Chapter 17 - Neurologic Emergencies
What is hemorrhagic stroke?
- 13% of all strokes - blood vessel ruptures and the accumulated blood then forms a blood clot, which compresses the brain tissue next to it
What is ischemic stroke?
- most common type of stroke (80% of all strokes) - blood flow to a particular part of the brain is stopped by a blockage inside a blood vessel
What is aphasia?
- Difficulty expressing thoughts or inability to use the right words (expressive aphasia) - Difficulty understanding spoken words (receptive aphasia)
What medications are used to treat seizures?
- Levetiracetam (Keppra) - Phenytoin (Dilantin) - Phenobarbital - Carbamazepine (Tegretol) - Valproate (Depakote) - Topiramate (Topamax) - Clonazepam (Klonopin)
What side of the brain is speech generally controlled in?
Left side
What is generalized (tonic-clonic) seizure?
- seizure that features rhythmic back-and-forth motion of an extremity and body stiffness, or extreme twitching of all of the body's muscles, that may last several minutes or more; formerly known as a grand mal seizure.
What is a cerebrovascular accident?
- stroke - interruption of blood flow to an area within the brain that results in the loss of brain function. When brain cells die or are injured, severe disability may result
What is coma?
A state of profound unconsciousness from which the patient cannot be roused
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? - He has experienced seizures since he was 20 - His Glasgow Coma Scale (GCS) score is 15 - He is currently not prescribed any medications - His wife states that this was his "usual" seizure
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? - He has experienced seizures since he was 20 - His Glasgow Coma Scale (GCS) score is 15 *- He is currently not prescribed any medications* - His wife states that this was his "usual" seizure
During the primary assessment of a semiconscious 70-year-old female, you should: - insert a nasopharyngeal airway and assist ventilations. - ensure a patent airway and support ventilation as needed. - immediately determine the patient's blood glucose level. - ask family members if the patient has a history of stroke.
During the primary assessment of a semiconscious 70-year-old female, you should: - insert a nasopharyngeal airway and assist ventilations. *- ensure a patent airway and support ventilation as needed.* - immediately determine the patient's blood glucose level. - ask family members if the patient has a history of stroke.
A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: - is older than 60 years of age. - has had a prior heart attack. - has bleeding within the brain. - has a GCS score that is less than 8.
A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: - is older than 60 years of age. - has had a prior heart attack. *- has bleeding within the brain.* - has a GCS score that is less than 8.
A patient whose speech is slurred and difficult to understand is experiencing: - aphasia. - dysarthria. - dysphagia. - paraplegia.
A patient whose speech is slurred and difficult to understand is experiencing: - aphasia. *- dysarthria.* - dysphagia. - paraplegia.
A patient with an altered mental status is: - typically alert but is confused as to preceding events. - usually able to be aroused with a painful stimulus. - completely unresponsive to all forms of stimuli. - not thinking clearly or is incapable of being aroused.
A patient with an altered mental status is: - typically alert but is confused as to preceding events. - usually able to be aroused with a painful stimulus. - completely unresponsive to all forms of stimuli. *- not thinking clearly or is incapable of being aroused.*
What are signs and symptoms of 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 Slurred speech (dysarthria) Sudden and severe headache Confusion Dizziness Weakness Combativeness Restlessness Tongue deviation Coma
Interruption of cerebral blood flow may result from all of the following, EXCEPT: - an acute arterial rupture. - an embolism. - cerebral vasodilation. - a thrombus.
Interruption of cerebral blood flow may result from all of the following, EXCEPT: - an acute arterial rupture. - an embolism. *- cerebral vasodilation.* - a thrombus.
What are the signs and symptoms of left vs. right hemisphere stroke?
Left Hemisphere - speed disorder - right side paralysis Right Hemisphere - words slurred or hard to understand - left side paralysis - neglect (ignore left parts of the body)
The MOST significant risk factor for a hemorrhagic stroke is: - heavy exertion. - severe stress. - diabetes mellitus. - hypertension.
The MOST significant risk factor for a hemorrhagic stroke is: - heavy exertion. - severe stress. - diabetes mellitus. *- hypertension.*
The left cerebral hemisphere controls: - heart rate and pupil reaction. - the right side of the body. - the right side of the face. - breathing and blood pressure.
The left cerebral hemisphere controls: - heart rate and pupil reaction. *- the right side of the body.* - the right side of the face. - breathing and blood pressure.
The three major parts of the brain are the: - cerebrum, cerebellum, and brain stem. - midbrain, cerebellum, and spinal cord. - cerebellum, medulla, and occiput. - brain stem, midbrain, and spinal cord.
The three major parts of the brain are the: *- cerebrum, cerebellum, and brain stem.* - midbrain, cerebellum, and spinal cord. - cerebellum, medulla, and occiput. - brain stem, midbrain, and spinal cord.
What criteria must be met for a patient to have status epilepticus? - A seizure lasting more than 30 minutes - A seizure that was preceded by an aura - The presence of incontinence during the seizure - Multiple seizures with normal consciousness between each event
What criteria must be met for a patient to have status epilepticus? *- A seizure lasting more than 30 minutes* - A seizure that was preceded by an aura - The presence of incontinence during the seizure - Multiple seizures with normal consciousness between each event
What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage? - Ischemic stroke - Hemorrhagic stroke - Seizure - Status epilepticus
What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage? *- Ischemic stroke* - Hemorrhagic stroke - Seizure - Status epilepticus
What is the difference between a stroke and a transient ischemic attack? - A TIA has longer-lasting effects than a stoke. - A TIA involves surges of electrical activity in the brain. - A TIA resolves completely within 24 hours of onset. - A TIA affects a limited portion of the brain.
What is the difference between a stroke and a transient ischemic attack? - A TIA has longer-lasting effects than a stoke. - A TIA involves surges of electrical activity in the brain. *- A TIA resolves completely within 24 hours of onset.* - A TIA affects a limited portion of the brain.
What is the name of the condition when the patient forgets about the injured side after a stroke? - Hemiparesis - Neglect - Aphasia - Ataxia
What is the name of the condition when the patient forgets about the injured side after a stroke? - Hemiparesis *- Neglect* - Aphasia - Ataxia
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. - observe movement of the arms for approximately 2 minutes. - expect to see one arm slowly drift down to the patient's side. - ask the patient to hold his or her arms up with the palms down.
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.* - observe movement of the arms for approximately 2 minutes. - expect to see one arm slowly drift down to the patient's side. - ask the patient to hold his or her arms up with the palms down.
When caring for a patient with documented hypoglycemia, you should be MOST alert for: - a febrile convulsion. - a seizure. - an acute stroke. - respiratory distress.
When caring for a patient with documented hypoglycemia, you should be MOST alert for: - a febrile convulsion. *- a seizure.* - an acute stroke. - respiratory distress.
When you are assessing for a stroke, which of the following neurologic tests should be included in the assessment as a minimum? - Speech - Facial movement - Arm movement - Balance
When you are assessing for a stroke, which of the following neurologic tests should be included in the assessment as a minimum? *- Speech* *- Facial movement* *- Arm movement* - Balance
When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine: - if the patient has been hospitalized before. - if there is a family history of a stroke. - when the patient last appeared normal. - the patient's overall medication compliance.
When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine: - if the patient has been hospitalized before. - if there is a family history of a stroke. *- when the patient last appeared normal.* - the patient's overall medication compliance.
Which of the following MOST accurately describes a simple partial seizure? - A seizure that causes the patient to stare blankly - A generalized seizure without incontinence - A seizure that is not preceded by an aura - A seizure that begins in one extremity
Which of the following MOST accurately describes a simple partial seizure? - A seizure that causes the patient to stare blankly - A generalized seizure without incontinence - A seizure that is not preceded by an aura *- A seizure that begins in one extremity*
Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? - Hyperventilation and hypersalivation - A gradually decreasing level of consciousness - A rapidly improving level of consciousness - Confusion and fatigue
Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? - Hyperventilation and hypersalivation - A gradually decreasing level of consciousness - A rapidly improving level of consciousness *- Confusion and fatigue*
Which of the following conditions would MOST likely affect the entire brain? - Blocked cerebral artery in the frontal lobe - Ruptured cerebral artery in the occipital lobe - Reduced blood supply to the left hemisphere - Respiratory failure or cardiopulmonary arrest
Which of the following conditions would MOST likely affect the entire brain? - Blocked cerebral artery in the frontal lobe - Ruptured cerebral artery in the occipital lobe - Reduced blood supply to the left hemisphere *- Respiratory failure or cardiopulmonary arrest*
Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? - Hypovolemia - A postictal state - Intracranial bleeding - Hypoglycemia
Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? *- Hypovolemia* - A postictal state - Intracranial bleeding - Hypoglycemia
Which of the following is a metabolic cause for a seizure? - Brain tumor - Head trauma - Hypoglycemia - High fever
Which of the following is a metabolic cause for a seizure? - Brain tumor - Head trauma *- Hypoglycemia* - High fever
Which of the following mimics a stroke and also causes a seizure? - Meningitis - Postictal state - Hypoglycemia - Migraine headache
Which of the following mimics a stroke and also causes a seizure? - Meningitis - Postictal state *- Hypoglycemia* - Migraine headache
Which of the following symptoms would lead the EMT to believe that a patient's headache is caused by sinus congestion? - The headache began suddenly - There is numbness in the extremities - There is associated neck stiffness - The pain is worse when bending over
Which of the following symptoms would lead the EMT to believe that a patient's headache is caused by sinus congestion? - The headache began suddenly - There is numbness in the extremities - There is associated neck stiffness *- The pain is worse when bending over*
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: - ventilatory assistance and transport. - oral glucose gel and transport. - high-flow oxygen and transport. - recovery position and transport.
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: - ventilatory assistance and transport. - oral glucose gel and transport. - high-flow oxygen and transport. *- recovery position and transport.*
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? - Right hemisphere - Left hemisphere - Brain stem - Cerebellum
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? - Right hemisphere *- Left hemisphere* - Brain stem - Cerebellum *Aphasia is the inability to produce or understand speech. This occurs when the left hemisphere of the cerebrum is impacted by a stroke. If a patient's right hemisphere is impacted, the patient will be able to speak, but the words may be slurred.*
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? - Generalized - Simple partial - Complex partial - Status epilepticus
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? - Generalized - Simple partial *- Complex partial* - Status epilepticus
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? - 3 - severe dysfunction - 6 - severe dysfunction - 9 - moderate dysfunction - 12 - mild dysfunction
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? - 3 - severe dysfunction - 6 - severe dysfunction *- 9 - moderate dysfunction* - 12 - mild dysfunction
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? - Chicago Prehospital Stroke Scale - 3-Item Stroke Severity Scale - Cincinnati Prehospital Stroke Scale - Glasgow Coma Scale
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? - Chicago Prehospital Stroke Scale - 3-Item Stroke Severity Scale *- Cincinnati Prehospital Stroke Scale* - Glasgow Coma Scale
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: - transport the child to the hospital and reassure the mother en route. - advise the mother to take her child to the doctor the following day. - call medical control and request permission to give the child aspirin. - cover the child with wet towels and give oxygen via nasal cannula.
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: *- transport the child to the hospital and reassure the mother en route.* - advise the mother to take her child to the doctor the following day. - call medical control and request permission to give the child aspirin. - cover the child with wet towels and give oxygen via nasal cannula.
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: - 7. - 8. - 9. - 6.
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: - 7. *- 8.* - 9. - 6.
________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion. - Poor blood supply to one side of the brain - Low oxygen levels in the bloodstream - Very low blood glucose levels - Aneurysms
________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion. - Poor blood supply to one side of the brain *- Low oxygen levels in the bloodstream* - Very low blood glucose levels - Aneurysms