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Test 6 > Neurological Emergencies > Flashcards

Neurological Emergencies Flashcards

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1
Q

Cerebrum

A

2 hemispheres

4 lobes

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2
Q

Frontal Lobe

A
  • Speech (Broca’s area)
  • Abstract thinking
  • Personality
  • Touch (primary sensory center)
  • Voluntary movement (right-left)
  • Primary motor center
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3
Q

Parietal Lobe

A

•Proprioception
-The ability to tell the location of a body part
•Math
•Language processing

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4
Q

Occipital Lobe

A
  • Sight

* Color vision

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5
Q

Temporal Lobe

A

•Hearing and understanding speech

•Wernicke’s
-Behavior and storage of memory

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6
Q

Thalamus

A
  • Relays sensory to cerebral cortex
  • Wakefulness

•Does not relay smell

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7
Q

Hypothalamus

A
  • Temperature
  • Pituitary control
  • Links ANS to Endocrine system
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8
Q

Pituitary

A

Bridge to PNS

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9
Q

Cerebellum

A
  • Movement
  • Fine motor control
  • Coordination
  • Balance
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10
Q

Cerebral Cortex

A 
•Outermost portion of cerebrum 
•Works with RAS= consciousness 
•Distributes impulses to other brain areas
•Interprets sensory from body
 -Afferent
•Motor muscular control 
 -Efferent 
•Aids judgment 
•Concentration 
•Analysis
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11
Q

Limbic System

A 
•Hypothalamus
•Amygdala 
 -Temporal Lobe 
•Hippocampus 
•Limbic cortex 
•Controls-
 -Emotions 
 -Fear
 -Pleasure
 -Mood 
 -Behavior 
 -Long term memory 
 -Motivation
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12
Q

Midbrain

A
  • Hearing and visual reflexes
  • Posture
  • Muscle tone
  • Reticular Activating System (RAS)
  • Consciousness
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13
Q

Pons

A 
•Relays impulses to and from medulla and cerebrum 
•Apneustic and pneumotaxic centers
•Regulating-
 -Respiratory rate
 -Arousal
 -Sleep
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14
Q

Medulla Oblongata

A
  • Heart rate
  • Blood pressure
  • Breathing
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15
Q

Diencephalon

A

Comprised of the Thalamus and Hypothalamus

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16
Q

RAS and Cerebral Cortex

A 
•Work together to maintain consciousness 
•1 disrupted 
 -Altered LOC
•Both disrupted 
 -Unresponsive
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17
Q

Brain Blood Supply

Circle of Willis

A

Ensures blood supply to all parts of the brain if blockages occur

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18
Q

Brain Blood Supply

Blood Brain Barrier

A

Capillaries tightly packed together allowing only certain molecules into brain’s circulation

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19
Q

Ventricles of the Brain

A
  • Space in cerebral hemispheres
  • 2 hemispheres
  • Cerebrospinal fluid is created here
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20
Q

Neurons- Fundamental unit

A 
•Cell body, axon, and dendrites
•Cell body = gray matter
 -Brain, brain stem, cord
•Axons = white matter
 -Myelin- fatty insulation 
 -Increases speed of impulse conduction
•Bundles of neurons = nerve
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21
Q

Anatomy- CNS & PNS

A 
•Central nervous system 
 -Brain and spinal cord
•Peripheral nervous system 
•Spinal nerves- 31 pairs
 -Sensory ➡️ Afferent (arrives)
 -Motor ➡️ Efferent (exits)
 -8 cervical 
 -12 thoracic 
 -5 lumbar 
 -5 sacral
 -1 coccygeal
•Cranial nerves- 12 pairs 
 -Affect SAME side of body as place of origin
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22
Q

CN I

A

Olfactory- smell

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23
Q

CN II

A

Optic- vision

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24
Q

CN III

A
  • ***Oculomotor (part of PNS)
  • Eyeball movement
  • Raising eyelid
  • Pupil constriction
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25
CN IV
•Trochlear | -Eye move down / inward
26
CN V
•Trigeminal - Sensation forehead to chin - Mastication
27
CN VI
Abducens- eye movement outward
28
CN VII
* Facial expression | * part of PNS
29
CN VIII
•Acoustic-Vestibulocochlear | -Hearing and balance
30
CN IX
``` •Glossopharyngeal -Swallowing -Gag reflex -Speech •Part of PNS ```
31
CN X
``` •Vagus -Sense hypo pharynx -Throat -Heart rate -Respirations -Digestion •Part of the PNS ```
32
CN XI
•Spinal accessory - Turn head - Shrug shoulders
33
CN XII
•Hypoglossal | -Tongue movements
34
Dermatones
``` •Spinal nerves •Specific area of skin -Carries sensory impulse to brain •Key locations -Collar region: C-3 (turtle neck) -Middle finger: C-7 -Nipple line: T-4 -Umbilicus: T-10 -Small toe: S-1 •Sensory assessment findings ```
35
Neuro Assessment
``` •Focal deficit- specific -Part of body -Pinpoint damaged area •General impression -Muscle tone- Posture, facial, extremities •Flacid paralysis= weakness/paralysis with ⬇️ muscle tone -Involuntary movements or tremors -One side or both sides? -Facial droop ```
36
Pupil Eye Exam
•Pupils -Unequal >1 mm - consider ⬆️ ICP -Dilated = CNS stimulant -Constricted = CNS depressant -Aniscoria = Normal difference- pupil size •PERRLA -Accommodation- able to focus both eyes as distance changes -Consensual response- Both eyes react to light •Eyes -Nystagmus- smooth eye movement one direction •Jerky, fast movement in opposite direction -Dysconjugate gaze- failure of eyes to turn together in same direction -Diplopia- double vision
37
Posturing Decorticate
``` •Flexion •Cerebral cortex to thalamus •Upper arms pulled inward to core •Flexed elbows •Flexed wrists -Clenched fists •Extended lower extremities -Toes point down •GCS of... ```
38
Posturing Decerebrate
``` •Extension •Brain stem injury •Upper arms pulled inward to side •Extended elbows •Pronated wrists -Turned outward •Extended lower extremities -Toes point down •GCS of... ```
39
Meningeal Exam Brudzinski sign
* Flexion of neck painful * Patient will flex hips and knees * Meningitis * Subarachnoid bleed
40
Meningeal Exam Kernig’s Sign
* Flex hip to 90 degrees * Extend lower leg * Causes extreme pain * Meningitis * Subarachnoid bleed
41
Motor/Sensory Exam
Assess both sides at the same time
42
Hemiparesis
One sided weakness - Strength - Grips, pedal
43
Hemiplegia
Paralysis one side
44
Paresthesia
Abnormal sensation
45
Anesthesia
Absence of sensation
46
Babinski
``` •Stroke lateral, plantar foot •Positive -Dorsiflexion great toe -May fan toes •Positive Babinski is bad •Not for babies -12-18 months ```
47
Mental status Level of Consciousness
Arousability Responsiveness AVPU scale
48
Mental Status Glasgow Coma Scale
Detailed responses BEST response Compare to baseline <8 ➡️ intubate!
49
Retrograde Amnesia
Prior to event
50
Antegrade Amnesia
After event
51
Coma
Absolute unresponsive
52
Confusion
* Memory not correct | * Can’t learn new material
53
Lethargy
Slow response to stimuli
54
Reticular Activating System
``` •Brainstem to cerebral cortex •Initiates, maintains arousal & awareness •Cerebral cortex & RAS intact -Maintains consciousness •If one or other is altered, damaged -Altered mental status •If both altered, damaged -Unresponsive •ANY ⬇️ LOC at ANY time = HIGH PRIORITY ```
55
Altered Mental Status- Tx
``` •ABC’s •Oxygen; SpO2 monitoring •Ventilate prn •Vitals; IV; cardiac monitor •Check BGL -<60 ➡️ D50 or glucagon (Consider thiamine 100mg) ->350 ➡️ fluid boluses(unless contraindicated) •Consider naloxone- suspect what? •Rapid transport, med control contact ```
56
Delirium
``` •Acute •Temporary •Confusion •Changing LOC •Possible -Hallucinations- visual or auditory -Delusions- false beliefs •Causes -Illnesses, meds, cardiac, CVA, alcohol •MADCAP ```
57
Dementia
* Chronic * Progressive * Decline mental function * Memory * Judgement * Concentration * Bizarre behavior * Irrational * Violent * Neurological cause
58
Seizures
``` •Temporary •Altered LOC or behavior •Massive firing of neurons in the brain -Electric storm •3 types -Generalized •Involves both hemispheres of the brain •Consciousness is involved -Focal (partial) •Isolated area(s) of one brain hemispheres •Motor or non-motor •May also include consciousness -Unknown onset •Doesn’t fit other categories ```
59
Seizures Generalized onset- non-motor
``` •Absence seizure •Children = >5 years old; girls •Lapse of awareness -Vacant stare •No loss of muscle tone -Eye blinking or fluttering •Sudden onset •Duration-30 sec •NO aura •NO postictal state •May progress to Grand Mal Seizures -Adolescence ```
60
Seizures Generalized - motor
``` •Tonic- 15-20 sec -Whole body muscle contraction -Stiff, rigid •Clonic- 90 sec- 2 min - Rhythmic jerking -Alternating relaxation -Incontinence urine -Ventilations inadequate •Grand Mal is no longer used •Sudden •4 phases •Aura- sensation •(Actually focal aware seizure) -Smell -Taste -Visual- lights -Stomach -Not all patients have auras •Postictal-15-30 min or longer -Gradual return -Drowsy, confused, combative -Fatigue! -Check BGL - high demand glucose -Amnesia -Headache, VOMITING •History event •Onset -Consider C-spine -Tongue biting? •Appearance -Typical or atypical •Time and duration •Previous Hx -Meds? Changes? •Recent trauma, fever, H/A, stiff neck? ```
61
Status Epilepticus
``` •Medical emergency •May lead to death! •Single lasting >5 min •Recurrent without full recovery and >5 minutes -Brain still seizing! •Convulsive and non-convulsive •Hypoxia Brain cells -Acidosis (kind??) •Postictal without improvement? -Brain may still be seizing ```
62
Tx-Prolonged Status
* Airway-NPA, nasal ETT * O2, ventilation, suction * Position protect Injury * Spinal precautions? * IV * Benzodiazepines * BGL check and treat * Thiamine? * Transport
63
Benzodiazepines Diazepam (Valium)
* 5-10 mg IM or slow IV (rectal) * IV preferred * Repeat 10-15 min * Max 30 mg * Onset 1-5 min * Short duration 20 min
64
Benzodiazepines Lorazepam (Ativan)
* 4 mg IM or slow IV * Dilute with equal mL saline * Max 8 mg * Onset 1-5 min * Duration 6 hours * Status Epilepticus * Stops a prolonged seizure longer
65
Benzodiazepines Midazolam (Versed)
``` •1.0-2.5 mg IV, IO •Slowly over 2 minutes •Repeat in small increments -Max 5 mg •Elderly, chronic ill -Reduce 1.0-1.5 mg -Slowly 2 minutes •If opiate concurrent -Reduce 50% •Dose is individualized •Allow 2-4 min to gauge therapeutic effects ```
66
Focal Seizures Aware
``` •Old: simple partial •Awareness intact •Motor or non-motor •Twitching rhythmic muscle contractions •One part of body •Hallucinations -Auditory -Visual -Olfactory •See note chart •These may be aura for generalized motor ```
67
Focal Seizures Impaired Awareness
``` •Old: complex partial •Altered awareness •Blank stare •Automatisms -Lip smacking -Chewing or twitching in face •Mumbling •Dazed, disoriented •Oblivious-surroundings •Violent??? ```
68
Myoclonic Seizures
* Generalized type * Sudden, brief jerking both upper arms (typical) or legs * After awakening or prolonged sleep deprivation
69
Atonic Seizures (Drop Seizures)
* Generalized type * Loss of muscle control * Neck ➡️ head falls forward * Legs ➡️ body collapses
70
Psychogenic Non-Epileptic Seizures PNES
* Conversion Disorder (PTSD often) | * Diagnosed by neurologist- rule out epilepsy as cause
71
Febrile Seizures
``` •Children 3 months to 5 years -6-18 months most common -1st relative (parent, sibling) predispose •Sudden spike in temperature •Short duration, frightening to parents •Treatment -Supportive -Passive cooling ➡️ no shivering -Antipyretic(Tylenol) -Possible benzodiazepine -transport, calming, parents ```
72
Syncope
``` •Transient loss of consciousness •Atony •Falling •Regain consciousness -Supine position •Near syncope -No LOC -Hearing/vision loss •Vasovagal -Common •Stimulate vagus nerve -Pain, fright, stress •Overcompensation sympathetic stimulation -Needle stick -Bearing down abdomen -forceful cough, swallow -Prolonged sitting, then standing -Shaving -Micturition- urination •Full bladder ```
73
Syncope Assessment
``` •Syncope vs cardiac, seizures, neuro, trauma issues •SCENT -Before syncope -Supine, no warning -Cardio/neuro •TIPS -During •CHAN -After •Treat- underlying cause •ABC’s -Oxygen, ventilation’s •C-spine?? •IV-fluids?? •Cardiac monitor-SpO2 •BGL •Transport recommended ```
74
Atony
Loss of muscle tone
75
Headache- Vascular Migraine
``` •Recurrent •Nausea/vomiting •Photophobia •Sound sensitive •Throbbing, pulsating •One or both sides •Auras •Rest/sleep alleviates •Family Hx/ Triggers -Tyramine foods -Msg •Medication Rx -Beta-blockers -Tricyclic antidepressants -Depakote -Topamax •Other possible causes -Neuron hyper-excitability -Hypomagnesemia ```
76
Cluster Headache- Vascular
``` •Severe stabbing -Eye, temple, forehead, cheek •One side •Watery eye, rhinorrhea •Rock back and forth •Pace •Males > females ```
77
Rhinorrhea
Runny nose
78
Cerebral Vascular Accident- Stoke
``` •Neurological deficits -Decrease in blood flow to brain •Ischemic-80% -Blocked artery -Thrombus or embolism •Hemorrhagic-20% -HTN -Arteriovenous malformations •Abnormal connections-Arteries and veins •Congenital -Aneurysm- weaken area ```
79
Ischemic Stroke - Thrombotic
``` •Atherosclerotic plaques •Bifurcation of arteries •Slower to develop -Than hemorrhagic •Risks -HTN -Diabetes ```
80
Ischemic Stroke Findings
``` •Dysarthria -Slurred speech; lacking muscle control •Aphasia -Expressive- understands; unable to verbalize -Receptive- no understanding; verbal response inappropriate -Global- no understanding; unable to verbalize •Hemiparesis •Hemiplegia •Hemiparesthesia -Abnormal sensation, unilateral •Arm drift, facial droop •Ataxia -Uncoordinated movements •Headache •Seizures •Hypertension •Vertigo- dizziness •Vision loss -Half sight -Left or right ```
81
Hemorrhagic Stroke
``` •Morbidity/mortality- often fatal •Sudden -“Worse headache of my life” •⬆️ICP -Excessive pressure in cranium -“pushes” brain downward -Herniates into foreman magnum •Cushing’s triad -High BP w/ wide pulse pressure -Bradycardia -Abnormal, irregular, bradypneic respiration’s •Unresponsive •Hyperthermia ```
82
Subarachnoid Hemorrhage
``` •Cause- aneurysm •Sudden onset SEVERE headache -“Thunderclap” headache -To occiput •Brief loss of consciousness •Forceful vomiting •Unilateral pupil dilation •Rapid progression •Females 20-30 years old •Supportive ABC’s, expedite transport ```
83
Transient Ischemic Attacks
* Cerebral dysfunction lasting from minutes to several hours * Return to normal <24 hrs •No permanent neurological deficit -Indication of impending stroke •S/S same as CVA
84
Prehospital Stroke Management
``` •Rapid transport •Determine time of onset -Last known normal -3 hour window •Manage airway/ Oxygen •Ventilation •Monitor vital signs and ECG •Initiate IV- KVO en route •Assess blood glucose -D-50 for low BGL •Control seizures -Benzodiazepines •Supine, head elevated •On side -Affected side down •Stroke screen •Stroke center ```
85
Cincinnati Stroke Scale
``` •Arm drift -Both arms out, palms up -Close eyes -One arm drifts down •Speech -“The sky is blue in Ohio” -“No if’s, ands or but’s” •Facial droop (CN 7) -Smile and show teeth ```
86
Parkinson’s Disease
``` •Degeneration or damage to nerve cells within basal ganglia in brain •Lack of DOPAMINE •Leading neurologic disability in persons over 60 years old •Characterized by: -Muscle rigidity -Tremors (start on one side) -Weakness -Shuffling gait -May lead to dementia ```
87
Alzheimer’s
``` •Degenerative •Dementia-senile •Neurons get choked off protein growth -Dying brain •⬇️ memory, cognition •⬇️ ability to care for self •Personality changes -Combative, hostile, angry •Supportive care -Cautious if combative ```

Test 6 (3 decks)

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