EMT Chapter 18: Altered Mental Status, Stroke, and Headache

Tension headache

-A headache that occurs from long, endured contraction of the skeletal muscles around the face, scalp, upper back, and neck. -NO nausea or vomiting -NO appetite

Thrombotic stroke

-A type of ischemic stroke caused by a stationary clot that forms in and blocks a cerebral artery.

Signs and Symptoms of Altered Mental Status Commonly Associated w/ a Nontraumatic or Medical Condition

-Abnormal respiratory pattern -Dry or moist skin -Cool or hot skin -Pinpoint, midsize, dilated, or unequal pupils -Stiff neck -Lacerations to the tongue indicating seizure activity -High systolic pressure and low heart rate -Loss of bowel or bladder control -Abnormally high or abnormally low blood glucose reading

Los Angeles Prehospital Stroke Screen (LAPSS)

-Age greater than 45 years old -No history of seizure or epilepsy -Duration of symptoms is less than 24 hours -Patient is not wheelchair bound or bedridden -Blood glucose level b/w 60 and 400 mg/dL A. Have patient look up, smile, and show teeth B.Compare grip strength of upper extremities C.Assess arm strength for drift weakness Answers: Equal, R weakness, and or L weakness

Coma

-An unconscious state in which the patient does not respond to painful stimuli

Structural Causes of Altered Mental Status

-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

Embolic stroke

-Caused by a clot or group of clots that break off from one area of the body and travel to the cerebral arteries via the carotid artery or Vetebrobasilar system.

General signs and symptoms of stroke

-Decreased consciousness -Change in personality -Pupils unequal size -Severe headache, nausea and vomiting -Arm drift -Paralysis or weakness of on or both sides -Inability to speak -Loss of vision, dimness, or double vision

Neurological deficit

-Defined as any deficiency in the functioning of the brain or nervous system

Acute stroke

-Due to an inadequate amount of blood being delivered to a portion of the brain caused by a blood clot obstructing a blood vessel in the brain or loss of continuity of the blood vessel. -In a heart attack, a coronary artery is occluded; in a stroke, a cerebral (brain) artery is occluded

Cluster headache

-Intensely painful headaches that affect one side of the head and may be associated with tearing of the eyes and nasal congestion.

Reticular activating system (RAS)

-Is not an actual strucute but a network of nerve cells in the brainstem that constantly transmit environmental and sensory stimuli to and from the cerebrum

Nontraumatic brain injury

-Medical injury to the brain that is not related to trauma (stroke)

Signs and Symptoms of Altered Mental Status Commonly Associated w/ Trauma

-Obvious signs of trauma: deformity, contusions, abrasion.. -Abnormal respiratory pattern -Increased or decreased heart rate -Unequal pupils -High or low blood pressure -Discoloration around the eyes (late sign) -Discoloration behind the ears (late sign) -Pale, cool, moist skin -Flexion (decorticate posturing-> arms flexed, legs extended) or extension (decerebrate posturing-> arms and legs extended)

Vascular headache

-Occurs as a result of dilation or distension of vessels or inflammation within the cranium; similar to a migraine; photosensitive, blind spots, nausea, vomiting, sweating, bright shimmering light, numbness or tingling to one side of the body, uncoordination, visual and auditory hallucinations...

Hemorrhagic stroke

-One of the two main types of stroke; occurs as a result of bleeding inside the brain.

Ischemic stroke

-One of the two main types of stroke; occurs when blood flow to a particular part of the brain is cut off by a blockage (eg, a clot) inside a blood vessel.

Organic, traction, or inflammatory headaches

-Result of tumors, infection, stroke, or inflammatory disorders w/in the cranium such as meningitis, hemorrhagic stroke, and tumor.

Transient Ischemic Attack

-Same S and S as a stroke but difference is TIA S and S disappear w/o any obvious permanent neurological deficits. -S and S usually resolve themselves after 1-2 hours but can last up to 24 hours.

Toxic-Metabolic Causes of Altered Mental Status

-Severe hypoxia or anoxia (Reduced oxygen or no oxygen) -Abnormal blood glucose conditions (high blood glucose or low blood glucose) -Liver failure -Kidney failure -Poisoning (e.g. carbon monoxide, cyanide..)

Other Causes of Altered Mental Status

-Shock -Drug that depress the central nervous system (e.g. narcotics, alcohol..) -Post seizure (the patient has suffered a seizure and is just beginning to recover) -Infection -Cardiac rhythm disturbance -Stroke

Altered mental status

-Significant indication of injury or illness in a patient. -The alteration may range from simple disorientation to complete unconsciousness in which the patient is not responsive, even to painful stimuli.

Stroke

-Sudden loss of consciousness, sensation, and voluntary motion caused by rupture or obstruction (as by a clot) of a blood vessel of the brain.

Emergency Medical Care of Patient w/ Headache

1. Establish and maintain an adequate airway. 2. Be prepared to suction 3. Assess and maintain adequate ventilation 4. Maintain adequate oxygenation 5. Place the patient in a position of comfort -Lower lights in the back of the ambulance 6. Always be prepared for seizures and transport to medical facility

Emergency Medical Care of Stroke Patient

1. Maintain patent airway 2. Suction mouth if needed 3. Assist in ventilations of needed 20/min 4. Maintain adequate oxygenation 5. Position the patient in lateral left recumbent if altered mental status or can't help himself. Place responsive patient in supine position. If they want to be semi-Fowlers position do not elevate head or chest more than 30 degrees 6. Check blood glucose level -Blood glucose level less than 60 mg/dL suspect low blood sugar (hypoglycemia) 7. Protect any paralyzed extremities 8. Rapid transport

Emergency Medical Care of Altered Mental Status Patient

1. Manual spin stabilization if trauma is suspected 2. Maintain patent airway 3. Suction mouth if needed 4. Maintain adequate oxygenation -Check spo2 -15 lpm nonrebreather -BVM if needed 5. Be prepared to assist in ventilation 6. Position the patient in lateral recumbent and if spinal injury then fully immobilize. 7. Transport

Cincinnati Prehospital Stroke Scale

1.Facial droop -Have patient look at you, smile, and show his teeth 2. Arm Drift -Have patient lift arms up and hold them out with eyes closed for 10 seconds 3. Abnormal speech -Have the patient say, "You can't teach an old dog new tricks."