EMT Chapter 17 - Neurologic Emergencies

Tonic phase

Phase of seizure , usually only lasting seconds, when patient experiences constant muscle contraction and trembling, tongue biting, bladder and bowel incontinence.

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

dysarthria.

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

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

B

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:

8.

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

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? Select one: A. He is currently not prescribed any medications B. His wife states that this was his "usual" seizure C. His Glasgow Coma Scale (GCS) score is 15 D. He has experienced seizures since he was 20

A

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

A

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

A

A transient ischemic attack (TIA) occurs when: Choose one answer. A. the normal body processes destroy a clot in a cerebral artery. B. medications are given to dissolve a cerebral blood clot. C. a small cerebral artery ruptures and causes minimal damage.

A

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

A

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: Select one: A. recovery position and transport. B. high-flow oxygen and transport. C. oral glucose gel and transport. D. ventilatory assistance and transport.

A

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: Choose one answer. A. assist ventilations, perform a rapid exam, and prepare for immediate transport. B. apply oxygen via a non-rebreathing mask, place her on her left side, and transport. C. apply oxygen via non-rebreathing mask and transport her for a blood-alcohol test. D. place a bite block in her mouth in case she has a seizure and transport at once.

A

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

A

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? Choose one answer. A. 8 B. 6 C. 9 D. 10

A

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

A

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

A

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

A

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: Choose one answer. A. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport. B. an oral airway, assisted ventilation with a bag-mask device, Fowler's position, and transport. C. assisted ventilation with a bag-mask device, right lateral recumbent position, and transport. D. oxygen via a nonrebreathing mask, supine position with legs elevated 6″ to 12″, and transport.

A

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: Select one: A. transport the child to the hospital and reassure the mother en route. B. cover the child with wet towels and give oxygen via nasal cannula. 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.

A

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

A TIA resolves completely within 24 hours of onset.

Postictal state

After seizure ends patient in unresponsive at first and then gradually regains consciousness.

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

B

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

B

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

B

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

B

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

B

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

B

Cerebral hemorrhage

Bleeding in the brain. May have very high bp. High bp can cause the bleeding, but often high bp is the body trying to compensate for bleeding as well

BP during cerebral hemorrhage

Bp will increase to compensate for bleeding, then it will be tapered off, then it will drop as the patient's condition worsens

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

C

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

C

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

C

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

C

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

C

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

C

Which of the following conditions would MOST likely affect the entire brain? Select one: A. Reduced blood supply to the left hemisphere B. Blocked cerebral artery in the frontal lobe C. Respiratory failure or cardiopulmonary arrest D. Ruptured cerebral artery in the occipital lobe

C

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

C

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: Select one: A. 9. B. 6. C. 8. D. 7.

C

Febrile seizures

Caused by high fever, usually in children

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

Stroke assessment tools

Cincinnati Prehospital Stroke Scale, Los Angeles Prehospital Stroke Screen. Evaluates face, arms and speech. Speech: Ask patient to repeat simple phrase. Facial Movement: Ask patient to show their teeth. Arm movement: ask patient to hold arms in front of his/her body with palms facing up and tell them to close their eyes for 10 sec (If both arms fall, move the patient's arms into place yourself)

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

D

A patient who may experience a speech disorder; the inability to produce or understand speech is experiencing: Select one: A. paraplegia. B. dysarthria. C. dysphagia. D. aphasia.

D

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

D

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

D

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

D

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

D

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

D

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

D

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

D

Causes for seizures

Epilepsy, high fever, structural problems in brain, metabolic or chemical problems in body, benign or cancerous tumor, infection (brain abcess), scar tissue from some type of injury

Epidural bleeding

Fracture near the temples may cause artery to bleed on top of the dura, resulting in pressure on the brain. Usually very rapid after injury

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. What would be the most compelling reason to disagree with his refusal of transport?

He is currently not prescribed any medications

what mimics a stroke and also causes a seizure?

Hypoglycemia

Conditions that may mimic stroke

Hypoglycemia, Postictal state (labored respirations, AMS), subdural and epidural bleeding (collection of blood near skull that presses on brain)

SAMPLE history

In patients with stroke make an extreme effort to determine when the last time they appeared healthy was, because this will help physicians determine what meds to give. Most meds don't do any good if given later than 3 hours after stroke begins.

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

Ischemic 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

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

Low oxygen levels in the bloodstream

Hypoglycemia v. Seizure

Mental status of a patient who has had typical seizure is likely to improve. Patient with hypoglycemia will have mental status that is not likely to improve, even after several minutes

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

Neglect

Stroke v. Hypoglycemia

Patient who has had a stroke may be alert and attempting to communicate normally, whereas patient with hypoglycemia almost always has an altered or decreased LOC

Signs of patients with Hemorrhagic Stroke

Pressure on the brain slows pulse and causes respirations to be erratic. BP is usually high to compensate for poor perfusion. Changes in pupil sizes and reactivity indicate significant bleeding and pressure on brain

Status epilepticus

Seizures lasting more than 5 minutes are likely to progress into this. Seizures occur every few minutes without the person regaining consciousness or last longer than 30 min.

Therapy for Strokes

Thrombolytic therapy may reverse stroke symptoms and even stop the stroke if given within 2 to 3 hours of onset of symptoms. Cannot bee given to patients with hemorrhagic strokes

Generalized seizure

Unconscious and generalized severe twitching of all the body's muscles that lasts for several minutes or longer. Or may be characterized by brief lapse of consciousness in which patient seems to stare and not respond to anyone (petit mal or absence seizure). Results from abnormal discharges from large areas of the brain, usually involving both hemispheres,formerly known as a grand mal seizure.

Subdural bleeding

Veins just below the dura may be torn and bleed. Occurs more slowly, sometimes over period of days.

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 ruptured cerebral artery.

When assessing for arm drift of a patient with a suspected stroke, you should:

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

Partial seizure

begins in one side of brain. Classified as simple or complex, Simple partial seizure: no change in patient's LOC. May complain of numbness, weakness or dizziness. May report visual changes and unusual spells. May have brief paralysis. Complex partial seizure: patient has AMS and does not interact normally with his/her environment. Results from abnormal discharges from temporal lobe . Lip smacking, eye blinking, isolated convulsions or jerking of body or one part of the body. May experience unusual smells and visual hallucinations, exhibit uncontrollable fear, and perform receptive physical behavior such as constant sitting and standing.

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the:

brain stem.

Idiopathic

cause of seizure cannot be determined

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

cerebral vasodilation.

Petit Mal/ Absence seizure

characterized by brief lapse of consciousness in which patient seems to stare and not respond to anyone . Sometimes only lasts seconds and patient fully recovers with brief lapse of memory of event.

Epilepsy

congenital

Phenytoin

drug used to control seizures, can cause seizures itself if person takes too much

3 types of seizures

generalized, partial, status epilepticus

The most significant risk factor for a hemorrhagic stroke is:

hypertension.

what is a metabolic cause for a seizure?

hypoglycemia

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:

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

Ataxia

lack of muscle coordination

Dura

leathery covering over the brain, next to the skull

Tonic-clonic seizure

patient may exhibit bilateral movement characterized by muscle rigidity and relaxation usually lasting 1-3 minutes. Paitnet may experience tachycardia, hyperventilation, sweating, intense salivation

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 phenytoin (Dilantin) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you should:

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

Medications to control epilepsy

phenytoin (Dilantin), phenobarbital, carbamazepine (Tegretol)

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:

recovery position and transport.

Subdural and epidural bleeding

usually occurs as result of trauma. Onset of stroke like symptoms may be subtle.

Hemiparesis

weakness on one side of body, resembling a stroke. Can happen in postictal state. Unlike a stroke, hypoxic hemiparesis soon resolves.

When you are obtaining medical history from the family of a suspected stroke patient, it is most important to determine:

when the patient last appeared normal.