EMT - Chapter 17: Neurologic Emergencies

Computed tomography (CT) scan of the head

The only reliable way to tell whether there is bleeding in the brain is with a special type of imaging test called...

Complex partial seizure

The patient has an altered mental status and does not interact normally with his environment.

Ischemic and hemorrhagic.

The two main types of stroke:

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?

Confusion and fatigue.

Common causes of Epileptic seizures

Congenital origin

Front part of the cerebrum

Controls emotion and thought.

Middle part of the cerebrum

Controls sensation and movement.

BRAIN STEM

Controls the most basic functions of the body such as breathing, BP, swallowing & pupil constriction.

Embolus

A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage.

Thrombosis

A blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke.

Hemorrhagic stroke

A type of stroke that occurs as a result of bleeding inside the brain.

Ischemic stroke

A type of stroke that occurs when blood flow to a particular part of the brain is cut off by a blockage (eg, a blood clot) inside a blood vessel.

Which of the following MOST accurately describes a simple partial seizure? A. a seizure that begins in one extremity B. a seizure that causes the patient to stare blankly C. a seizure that is not preceded by an aura D. a generalized seizure without incontinence

A. a seizure that begins in one extremity

Which of the following MOST accurately describes the cause of an ischemic stroke? A. blockage of a cerebral artery B. acute atherosclerotic disease C. rupture of a cerebral artery D. narrowing of a carotid artery

A. blockage of a cerebral artery

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: A. brain stem. B. cerebrum. C. cerebellum. D. cerebral cortex.

A. brain stem.

A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is: A. epilepsy. B. a brain tumor. C. a serious infection. D. intracranial bleeding.

A. epilepsy.

The spinal cord exits the cranium through the: A. foramen magnum. B. vertebral foramen. C. foramen lamina. D. cauda equina.

A. foramen magnum.

Headache, vomiting, altered mental status, and seizures are all considered early signs of: A. increased intracranial pressure. B. decreased intracranial pressure. C. increased extracranial pressure. D. decreased extracranial pressure.

A. increased intracranial pressure.

You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include: A. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport. B. assisted ventilation with a bag-mask device, right lateral recumbent position, and transport. C. an oral airway, assisted ventilation with a bag-mask device, Fowler's position, and transport. D. oxygen via a nonrebreathing mask, supine position with legs elevated 6″ to 12″, and transport.

A. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.

An absence seizure is also referred to as a: A. petit mal seizure. B. grand mal seizure. C. total body seizure. D. generalized motor seizure.

A. petit mal seizure.

Which of the following is a metabolic cause of a seizure? A. poisoning B. head trauma C. brain tumor D. massive stroke

A. poisoning

You are caring for a 68-year-old man with sudden onset of left-sided paralysis and slurred speech. His airway is patent, his respirations are 14 breaths/min with adequate depth, and his oxygen saturation is 98%. Treatment for this patient should include: A. recovery position and transport. B. ventilatory assistance and transport. C. high-flow oxygen and transport. D. oral glucose gel and transport.

A. recovery position and transport.

A generalized seizure is characterized by: A. severe twitching of all the body's muscles. B. a blank stare and brief lapse of consciousness. C. unconsciousness for greater than 30 minutes. D. a core body temperature of greater than 103°F (40°C).

A. severe twitching of all the body's muscles.

You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, and is breathing at a normal rate with adequate depth. You should: A. suction her oropharynx and apply 100% oxygen. B. insert an oral airway, apply oxygen, and transport. C. use a bag-mask device to assist her ventilations. D. place her on her side and prepare for rapid transport.

A. suction her oropharynx and apply 100% oxygen.

You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, is breathing at a normal rate with adequate depth, and has an oxygen saturation of 96%. You should: A. suction her oropharynx and apply 100% oxygen. B. insert an oral airway, apply oxygen, and transport. C. use a bag-mask device to assist her ventilations. D. place her on her side and prepare for rapid transport.

A. suction her oropharynx and transport immediately.

When obtaining medical history information from the family of a suspected stroke patient, it is MOST important to determine: A. when the patient last appeared normal. B. if there is a family history of a stroke. C. if the patient has been hospitalized before. D. the patient's overall medication compliance.

A. when the patient last appeared normal.

Muscle control and body coordination are controlled by the: A. cerebrum. B. cerebellum. C. brain stem. D. cerebral cortex.

B. cerebellum.

A patient whose speech is slurred and difficult to understand is experiencing: A. aphasia. B. dysarthria. C. dysphagia. D. paraplegia.

B. dysarthria.

The anterior aspect of the cerebrum controls: A. touch. B. emotion. C. movement. D. vision.

B. emotion.

Patients with a subarachnoid hemorrhage typically complain of a sudden severe: A. bout of dizziness. B. headache. C. altered mental status. D. thirst.

B. headache.

Which of the following medications is NOT used to treat patients with a history of seizures? A. phenytoin (Dilantin) B. hydromorphone (Dilaudid) C. carbamazepine (Tegretol) D. phenobarbital

B. hydromorphone (Dilaudid)

The MOST significant risk factor for a hemorrhagic stroke is: A. severe stress. B. hypertension. C. heavy exertion. D. diabetes mellitus.

B. hypertension.

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. hypoglycemia B. hypovolemia C. a postictal state D. intracranial bleeding

B. hypovolemia

You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should: A. assess the patient for a facial droop and hemiparesis. B. initiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible. C. obtain a blood glucose sample to rule out hypoglycemia. D. perform CPR for 5 minutes before applying the AED.

B. initiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible.

The principal difference between a patient who has had a stroke and a patient with hypoglycemia almost always has to do with the A. papillary response. B. mental status. C. blood pressure. D. capillary refill time.

B. mental status.

You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to: A. determine if the patient is a known alcohol abuser. B. obtain a description of how the seizure developed. C. determine when he was last seen by his physician. D. ask her how long the patient has been taking his medication.

B. obtain a description of how the seizure developed.

When transporting a stable stroke patient with unilateral paralysis, it is best to place the patient in a: A. recumbent position with the paralyzed side up. B. recumbent position with the paralyzed side down. C. sitting position with the head at a 45° to 90° angle. D. supine position with the legs elevated 6″ to 12″.

B. recumbent position with the paralyzed side down.

You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: A. repeat the arm drift test and ensure that her palms are facing downward. B. repeat the arm drift test, but move the patient's arms into position yourself. C. instruct the patient to keep her eyes open and then repeat the arm drift test. D. defer this part of the test and assess her for facial droop and slurred speech.

B. repeat the arm drift test, but move the patient's arms into position yourself.

Which of the following conditions is NOT a common cause of seizures? A. poisoning or overdose B. severe hypovolemia C. acute hypoglycemia D. acute alcohol withdrawal

B. severe hypovolemia

Hypoglycemia

An abnormally low blood glucose level.

Stroke

An interruption of blood flow to the brain that results in the loss of brain function; also called a cerebrovascular accident (CVA).

Cerebrovascular accident (CVA)

An interruption of blood flow to the brain that results in the loss of brain function; also called a stroke.

An area of swelling or enlargement in a weakened arterial wall is called: A. a thrombus. B. an aneurysm. C. an embolism. D. atherosclerosis.

B. an aneurysm.

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should: A. cover the child with wet towels and give oxygen via nasal cannula. B. transport the child to the hospital and reassure the mother en route. C. advise the mother to take her child to the doctor the following day. D. call medical control and request permission to give the child aspirin.

B. transport the child to the hospital and reassure the mother en route.

Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of: A. 6. B. 7. C. 8. D. 9.

C. 8.

Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should: A. place a bite block in her mouth in case she has a seizure and transport at once. B. apply oxygen via a nonrebreathing mask, place her on her left side, and transport. C. assist ventilations, perform a rapid exam, and prepare for immediate transport. D. apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.

C. assist ventilations, perform a rapid exam, and prepare for immediate transport.

Interruption of cerebral blood flow may result from all of the following, EXCEPT: A. a thrombus. B. an embolism. C. cerebral vasodilation. D. an acute arterial rupture.

C. cerebral vasodilation.

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? A. hyperventilation and hypersalivation B. a rapidly improving level of consciousness C. confusion and fatigue D. a gradually decreasing level of consciousness

C. confusion and fatigue

The mental status of a patient who has experienced a typical seizure: A. progressively worsens over a period of a few hours. B. is easily differentiated from that of acute hypoglycemia. C. is likely to improve over a period of 5 to 30 minutes. D. typically does not improve, even after several minutes.

C. is likely to improve over a period of 5 to 30 minutes.

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: A. brain. B. kidneys. C. liver. D. pancreas.

C. liver.

Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke Scale? A. speech B. arm drift C. memory D. facial droop

C. memory

You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes valproate (Depakote) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to administering oxygen, you should: A. administer one tube of oral glucose and prepare for immediate transport. B. place her in the recovery position and transport her with lights and siren. C. monitor her airway and breathing status and assess her blood glucose level. D. give her small cups of water to drink and observe for further seizure activity.

C. monitor her airway and breathing status and assess her blood glucose level.

A transient ischemic attack (TIA) occurs when: A. medications are given to dissolve a cerebral blood clot. B. a small cerebral artery ruptures and causes minimal damage. C. the normal body processes destroy a clot in a cerebral artery. D. signs and symptoms resolve spontaneously within 48 hours.

C. the normal body processes destroy a clot in a cerebral artery.

The left cerebral hemisphere controls: A. the right side of the face. B. heart rate and pupil reaction. C. the right side of the body. D. breathing and blood pressure.

C. the right side of the body.

A patient who is experiencing aphasia is: A. not able to swallow without choking. B. experiencing a right hemispheric stroke. C. unable to produce or understand speech. D. usually conscious but has slurred speech.

C. unable to produce or understand speech.

Tension headaches

Caused by muscle contractions in the head and neck and are attributed to stress. Patients usually describe the pain as squeezing, dull, or an ache.

Sinus headaches

Caused by pressure that is the result of fluid accumulation in the sinus cavities.

The brain stem

Controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil construction.

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to: A. list all of the patient's current medications. B. obtain a complete set of baseline vital signs. C. administer glucose to rule out hypoglycemia. D. ask his wife when she noticed the symptoms.

D. ask his wife when she noticed the symptoms.

The three major parts of the brain are the: A. cerebellum, medulla, and occiput. B. brain stem, midbrain, and spinal cord. C. midbrain, cerebellum, and spinal cord. D. cerebrum, cerebellum, and brain stem.

D. cerebrum, cerebellum, and brain stem.

A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min and adequate. In addition to high-flow oxygen, further treatment should include: A. assisting him with his migraine medication and transporting without lights and siren. B. placing him in a supine position and transporting with lights and siren to a stroke center. C. applying warm compresses to the back of his neck and transporting with lights and siren. D. dimming the lights in the back of the ambulance and transporting without lights and siren.

D. dimming the lights in the back of the ambulance and transporting without lights and siren.

During the primary assessment of a semiconscious 70-year-old female, you should: A. insert a nasopharyngeal airway and assist ventilations. B. immediately determine the patient's blood glucose level. C. ask family members if the patient has a history of stroke. D. ensure a patent airway and support ventilation as needed.

D. ensure a patent airway and support ventilation as needed.

A patient with an altered mental status is: A. completely unresponsive to all forms of stimuli. B. typically alert but is confused as to preceding events. C. usually able to be aroused with a painful stimulus. D. not thinking clearly or is incapable of being aroused.

D. not thinking clearly or is incapable of being aroused.

Status epilepticus is characterized by: A. generalized seizures that last less than 5 minutes. B. an absence seizure that is not preceded by an aura. C. profound tachycardia and total muscle flaccidity. D. prolonged seizures without a return of consciousness.

D. prolonged seizures without a return of consciousness.

Which of the following conditions would MOST likely affect the entire brain? A. blocked cerebral artery in the frontal lobe B. reduced blood supply to the left hemisphere C. ruptured cerebral artery in the occipital lobe D. respiratory failure or cardiopulmonary arrest

D. respiratory failure or cardiopulmonary arrest

Hypoglycemia can mimic conditions such as: A. cystic fibrosis. B. myocardial infarction. C. high fever. D. stroke.

D. stroke.

Which of the following clinical signs is MOST suggestive of a ruptured cerebral artery? A. unilateral hemiparesis B. confusion and weakness C. nasal discharge of blood D. sudden, severe headache

D. sudden, severe headache

Successful treatment of a stroke depends on whether: A. surgical intervention is performed to remove obstructive clots. B. medications are given to restore the function of infarcted cells. C. the stroke occurs within the left or right hemisphere of the brain. D. thrombolytic therapy is given within 3 hours after symptoms began.

D. thrombolytic therapy is given within 3 hours after symptoms began.

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia: A. always take oral medications to maintain normal blood glucose levels. B. do not present with slurred speech or weakness to one side of the body. C. are typically alert and attempt to communicate with health care providers. D. usually have an altered mental status or decreased level of consciousness.

D. usually have an altered mental status or decreased level of consciousness.

The cerebrum

Located above the cerebellum, is divided down the middle into the right and left cerebral hemispheres. Each hemisphere controls activities on the opposite side of the body.

The cerebellum

Located just behind the brain stem, which controls muscle and body coordination; Is responsible for coordinating complex tasks that involve many muscles

Neglect

Condition when the patient forgets about the injured side after a stroke.

Treatment of a migraine

- High flow oxygen - Provide a darkened and quiet environment - Do not use lights and sirens during transport

HEMORRHAGIC STROKE

1 of the 2 main types of stoke;occurs as a result of bleeding inside the brain.

ISCHEMIC STROKE

1 of the 2 main types of stroke;occurs when blood flow 2 a particular part of the brain is cut off by blockage (a clot) inside a blood vessel.

Conditions That My Mimic Stroke

1) Hypoglycemia 2) Postictal State 3) Subdural / Epidural Bleeding

Glascow Coma Scale (GCS)

Neurologic assessment of a patient's best verbal response, eye opening, and motor function.

Simple partial seizure

No change occurs in the patient's level of consciousness.

Tension headaches, migraines, and sinus headaches.

The most common types of headaches:

Syncope

A fainting spell or transient loss of consciousness.

PARTIAL SEIZURE

A seizure affecting a limited portion of the brain. Partial seizure may involve some twitching of the muscles but it is not characterized by the dramatic twitching seen in a generalized seizure. Partial seizures can B simple or complex

GENERALIZED SEIZURE

A seizure characterized by severe twitching of all of the body's muscles that may last several minutes or more;formerly known as grand mal seizures.

Idiopathic seizure

A seizure for which the cause cannot be determined.

Which of the following statements regarding the AED and defibrillation is correct? A. The AED will not analyze the rhythm of a moving patient. B. Defibrillation is the first link in the American Heart Association chain of survival. C. The AED will shock any rhythm not accompanied by a pulse. D. CPR should be performed for 5 minutes before using the AED.

A. The AED will not analyze the rhythm of a moving patient.

Lucid interval

After a head injury, a patient may have normal mental status for a period of time (usually minutes to hours), only to deteriorate markedly; period between injury and deterioration.

GLASGOW COMA SCALE

All patients w AMS should have a Glasgow Coma score calculated.

High-flow oxygen.

All patients with altered mental status, regardless of cause, should receive...

The descending aorta divides into the two iliac arteries at the level of the: A. nipple line. B. umbilicus. C. iliac crest. D. pubic symphysis.

B. umbilicus.

A dissecting aortic aneurysm occurs when: A. all layers of the aorta suddenly contract. B. a weakened area develops in the aortic wall. C. the inner layers of the aorta become separated. D. the aorta ruptures, resulting in profound bleeding.

C. the inner layers of the aorta become separated.

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: A. has had a prior heart attack. B. is older than 60 years of age. C. has a GCS score that is less than 8. D. has bleeding within the brain.

D. has bleeding within the brain.

A patient whose speech is slurred and difficult to understand is experiencing:

Dysarthria.

SIGNS OF INCREASED INTRACRANIAL PRESSURE

Headache, vomiting, AMS & seizures. Increasing intracranial pressure can b from hemorrhagic stroke or from head trauma.

The MOST significant risk factor for a hemorrhagic stroke is:

Hypertension.

what mimics a stroke and also causes a seizure?

Hypoglycemia

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke?

Hypovolemia.

Common causes of Metabolic seizures

Hypoxia Abnormal blood chemical values Hypoglycemia Poisoning Drug overdose Sudden withdrawal from alcohol or medications

3-Item Stroke Severity Scale (LAG)

ITEM/CRITERIA/SCORE Level of consciousness: - Normal [0] - Mild dysfunction [1] - Severe dysfunction (unconscious) [2] Arm drift (hemiparesis): - Normal function [0] - Mild dysfunction [1] - Severe dysfunction (flaccid) [2] Gaze: - Normal gaze (follows pen/finger to left and right sides) [0] - Mild dysfunction [1] - Severe dysfunction (fixed gaze) [2] Score (total): >4 indicates stroke is likely

Simple or complex

Partial seizures have two classifications:

What would be the result of a low oxygen level in the bloodstream?

Patient could be anxious, restless, and confused.

Name Medications Which R Used 2 Control Epileptic Seizures

Phenytoin (Dilantin) Phenobarbital Carbamazepine (Tegretol)

Back part of the cerebrum

Processes sight.

FEBRILE SEIZURES

Seizures that result from sudden high fevers, particularly in children. Febrile seizures R typically well tolerated by children however rapid transport is still required.

Febrile seizures

Seizures that result from sudden high fevers; most often seen in children.

A sudden, severe headache, often described as the worst pain the patient has ever had.

Sign of a hemorrhagic stroke:

Phases Of A General Tonic-Clonic Seizure

a. Aura - since of deja vu. b. Tonic - lasting a few seconds, person loses consciousness & skeletal muscles tense. c. Clonic - muscles contract & relax rapidly. d. Postictal - state of altered consciousness person enters after experiencing a seizure.

what is a metabolic cause for a seizure?

hypoglycemia

Interruption of cerebral blood flow may result from all of the following, EXCEPT:

cerebral vasodilation.

A patient whose speech is slurred and difficult to understand is experiencing:

dysarthria.

The most significant risk factor for a hemorrhagic stroke is:

hypertension.

Headache, vomiting, altered mental status, and seizures.

Early signs of increased intracranial pressure include:

Signs & Symptom of Stroke / Transient Ischemic Attack

1) Confused, Dizzy, Weak 2) Decreasing or increasing LOC 3) Combative or uncooperative or restless 4) Facial drooping, inability 2 swallow, tongue deviation 5) Double vision or blurred vision 6) Difficulty speaking or absence speech 7) Decreased or absent movement of 1 or more extremities 8) Headache 9) Decreased or absent sensation in 1 or more extremities or other areas of the body 10) Coma

SEIZURE MANAGEMENT

1) Safety of patient / position 2) ABCs, consider nasopharyngeal airway 3) Oxygen / suction 4) Pulse oximetry 5) Emotional support

Management Of Patient W Stroke Assessment Findings

1) Scene safety & PPE 2) ABCs / Position 3) Oxygen / Suction 4) Emotional support 5) Rapid transport

SEIZURE ASSESSMENT

1) Spasms, muscle contractions 2) Bite tongue, increased secretions 3) Sweating 4) Cyanosis 5) Unconscious gradually increasing LOC 6) May cause shaking or tremors & no LOC 7) Incontinent 8) Amnesia of event

CAUSES OF MIGRAINES

2nd most common cause of headaches. Caused by changes in the blood vessel @ the base of the brain. Described as pounding, throbbing or pulsating. Associated w nausea, vomiting or visual changes. Can last for several days.

You are performing a Glasgow Coma Scale on a patient who opens her eyes in response to pain, is confused in her responses to questions, and has abnormal flexion. What is this patient's GCS score and corresponding state of dysfunction?

9 - moderate dysfunction

what most accurately describes a simple partial seizure?

: A seizure that begins in one extremity

What is the difference between a stroke and a transient ischemic attack?

A TIA resolves completely within 24 hours of onset.

HYPOGLYCEMIA

A condition characterized by low blood glucose level. Since glucose is also required for brain function, hypoglycemia may mimic conditions associated w stroke such as hemiparesis. THE MAIN DIFFERENCE is a patient w a stroke may B alert & attempting 2 communicate normally whereas a patient w hypoglycemia almost always has an altered or decreased level of consciousness.

STATUS EPILEPTICUS

A condition in which seizures recur every few min. or last more than 30 min.

Status epilepticus

A condition in which seizures recur every few minutes or last longer than 30 minutes.

TRANSIENT ISCHEMIC ATTACK (TIA)

A disorder of the brain in which brain cells temporarily stop working b/c of insufficient oxygen, causing stroke like Sx that resolve completely within 24 hrs of onset.

Phenytoin

A drug that is used to control seizures, may itself cause seizures if the person takes too much.

A - Alcohol E - Epilepsy, endocrine, electrolytes I - Insulin O - Opiates and other drugs U - Uremia (kidney failure) T - Trauma I - Infection P - Poisoning, psychogenic causes S - Shock, stroke, seizure, syncope, space-occupying lesion, subarachnoid hemorrhage.

A helpful mnemonic to use when reviewing the possible causes of altered mental status.

ISCHEMIA

A lack of oxygen in the cells of the brain that causes them not to function properly.

- Sudden onset of symptoms - Explosive/thunderclap pain - Altered mental status - Age > 50 - Depressed immune system (known to be at higher risk for infection) - Neurologic deficits - Neck stiffness/pain - Fever - Changes in vision - One-sided paralysis or weakness

A patient who has a headache associated with any of the following should be evaluated for a potentially life-threatening condition:

POSTICTAL STATE

A period following a seizure that lasts between 5 & 30 min;characterized by labored respirations & some degree of altered mental status.

Which of the following MOST accurately describes a simple partial seizure?

A seizure that begins in one extremity.

When caring for a patient documented hypoglycemia, you should be MOST alert for:

A seizure.

Aura

A sensation experienced before a seizure; serves as a warning sign that a seizure is about to occur.

AURA

A sensation experienced prior 2 a seizure;serves as a warning sign that a seizure is about 2 occur.

Simple Partial Seizure VS Complex Partial Seizure

A simple partial seizure may cause twitching in the muscles of the extremities & may move slowly from 1 body part 2 another. In a complex partial seizure a patient has an AMS & does not interact normally w their environment. Complex partial seizures result from abnormal discharge from the temporal lobe of the brain.

COMA

A state of profound unconsciousness which 1 cannot B roused.

Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger? A. furosemide (Lasix) B. aspirin C. oxygen D. digoxin (Lanoxin)

B. aspirin

Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? A. a rapid heart rate B. syncope or dizziness C. heart rate less than 60 beats/min D. generalized weakness

A. a rapid heart rate

Which of the following MOST accurately describes a simple partial seizure? A. a seizure that begins in one extremity B. a seizure that causes the patient to stare blankly C. a seizure that is not preceded by an aura D. a generalized seizure without incontinence

A. a seizure that begins in one extremity

When caring for a patient with documented hypoglycemia, you should be MOST alert for: A. a seizure. B. an acute stroke. C. respiratory distress. D. a febrile convulsion.

A. a seizure.

Prompt transport of a patient with a suspected AMI is important because: A. the patient may be eligible to receive thrombolytic therapy. B. 90% of the cardiac cells will die within the first 30 minutes. C. nitroglycerin can only be given in the emergency department. D. many patients with an AMI die within 6 hours.

A. the patient may be eligible to receive thrombolytic therapy.

A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should: A. administer oxygen, give her 324 mg aspirin, and assess her further. B. obtain a SAMPLE history and contact medical control for advice. C. give her 100% oxygen, attach the AED, and transport immediately. D. give her one nitroglycerin and reassess her systolic blood pressure.

A. administer oxygen, give her 324 mg aspirin, and assess her further.

Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: A. assess the scene for potential hazards. B. determine if you need additional help. C. request a paramedic unit for assistance. D. gain immediate access to the patient.

A. assess the scene for potential hazards.

You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should: A. begin high-quality CPR and apply the AED without delay. B. have your partner perform CPR while you question the bystanders. C. perform two-rescuer CPR for 5 minutes and request ALS backup. D. immediately apply the AED pads and analyze his cardiac rhythm.

A. begin high-quality CPR and apply the AED without delay.

When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that: A. blood can pass from the atria to the ventricles. B. blood returning from the body can fill the atria. C. the impulse can spread through the Purkinje fibers. D. the SA node can reset and generate another impulse.

A. blood can pass from the atria to the ventricles.

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the: A. brain. B. kidneys. C. abdomen. D. legs.

A. brain.

Cardiogenic shock following AMI is caused by: A. decreased pumping force of the heart muscle. B. a profound increase in the patient's heart rate. C. hypovolemia secondary to severe vomiting. D. widespread dilation of the systemic vasculature.

A. decreased pumping force of the heart muscle.

Nitroglycerin relieves cardiac-related chest pain by: A. dilating the coronary arteries and improving cardiac blood flow. B. increasing the amount of work that is placed on the myocardium. C. contracting the smooth muscle of the coronary and cerebral arteries. D. constricting the coronary arteries and improving cardiac blood flow.

A. dilating the coronary arteries and improving cardiac blood flow.

The MOST common error associated with the use of the AED is: A. failure of the EMT to ensure the battery is charged. B. malfunction of the AED's internal computer processor. C. inappropriately placed adhesive defibrillation electrodes. D. inability of the EMT to recognize ventricular fibrillation.

A. failure of the EMT to ensure the battery is charged.

The iliac arteries immediately subdivide into the: A. femoral arteries. B. peroneal arteries. C. anterior tibial arteries. D. posterior tibial arteries.

A. femoral arteries.

The spinal cord exits the cranium through the: A. foramen magnum. B. vertebral foramen. C. foramen lamina. D. cauda equina.

A. foramen magnum.

Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: A. have chronic hypertension. B. regularly take illegal drugs. C. have had a stroke in the past. D. are older than 40 years of age.

A. have chronic hypertension.

Major risk factors for AMI include all of the following, EXCEPT: A. hypoglycemia. B. hypertension. C. diabetes mellitus. D. elevated cholesterol.

A. hypoglycemia.

Which of the following would cause the greatest increase in cardiac output? A. increased heart rate and increased stroke volume B. decreased stroke volume and increased heart rate C. decreased heart rate and increased stroke volume D. decreased stroke volume and decreased heart rate

A. increased heart rate and increased stroke volume

An acute myocardial infarction (AMI) occurs when: A. myocardial tissue dies secondary to an absence of oxygen. B. the heart muscle progressively weakens and dysfunctions. C. coronary artery dilation decreases blood flow to the heart. D. the entire left ventricle is damaged and cannot pump blood.

A. myocardial tissue dies secondary to an absence of oxygen.

You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should: A. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport. B. immediately remove the nitroglycerin patch, apply the AED in case he develops cardiac arrest, and transport to the closest hospital. C. move the nitroglycerin patch to the other side of his chest in case you need to apply the AED, keep him warm, and transport without delay. D. ask him if the nitroglycerin patch he is wearing has improved his chest pressure, complete your secondary assessment, and transport promptly.

A. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.

In contrast to monophasic defibrillation, biphasic defibrillation: A. requires a lower energy setting. B. delivers all shocks at 360 joules. C. begins with 300 joules and escalates. D. is only effective for ventricular tachycardia.

A. requires a lower energy setting.

Deoxygenated blood from the body returns to the: A. right atrium. B. right ventricle. C. left atrium. D. left ventricle.

A. right atrium.

The purpose of defibrillation is to: A. stop the chaotic, disorganized contraction of the cardiac cells. B. cause a rapid decrease in the heart rate of an unstable patient. C. improve the chance of cardiopulmonary resuscitation (CPR) being successful in resuscitation. D. prevent asystole from deteriorating into ventricular fibrillation.

A. stop the chaotic, disorganized contraction of the cardiac cells.

Subdural bleeding

Bleeding beneath the dura but outside the brain.

Bacterial meningitis

An inflammation of the meninges caused by bacterial infection, is a central nervous system infection in which the patient may complain of a headache, stiff neck, fever, and sensitivity to light.

Cerebrovascular Accident (CVA)

An interruption of blood flow 2 the brain that results in the loss of brain function. Also called a stroke.

STROKE

An interruption of blood flow 2 the brain that results in the loss of brain function;also called a cerebrovascular accident (CVA).

The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they: A. are elderly. B. are in denial. C. cannot afford it. D. do not trust EMTs.

B. are in denial.

Epidural bleeding

Bleeding outside the dura and under the skull.

Which of the following is a major difference between angina pectoris and AMI? A. AMI is caused by myocardial ischemia. B. Anginal pain typically subsides with rest. C. Nitroglycerin has no effect on angina pectoris. D. Pain from an AMI subsides within 30 minutes.

B. Anginal pain typically subsides with rest.

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. hypoglycemia B. hypovolemia C. a postictal state D. intracranial bleeding

B. Hypovolemia

What is the function of the left atrium? A. It ejects oxygenated blood into the aorta. B. It receives oxygenated blood from the lungs. C. It receives blood from the pulmonary arteries. D. It receives oxygenated blood from the vena cava.

B. It receives oxygenated blood from the lungs.

Acute coronary syndrome (ACS) is a term used to describe: A. the warning signs that occur shortly before a heart attack. B. a group of symptoms that are caused by myocardial ischemia. C. a severe decrease in perfusion caused by changes in heart rate. D. the exact moment that a coronary artery is completely occluded.

B. a group of symptoms that are caused by myocardial ischemia.

You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow respirations; and has a thready pulse. You should: A. obtain baseline vital signs. B. begin ventilatory assistance. C. attach the automated external defibrillator (AED) immediately. D. apply a nonrebreathing mask.

B. begin ventilatory assistance.

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for: A. a cardiac arrhythmia. B. congestive heart failure. C. significant hypotension. D. right ventricular failure.

B. congestive heart failure.

Which of the following is NOT a function of the sympathetic nervous system? A. dilation of blood vessels in the muscles B. constriction of blood vessels in the muscles C. increases in the heart and respiratory rates D. constriction of blood vessels in the digestive system

B. constriction of blood vessels in the muscles

Ischemic heart disease is MOST accurately defined as: A. absent myocardial blood flow due to a blocked coronary artery. B. decreased blood flow to one or more portions of the myocardium. C. death of a portion of the heart muscle due to a decrease in oxygen. D. decreased blood flow to the heart muscle due to coronary dilation.

B. decreased blood flow to one or more portions of the myocardium.

Which of the following signs is commonly observed in patients with right-sided heart failure? A. labored breathing B. dependent edema C. pulmonary edema D. flat jugular veins

B. dependent edema

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What are her signs and symptoms MOST indicative of? A. unstable angina B. dissecting aortic aneurysm C. AMI D. hypertensive emergency

B. dissecting aortic aneurysm

Prior to attaching the AED to a cardiac arrest patient, the EMT should: A. contact medical control. B. dry the chest off if it is wet. C. perform CPR for 30 seconds. D. assess for a pulse for 20 seconds.

B. dry the chest off if it is wet.

A patient whose speech is slurred and difficult to understand is experiencing: A. aphasia. B. dysarthria. C. dysphagia. D. paraplegia.

B. dysarthria.

Blood that is ejected from the right ventricle: A. enters the systemic circulation. B. flows into the pulmonary arteries. C. has a high concentration of oxygen. D. was received directly from the aorta.

B. flows into the pulmonary arteries.

Common side effects of nitroglycerin include all of the following, EXCEPT: A. bradycardia. B. hypertension. C. hypotension. D. severe headache.

B. hypertension.

The MOST significant risk factor for a hemorrhagic stroke is: A. severe stress. B. hypertension. C. heavy exertion. D. diabetes mellitus

B. hypertension.

Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure? A. hypertension and tachycardia B. hypotension and flat jugular veins C. the presence of rales in the lungs D. trouble breathing while lying down

B. hypotension and flat jugular veins

After the AED has delivered a shock, the EMT should: A. assess for a carotid pulse. B. immediately resume CPR. C. reanalyze the cardiac rhythm. D. transport the patient at once.

B. immediately resume CPR.

The AED is MOST advantageous to the EMT because: A. it is lightweight, easy to use, and safe for the EMT who is using it. B. it delivers prompt defibrillation to patients with ventricular fibrillation. C. its use does not require the presence of ALS personnel. D. it delivers an unlimited number of shocks with the same amount of energy

B. it delivers prompt defibrillation to patients with ventricular fibrillation.

A patient with atherosclerotic heart disease experiences chest pain during exertion because the: A. coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. B. lumen of the coronary artery is narrowed and cannot accommodate increased blood flow. C. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen. D. ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.

B. lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

Angina pectoris occurs when: A. a coronary artery is totally occluded by plaque. B. myocardial oxygen demand exceeds the supply. C. one or more coronary arteries suddenly spasm. D. myocardial oxygen supply exceeds the demand.

B. myocardial oxygen demand exceeds the supply.

Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must: A. ensure the medication is in tablet form. B. obtain authorization from medical control. C. determine who prescribed the nitroglycerin. D. wait at least 5 minutes after assessing the blood pressure.

B. obtain authorization from medical control.

In contrast to AMI, a dissecting aortic aneurysm: A. is more commonly associated with pressure in the chest. B. often presents with pain that is maximal from the onset. C. usually presents gradually, often over a period of hours. D. is typically preceded by other symptoms, such as nausea.

B. often presents with pain that is maximal from the onset.

Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a "no shock advised" message. You should: A. reanalyze the patient's cardiac rhythm. B. perform CPR for 2 minutes and reassess. C. determine if a palpable pulse is present. D. immediately assess the patient's airway.

B. perform CPR for 2 minutes and reassess.

After assisting your patient with his or her nitroglycerin, you should: A. place the patient in a recumbent position in case he or she faints. B. reassess the blood pressure within 5 minutes to detect hypotension. C. avoid further dosing if the patient complains of a severe headache. D. perform a secondary assessment before administering further doses.

B. reassess the blood pressure within 5 minutes to detect hypotension.

When transporting a stable stroke patient with a paralyzed extremity, place the patient in a: A. recumbent position with the paralyzed side up. B. recumbent position with the paralyzed side down. C. sitting position with the head at a 45° to 90° angle. D. supine position with the legs elevated 6″ to 12″.

B. recumbent position with the paralyzed side down.

You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: A. repeat the arm drift test and ensure that her palms are facing downward. B. repeat the arm drift test, but move the patient's arms into position yourself. C. instruct the patient to keep her eyes open and then repeat the arm drift test. D. defer this part of the test and assess her for facial droop and slurred speech.

B. repeat the arm drift test, but move the patient's arms into position yourself.

The right coronary artery supplies blood to the: A. left ventricle and inferior wall of the right atrium. B. right ventricle and inferior wall of the left ventricle. C. right atrium and posterior wall of the right ventricle. D. left ventricle and posterior wall of the right ventricle.

B. right ventricle and inferior wall of the left ventricle.

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: A. defibrillate with the AED while continuing transport to the hospital. B. stop the ambulance, begin CPR, and attach the AED as soon as possible. C. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. D. alert the receiving hospital and perform CPR for the duration of the transport.

B. stop the ambulance, begin CPR, and attach the AED as soon as possible.

When the myocardium requires more oxygen: A. the heart contracts with less force. B. the arteries supplying the heart dilate. C. the heart rate decreases significantly. D. the AV node conducts fewer impulses.

B. the arteries supplying the heart dilate.

Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS. A. two B. three C. four D. five

B. three

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should: A. cover the child with wet towels and give oxygen via nasal cannula. B. transport the child to the hospital and reassure the mother en route. C. advise the mother to take her child to the doctor the following day. D. call medical control and request permission to give the child aspirin.

B. transport the child to the hospital and reassure the mother en route.

When documenting a patient's description of his or her chest pain or discomfort, the EMT should: A. use medical terminology. B. use the patient's own words. C. underline the patient's quotes. D. document his or her own perception.

B. use the patient's own words.

Nitroglycerin is contraindicated in patients: A. who have taken up to two doses. B. who have experienced a head injury. C. with a history of an ischemic stroke. D. with a systolic blood pressure less than 120 mm Hg.

B. who have experienced a head injury.

THROMBOSIS

Clotting of the cerebral arteries that may result in the interruption of cerebral blood flow & subsequent stroke.

Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray? A. Encourage the patient to chew the tablet to increase its effectiveness. B. Place the medication under the tongue and have the patient swallow it. C. Administer the medication sublingually and allow it to dissolve or absorb. D. Wait 15 minutes and reassess the blood pressure prior to administering another dose.

C. Administer the medication sublingually and allow it to dissolve or absorb.

Which of the following is the MOST reliable method of estimating a patient's cardiac output? A. Listen to heart sounds with a stethoscope. B. Connect the patient to an electrocardiogram. C. Assess the heart rate and strength of the pulse. D. Determine the average diastolic blood pressure.

C. Assess the heart rate and strength of the pulse.

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? A. hyperventilation and hypersalivation B. a rapidly improving level of consciousness C. confusion and fatigue D. a gradually decreasing level of consciousness

C. Confusion and fatigue

A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? A. Avoid defibrillation as this will damage the patient's AICD. B. Contact medical control and request permission to defibrillate. C. Deliver the shock followed by immediate resumption of CPR. D. Continue CPR and transport the patient to the closest appropriate hospital.

C. Deliver the shock followed by immediate resumption of CPR.

EMBOLUS

Clotting that forms in a remote area & travels 2 the site of blockage.

Febrile seizures: A. often result in permanent brain damage. B. are also referred to as petit mal seizures. C. are usually benign but should be evaluated. D. occur when a child's fever progressively rises.

C. are usually benign but should be evaluated.

The head and brain receive their supply of oxygenated blood from the: A. iliac arteries. B. brachial arteries. C. carotid arteries. D. subclavian arteries.

C. carotid arteries.

Interruption of cerebral blood flow may result from all of the following, EXCEPT: A. a thrombus. B. an embolism. C. cerebral vasodilation. D. an acute arterial rupture.

C. cerebral vasodilation.

When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin? A. sharp chest pain that lasts longer than 10 to 15 minutes B. an acute onset of dizziness during a period of exertion C. chest pain that does not immediately subside with rest D. difficulty breathing that awakens the patient from sleep

C. chest pain that does not immediately subside with rest

The main legal risk in using the AED is: A. negligence on the part of the manufacturer. B. failure of the AED's internal computer chip. C. failing to deliver a shock when one is needed. D. not assessing for a pulse after a shock is delivered.

C. failing to deliver a shock when one is needed.

Risk factors for AMI that cannot be controlled include: A. excess stress. B. hyperglycemia. C. family history. D. lack of exercise.

C. family history.

You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to: A. assess the effectiveness of the bystanders' CPR. B. quickly attach the AED and push the analyze button. C. have the bystanders stop CPR and assess the patient. D. request a paramedic unit and quickly attach the AED.

C. have the bystanders stop CPR and assess the patient.

The mental status of a patient who has experienced a generalized seizure: A. progressively worsens over a period of a few hours. B. is easily differentiated from that of acute hypoglycemia. C. is likely to improve over a period of 5 to 30 minutes. D. typically does not improve, even after several minutes.

C. is likely to improve over a period of 5 to 30 minutes.

When afterload increases: A. the volume of venous blood that returns to the right atrium increases. B. the amount of resistance that the ventricle must beat against decreases. C. it becomes harder for the ventricle to push blood through the blood vessels. D. the blood pressure falls because of significant dilation of the blood vessels.

C. it becomes harder for the ventricle to push blood through the blood vessels.

The EMT should use an AED on a child between 1 month and 8 years of age if: A. he or she is not breathing and has a weakly palpable pulse. B. his or her condition is rapidly progressing to cardiac arrest. C. pediatric pads and an energy-reducing device are available. D. special pads are used and the child has profound tachycardia.

C. pediatric pads and an energy-reducing device are available.

The left ventricle has the thickest walls because it: A. pumps blood to the lungs to be reoxygenated. B. uses less oxygen than other chambers of the heart. C. pumps blood into the aorta and systemic circulation. D. receives blood directly from the systemic circulation.

C. pumps blood into the aorta and systemic circulation.

Which of the following veins is located inferior to the trunk? A. cephalic B. axillary C. saphenous D. subclavian

C. saphenous

During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that: A. the AED has detected asystole. B. the AED detected patient motion. C. she is not in ventricular fibrillation. D. she has a pulse and does not need CPR.

C. she is not in ventricular fibrillation.

The electrical impulse generated by the heart originates in the: A. bundle of His. B. coronary sinus. C. sinoatrial (SA) node. D. atrioventricular (AV) node.

C. sinoatrial (SA) node.

In contrast to the sympathetic nervous system, the parasympathetic nervous system: A. prepares the body to handle stress. B. causes an increase in the heart rate. C. slows the heart and respiratory rates. D. dilates the blood vessels in the muscles.

C. slows the heart and respiratory rates.

You are examining a patient whose signs include lip smacking, jerking of the left arm, and agitation. Based on these signs, what type of seizure is this patient experiencing?

Complex partial

When treating a patient with chest pain, you should assume that he or she is having an AMI because: A. angina usually occurs after an AMI. B. most patients with chest pain are experiencing an AMI. C. the cause of the pain cannot be diagnosed in the field. D. angina and AMI present identically.

C. the cause of the pain cannot be diagnosed in the field.

A transient ischemic attack (TIA) occurs when: A. medications are given to dissolve a cerebral blood clot. B. a small cerebral artery ruptures and causes minimal damage. C. the normal body processes destroy a clot in a cerebral artery. D. signs and symptoms resolve spontaneously within 48 hours.

C. the normal body processes destroy a clot in a cerebral artery.

Sudden death following AMI is MOST often caused by: A. cardiogenic shock. B. severe bradycardia. C. ventricular fibrillation. D. congestive heart failure.

C. ventricular fibrillation.

Los Angeles Prehospital Stroke Screen

CRITERION - Yes/Unknown/No 1. Age >45 y 2. History of seizures of epilepsy absent 3. Symptoms <24 h 4. At baseline, patient is not wheelchair-bound or bedridden 5. Blood glucose between 60 and 400 mg/dL 6. Obvious asymmetry (right versus left) in any of the following three exam categories (must be unilateral): Equal/Right Weak/Left Weak - Facial smile/grimace *Droop* - Grip *Weak grip/No grip* - Arm strength *Drifts down/Falls rapidly* If all criteria 1-6 are marked yes, the probability of a stroke is 97%.

CAUSES OF SINUS HEADACHES

Caused by the accumulation of fluid in the sinus cavities. Patients may also have cold like Sx such as nasal congestion.

SPECIAL CONSIDERATION FOR PEDIATRICS

Causes of altered mental status in children (strokes, seizures, high / low blood glucose) Meningitis - causes of altered mental status Seizures - febrile seizures

Interruption of cerebral blood flow may results from all of the following, EXCEPT:

Cerebral vasodilation.

The three major parts of the brain are the:

Cerebrum, cerebellum, and brain stem.

You are treating a patient who is exhibiting slurred speech, facial droop, and an inability to move his left arm. Which neurologic examination emphasizes these possible stroke signs?

Cincinnati Prehospital Stroke Scale

THROMBOLYTIC THERAPY

Clot dissolvers may reverse stroke Sx if given within 2 to 3 hrs of Sx. Note this can't B used on hemorrhagic strokes.

Which of the following statements regarding the pain associated with AMI is correct? A. It is often described by the patient as a sharp feeling. B. It often fluctuates in intensity when the patient breathes. C. Nitroglycerin usually resolves the pain within 30 minutes. D. It can occur during exertion or when the patient is at rest.

D. It can occur during exertion or when the patient is at rest.

Which of the following statements regarding nitroglycerin is correct? A. The potency of nitroglycerin is increased when exposed to light. B. A maximum of five nitroglycerin doses should be given to a patient. C. Nitroglycerin should be administered between the cheek and gum. D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.

D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.

Which of the following symptoms would lead the EMT to believe that a patient's headache is caused by sinus congestion? A. The headache began suddenly B. There is associated neck stiffness C. There is numbness in the extremities D. The pain is worse when bending over

D. The pain is worse when bending over

Common signs and symptoms of a hypertensive emergency include: A. pallor, cool skin, and a temporary loss of hearing. B. syncope, a weak pulse, and bleeding from the ears. C. tachycardia, pain behind the eyes, and weakness. D. a bounding pulse, a severe headache, and dizziness.

D. a bounding pulse, a severe headache, and dizziness.

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: A. administer up to 324 mg of baby aspirin. B. administer up to three doses of nitroglycerin. C. obtain vital signs and a SAMPLE history. D. assess the adequacy of his respirations.

D. assess the adequacy of his respirations.

Narrowing of the coronary arteries due to a buildup of fatty deposits is called: A. angina pectoris. B. arteriosclerosis. C. acute ischemia. D. atherosclerosis.

D. atherosclerosis.

The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called: A. excitability. B. contractility. C. impulsivity. D. automaticity.

D. automaticity.

The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the: A. parietal lobe. B. pons and medulla. C. somatic nervous system. D. autonomic nervous system.

D. autonomic nervous system.

The posterior tibial pulse can be palpated: A. on the dorsum of the foot. B. above the lateral malleolus. C. in the fossa behind the knee. D. behind the medial malleolus.

D. behind the medial malleolus.

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: A. cerebellum. B. cerebrum. C. cerebral cortex. D. brain stem.

D. brain stem.

The three major parts of the brain are the: A. cerebellum, medulla, and occiput. B. brain stem, midbrain, and spinal cord. C. midbrain, cerebellum, and spinal cord. D. cerebrum, cerebellum, and brain stem.

D. cerebrum, cerebellum, and brain stem.

The myocardium receives oxygenated blood from the __________, which originate(s) from the __________. A. coronary sinus, vena cava B. aorta, inferior vena cava C. vena cava, coronary veins D. coronary arteries, aorta

D. coronary arteries, aorta

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by: A. scraping fatty deposits off of the lumen of the coronary artery. B. bypassing the coronary artery with a vessel from the chest or leg. C. placing a stent inside the coronary artery to keep it from narrowing. D. dilating the affected coronary artery with a small inflatable balloon.

D. dilating the affected coronary artery with a small inflatable balloon.

Which of the following blood vessels transports oxygenated blood? A. superior vena cava B. pulmonary arteries C. inferior vena cava D. pulmonary veins

D. pulmonary veins

CAUSES OF SEIZURES

Epileptic (congenital) Structural (tumor, infection, scar tissue, head trauma, stroke) Metabolic (hypoxia, abnormal blood chemical values, hypoglycemia, poisoning, drug overdose, sudden withdrawal from alcohol, medications Febrile - Sudden high fever

Prior to defibrillating a patient with an AED, it is MOST important that you: A. properly position the defibrillation pads. B. perform up to 5 minutes of effective CPR. C. confirm that the patient is in cardiac arrest. D. ensure that no one is touching the patient.

D. ensure that no one is touching the patient.

Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort? A. history of cigarette smoking B. history of previous heart attack C. presence of personal risk factors D. family history of hypertension

D. family history of hypertension

You arrive at the residence of a 33-year-old woman who is experiencing a generalized (tonic-clonic) seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should: A. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. B. wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter. C. restrain her extremities to prevent her from injuring herself, suction her airway to remove the vomitus, and assist her ventilations with a bag-mask device. D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

Common signs and symptoms of AMI include all of the following, EXCEPT: A. irregular heartbeat. B. sudden unexplained sweating. C. shortness of breath or dyspnea. D. pain exacerbated by breathing.

D. pain exacerbated by breathing.

A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes: A. nitroglycerin for her chest pain. B. ventilations with a bag-mask device. C. oxygen at 4 L/min via nasal cannula. D. placing her in an upright position.

D. placing her in an upright position.

The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you reanalyze the patient's cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to: A. obtain a blood pressure and apply the pulse oximeter. B. place him in the recovery position and apply oxygen. C. transport at once and reanalyze his rhythm en route. D. reassess airway and breathing and treat accordingly.

D. reassess airway and breathing and treat accordingly.

Defibrillator pads are placed on the patient's chest with one pad to the: A. left of the upper sternum and the other pad just to the right of the left nipple. B. right of the upper sternum and the other pad just to the right of the right nipple. C. left of the upper sternum and the other pad just to the right and below the left nipple. D. right of the upper sternum and the other pad just to the left and below the left nipple.

D. right of the upper sternum and the other pad just to the left and below the left nipple.

Ventricular tachycardia causes hypotension because: A. the volume of blood returning to the atria increases. B. the right ventricle does not adequately pump blood. C. blood backs up into the lungs and causes congestion. D. the left ventricle does not adequately fill with blood.

D. the left ventricle does not adequately fill with blood.

Cardiac output may decrease if the heart beats too rapidly because: A. a rapid heart beat causes a decrease in the strength of cardiac contractions. B. the volume of blood that returns to the heart is not sufficient with fast heart rates. C. as the heart rate increases, more blood is pumped from the ventricles than the atria. D. there is not enough time in between contractions for the heart to refill completely.

D. there is not enough time in between contractions for the heart to refill completely.

Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm? A. sinus tachycardia B. sinus bradycardia C. extra ventricular beats D. ventricular tachycardia

D. ventricular tachycardia

CINCINNATI PREHOSPITAL STROKE SCALE

Facial Droop (Ask patient 2 smile) Normal - Both sides of face move equally well. Abnormal - 1 side of the face does not move as well as the other. Arm Drift (Ask patient 2 close eyes & hold both arms out w palms up) Normal - Both arms move the same, or both arms do not move. Abnormal - 1 arm does not move, or 1 arm drifts down compared w the other side. Speech (Ask patient 2 say "The sky is blue in Cincinnati") Normal-patient uses correct words w no slurring abnormal-patient slurs words, uses inappropriate words, or is unable 2 speak.

SEIZURE

Generalized, uncoordinated muscular activity associated w a LOC;a convulsion.

INCIDENCE OF SEIZURE

Incidence of seizures is high representing 30% of 911 calls. Estimated 4 million people have seizures.

Patient W Seizure Refuses Transport. Which Questions Do U Ask?

Is the patient awake & completely oriented after the seizure (GCS 15) Does ur assessment show no evidence of trauma or complications from the seizure? Has ur patient ever had a seizure before? Was this seizure the "usual" seizure in every way (length, activity, recovery)? Is the patient currently being treated w medication & receiving regular evaluations by a physician?

What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage?

Ischemic stroke

- Time of onset of the signs and symptoms - Score on the Glascow Coma Scale - Results of a stroke assessment tool (Cincinnati, Los Angeles, LAG, or FAST) - Changes noted on reassessment

Key information to document for a patient who may have had a stroke:

You are dispatched to a home where you find a 70-year-old man. He is exhibiting facial drooping and, when you ask him to tell you what day it is, he says "January." Which part of the brain is most likely to have been affected?

Left hemisphere

CEREBRUM

Located above the cerebellum it is divided into right & left hemispheres & each hemisphere controls the opposite side of the body. Front controls emotion & thought, middle controls touch & movement & the back controls sight. The left / middle of the cerebrum controls speech.

CEREBELLUM

Located just behind the brain stem the cerebellum controls body coordination. It is responsible for coordinating complex tasks that involve many muscles such as walking, writing & playing piano.

INCONTINENCE

Loss of bowel / bladder control;may B the result of a generalized seizure.

Incontinence

Loss of bowel and/or bladder control; may be the result of a generalized seizure.

________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion.

Low oxygen levels in the bloodstream

Absence seizure (formerly called petit mal)

May last just for seconds, after which the patient fully recovers with only a brief lapse of memory of the event.

- Levetiracetam (Keppra) - Phenytoin (Dilantin) - Phenobarbital - Carbamazepine (Tegretol) - Valproate (Depakote) - Topiramate (Topamax) - Clonazepam (Klonopin)

Medications used most often to treat seizures include the following:

What is the name of the condition when the patient forgets about the injured side after a stroke?

Neglect

DYSARTHRIA

Slurred Speech

Dysarthria

Slurred speech.

SPECIAL STROKE CONSIDERATION FOR GERIATRICS

Stroke common in this age group overtime the brain gradually deteriorates and shrinks as a part of the normal aging process. This makes the patient more susceptible 2 injury, & lowers mental status.

LIFE THREATENING CAUSES OF HEADACHES

Stroke, tumor, infection of the CNS or hypertension. Headaches associated w other Sx or headaches described as the worst pain ever felt should B considered serious.

Common causes of Febrile seizures

Sudden high fever

Possible Causes of Altered Mental Status

TIPS AEIOU T - Trauma, I - Infection, P - Psychogenic Causes, S - Seizure / Syncope A - Alcohol, E - Electrolytes, I - Insulin, 0 - Opiates, U - Uremia (Toxic condition resulting in kidney disease)

CAUSES OF TENSION HEADACHES

Tension headaches R most common & R caused by muscle contractions in the head & neck. They R attributed 2 stress. Squeezing, dull or aching do not require med. attention.

F - Facial droop (ask the patient to smile; look for a droop on either side of the patient's face) A - Arm drift (ask the patient to close his or her eyes and hold arms out with palms up, then watch for one to drift down) S - Speech (ask the patient to repeat a simple phrase, then listen for slurred speech) T - Time (note the time the patient was last seen acting normally)

The FAST mnemonic can also be used in assessing for a stroke:

- Hypoglycemia - A postictal state (period following a seizure that lasts between 5 and 30 minutes, characterized by labored respirations and some degree of altered mental status) - Subdural or epidural bleeding (a collection of blood near the skull that presses on the brain)

The following conditions may appear to be a stroke:

- Facial drooping* - Sudden weakness or numbness in the face, arm, leg, or one side of the body - Decreased or absent movement and sensation on one side of the body - Lack of muscle coordination (ataxia) or loss of balance - Sudden vision loss in one eye; blurred or double vision - Difficulty swallowing (a primary reason for good airway management in a patient with a stroke) - Decreased level of responsiveness - Speech disorders - Aphasia; difficulty expressing thoughts or inability to use the right words (expressive aphasia) or difficulty understanding spoken words (receptive aphasia) - Slurred speech (dysarthria)* - Sudden and severe headache - Confusion - Dizziness - Weakness - Combativeness - Restlessness - Tongue deviation - Coma - Arm drift* - Grip

The general signs and symptoms of stroke include the following:

APHASIA

The inability 2 understand / produce speech

Dura

The leathery covering of the brain that lies next to the skull.

Which of the following symptoms would lead to the EMT to believe that a patient's headache is caused by sinus congestion?

The pain is worse when bending over.

Postictal state

The period following a seizure that lasts 5 to 30 minutes; characterized by labored respirations and some degree of altered mental status.

ANEURYSM

The swelling or enlargement of part of a blood vessel,resulting from weakening of the vessel wall.

Berry aneurysm

This type of aneurysm resembles a tiny balloon (or berry) that juts out from the artery.

Cincinnati Prehospital Stroke Scale

To rapidly identify stroke 1) Facial droop 2) Arm drift 3) Speech "The sky is blue in Cincinnati."

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child has been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should:

Transport the child to the hospital and reassure the mother en route.

Common causes of Structural seizures

Tumor (benign or cancerous) Infection (brain abscess) Scar tissue from injury Head trauma Stroke

Generalized and partial (focal)

Two basic groups of seizures:

HEMIPARESIS

Weakness on 1 side of the body

A patient with altered mental status cannot reliably tell you what is wrong, and there may be more than one cause.

What is the most significant difference between a patient with altered mental status and other emergencies?

Subarachnoid hemorrhages

When a berry aneurysm is overstretched and ruptures, blood spurts into an area between two of the coverings of the brain called the subarachnoid space.

Generalized (tonic-clonic) seizure

A seizure characterized by severe twitching of all the body's muscles that may last several minutes or more; formerly known as a grand mal seizure.

Coma

A state of profound unconsciousness from which the patient cannot be roused.

Aneurysm

A swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall.

Delirium

A temporary change in mental status characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a decreased level of consciousness.

Epilepsy

A disorder in which abnormal electrical discharges occur in the brain, causing seizure and possible loss of consciousness.

Atherosclerosis

A disorder in which calcium and cholesterol build up inside the walls of the blood vessels, forming plaque, potentially leading to a partial or complete blockage of blood flow.

Transient ischemic attack (TIA)

A disorder of the brain in which brain cells temporarily stop functioning because of insufficient oxygen, causing stroke-like symptoms that resolve completely within 24 hours of onset.

Ischemia

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.

Seizure

A neurologic episode caused by a surge of electrical activity in the brain; can be a convulsion characterized by a generalized, uncoordinated muscular activity, and can be associated with loss of consciousness.

Partial (focal) seizure

A seizure affecting a limited portion of the brain.

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? A. a 3-month-old female who was born prematurely B. a 17-year-old male with depression and anxiety C. a 35-year-old female in the later stages of AIDS D. an 88-year-old male with chronic renal problems

B. a 17-year-old male with depression and anxiety

You are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. His blood pressure is 190/94 mm Hg and his pulse rate is 50 beats/min. His wife tells you that he has hypertension and diabetes. He has MOST likely experienced: A. acute hypoglycemia. B. a ruptured cerebral artery. C. a complex partial seizure. D. an occluded cerebral artery.

B. a ruptured cerebral artery.

Altered mental status

Any deviation from alert and oriented to person, place, time, and event, or any deviation from a patient's normal baseline mental status.

What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position? A. 6 B. 8 C. 9 D. 10

B. 8

A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport? A. He has experienced seizures since he was 20 B. He is currently not prescribed any medications C. His wife states that this was his "usual" seizure D. His Glasgow Coma Scale (GCS) score is 15

B. He is currently not prescribed any medications

You are called to a home and find a 56-year-old woman supine in her bed. She appears alert, but has slurred speech. Her family tells you she has a history of TIAs and hypertension. You ask the patient, "What day is it today?" Her reply is, "Butterfly." Which area of the brain is likely affected? A. Occipital lobe B. Left hemisphere C. Cerebellum D. Right hemisphere

B. Left hemisphere

When blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel, the result is: A. a hemorrhagic stroke. B. atherosclerosis. C. an ischemic stroke. D. a cerebral embolism.

C. an ischemic stroke.

Febrile seizures: A. often result in permanent brain damage. B. are also referred to as petit mal seizures. C. are usually benign but should be evaluated. D. occur when a child's fever progressively rises.

C. are usually benign but should be evaluated.

When assessing arm movement of a patient with a suspected stroke, you should: A. observe for approximately 5 minutes. B. expect to see one arm slowly drift down to the patient's side. C. ask the patient to close his or her eyes during the assessment. D. ask the patient to hold his or her arms up with the palms down.

C. ask the patient to close his or her eyes during the assessment.

The brain stem, the cerebellum, and the cerebrum.

The brain is divided into three major parts:

Oxygen, glucose, and temperature levels.

The brain is most sensitive to these changes:

Aphasia

The inability to understand and/or produce speech.

Migraine headaches

Thought to be caused by changes in blood vessel size in the base of the brain. Pain is usually described as pounding, throbbing, or pulsating. Often associated with nausea and vomiting and may be preceded by visual warning signs such as flashing lights or partial vision loss.

Hemiparesis

Weakness on one side of the body.