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