EMT Chapter 17 Neurologic Emergencies
angina
chest pain
bacterial meningitis and symptoms
inflammation of meninges due to bacterial infection headache, stiff neck and sensitivity to light
AEIOU TIPS
pneumonic for causes of Altered Level of Consciousness Alcohol Epilepsy, endocrine, electrolytes Insulin Opiates Uremia (kidney failure) Trauma Infection Poisoning, psychogenic causes Shock, stroke, seizure, syncope, space-occupying lesion, subarachnoid hemorrhage
signs and symptoms of stroke
-facial drooping -sudden weakness or numbness in face, arm, leg or one side of the body -lack of muscle coordination or balance -sudden vision loss in one eye -headache -speech disorders -altered LOC -confusion
embolus
A clot that breaks lose and travels through the bloodstream to the site of a blockage
status epilepticus
A condition in which seizures recur every few minutes or last more than 30 minutes.
seizure
A neurologic episode caused by a surge of electrical activity in the brain; can be a convulsion characterized by generalized, uncoordinated muscular activity, and can be associated with loss of consciousness.
postictal state
A period following a seizure that lasts between 5 and 30 minutes; characterized by labored respirations and some degree of altered mental status
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 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 anxiety
Which of the following conditions is NOT a common cause of seizures? A. Poisoning or overdose B. Hypotension C. Acute hypoglycemia D. Acute alcohol withdrawal
B. Hypotension
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 topiramate (Topamax). 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.
Components of the Cincinnati Prehospital Stroke Scale include: A. speech, pupil reaction, and memory. B. arm drift, memory, and grip strength. C. arm drift, speech, and facial droop. D. facial droop, speech, and pupil size.
C. arm drift, speech, and facial droop.
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.
Which of the following clinical signs is MOST suggestive of a ruptured aneurysm? A. Unilateral hemiparesis B. Confusion and weakness C. Nasal discharge of blood D. Sudden, severe headache
D. Sudden, severe headache
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 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.
febrile seizures
Seizures that result from sudden high fevers, particularly in children.
thrombosis
a clot forms at the site of a blockage
generalized (tonic-clonic) seizure
abnormal electrical discharges from large areas of the brain unconsciousness and severe twitching of the body's muscles
complex partial seizure
altered mental status; results from abnormal discharges from the temporal lobe of the brain; lip smacking, eye blinking, isolated jerking; uncontrollable fear
delirium
an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech.
ischemia
an inadequate blood supply to an organ or part of the body
Brainstem controls
basic functions: breathing, blood pressure, swallowing, pupil constriction
subarachnoid hemorrhage
berry aneurysm aneurysm that is overstretched and ruptures with bleeding into subarachnoid space
hemorrhagic stroke and symptoms
blood vessel ruptures and the blood causes increased pressure in the brain (bleeding of the brain) severe headache, seizures, altered LOC
Petit mal or absence seizures
brief loss of consciousness, usually without jerking movements staring with no response
atherosclerosis
disorder when calcium and cholesterol build up forming plaque inside the walls of blood vessels
front cerebrum controls
emotion and thought
aphasia
inability to produce or understand speech
hemorrhagic stroke most common in
high blood pressure
conditions that can mimic stroke
hypoglycemia, postictal state and subdural or epidural bleeding
Transient ischemic attack
mini stroke typically resolve on their own in 24 hours usually after exertion and feel better after rest
Cerebellum controls
muscle and body coordination
simple partial seizure
no change in consciousness weakness, numbness or dizziness visual changes and unusual smells or tastes can have twitching of the muscles and extremities brief paralysis possible
brain most sensitive to changes in
oxygen, glucose and temperature levels
middle of cerebrum controls
sensation and movement
back part of cerebrum controls
sight
cerebrovascular accident
stroke interruption fo blood flow to an area within the brain that results in the loss of brain function
Ruptured aneurysm symptoms
sudden onset of the worst headache ever felt
aneurysm
swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall
aura
warning sign prior to seizure visual changes or hallucinations
hemiparesis
weakness on one side of the body