcards
Layers of Protection Skull
Skin
Fascia
Muscle
Outer Table / Inner Table
Dura
Arachnoid
Cerebrospinal Fluid
Blood Vessel
Pia Matter
Vascular Compromise
Signs / Sx: anxiety, restlessness, and altered mental status
Electrical Disturbance
Signs / Sx: uncontrolled movement, paralysis, loss of response
Secondary Assessment: Altered LOC
Vitals: Check blood glucose in addition to others.
Perform focused neurological exam:
1) Pupils
2) CSMs
3) Posturing
Posturing
Extension (decerebrate rigidity) - indicates injury to brainstem
Abnormal Flexion (decorticate rigidity) - indicates injury to brain cortex
Both occur with herniation
Treatment: Neurological Emergencies
Provide oxygen and if you suspect stroke use “Stroke Alert” to notify hospital.
Stroke
Injury or death of brain tissue due to oxygen deprivation.
“Brain Attack” or Cerebrovascular Accident (CVA)
Signs / Sx: Paralysis on one side, facial droop, limb weakness, numbness, decreased movement or sensation on one side, ataxia, vision loss, speech disorder, confusion
Treatment: Administer oxygen if hypoxic. Transport to designated stroke center if possible.
Transport: supine and elevate head 6”
Use Cincinnati Stroke Scale
Cerebral Aneurysm
Bulging or Ballooning of artery wall in brain.
May expand and rupture, especially with hypertension.
Hemorrhage tears and separates brain tissue.
Subarachnoid Hemorrhage
Small blood vessels in subarachnoid space bleed.
Impairs drainage of csf and rises intercranial pressure.
Brain tissue may herniate.
Herniation
Bleeding increases pressure and forces brain through foramen magnum.
Ischemic Stroke
Ischemic (80%): blockage in a blood vessel reduces blood flow to brain
- Embolus travels to cerebral vessel
- Thrombus forms within a cerebral vessel
Risk for Embolism: atrial fibrillation, damaged carotid or vertebral arteries
Risk for Thrombus: atherosclerosis
Hemorrhagic Stroke
Hemorrhagic: rupture of a blood vessel reduces blood supply and damages brain tissue
Aphasia
inability to speak
Dysphasia
difficulty speaking: expressing words
Dysarthria
impairment of tongue muscles essential to speech
Hemiparesis
inability to move half body
Nystagmus
involuntary eye jerking
Diplopia
double vision
Monocular blindness
one eye blindness
Transient Ischemic Attacks
Temporary interruption of blood supply to brain common in carotid artery disease.
Onset: abrupt but resolves within 24 hours or minutes.
Treatment: As stroke.
Seizures
Sudden changes in sensation, behavior, or movement caused by irregular electrical activity of brain.
Treatment: Place patient on floor, remove harmful objects, loosen restrictive clothing, and consider blow by oxygen. Afterwards place in recovery position
Generalized Seizure
Unconsciousness, generalized twitching of all muscles, apnea.
Last under 5 minutes.
Postictal State
Phase after seizure lasting 1 to 5 minutes typically but up to 30.
Patient is unresponsive with deep, noisy, and labored respirations.
Tonic Phase
muscle rigidity, loss of consciousness, and fall.
