EMS Chapter 17 - Neurologic Emergencies

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.

A TIA resolves completely within 24 hours of onset.

Glasgow Coma Scale (GCS) Eye Opening:

Highest score: 4 4) spontaneous 3) in response to speech 2) in response to pain 1) none

Glasgow Coma Scale (GCS) Best Verbal Response:

Highest score: 5 5) oriented conversation 4) confused conversation 3) inappropriate words 2) incomprehensible sounds 1) none

Glasgow Coma Scale (GCS) Best Motor Response:

Highest score: 6 6) obeys commands 5) localizes pain 4) withdraws to pain 3) abnormal flexion 2) abnormal extension 1) none

Which of the following is a metabolic cause for a seizure? Brain tumor Head trauma Hypoglycemia High fever

Hypoglycemia is a metabolic cause of seizures.

Which of the following mimics a stroke and also causes a seizure? Meningitis Postictal state Hypoglycemia Migraine headache

Hypoglycemia mimics stroke and can cause seizures due to low blood glucose levels.

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

Lip smacking, jerking of the left arm, and agitation are signs of a complex partial 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. Poor blood supply to one side of the brain Low oxygen levels in the bloodstream Very low blood glucose levels Aneurysms

Low oxygen levels in the bloodstream

aphasia

The inability to understand and/or produce speech.

postictal state

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

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

This patient has a GCS score of 9: Response to pain = 2; confused conversation = 4; abnormal flexion = 3

hypoglycemia

an abnormally low blood glucose level

Types of Seizures: Epileptic Common cause(s):

congenital origin

Types of Seizures: Metabolic Common cause(s):

hypoxia abnormal blood chemical values hypoglycemia poisioning drug overdose sudden withdrawal from alcohol or medications

dysarthria

slurred speech

coma

state of profound unconsciousness from which person cannot be roused

Types of Seizures: Febrile Common cause(s):

sudden high fever

Types of Seizures: Structural Common cause(s):

tumor (benign or cancerous) infection (brain abscess) scar tissue from injury head trauma stroke

Hemiparesis

weakness on one side of the body

Syncope

A fainting spell or transient loss of consciousness.

cerebrovascular accident (CVA)

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

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.

status epilepticus

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

epilepsy

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

Atherosclerosis

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

Transient Ischemic Attack (TIA)

A disorder of the brain in which brain cells temporarily stop working 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 generalized, uncoordinated muscular activity, and can be associated with loss of consciousness.

partial (focal) seizure

A seizure affecting a limited portion of the brain.

Generalized (tonic-clonic; grand mal) seizure

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

aura

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

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.

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.

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. He has experienced seizures since he was 20 C. His wife states that this was his "usual" seizure D. His Glasgow Coma Scale (GCS) score is 15

A. He is currently not prescribed any medications

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

A. a seizure.

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

A. foramen magnum.

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: Select one: A. monitor her airway and breathing status and assess her blood glucose level. B. place her in the recovery position and transport her with lights and siren. C. give her small cups of water to drink and observe for further seizure activity. D. administer one tube of oral glucose and prepare for immediate transport.

A. monitor her airway and breathing status and assess her 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).

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.

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.*

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. 8. C. 7. D. 6.

B. 8.

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? Select one: A. Intracranial bleeding B. Hypovolemia C. Hypoglycemia D. A postictal state

B. Hypovolemia

Which of the following is a metabolic cause of a seizure? Select one: A. Head trauma B. Poisoning C. Massive stroke D. Brain tumor

B. Poisoning

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

B. brain stem.

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

B. cerebral vasodilation.

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: Select one: A. assess the patient for a facial droop and hemiparesis. B. initiate CPR and attach an 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 CPR and attach an AED as soon as possible.

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

B. liver.

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

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

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

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: Select one: 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. defer this part of the test and assess her for facial droop and slurred speech. D. instruct the patient to keep her eyes open and then repeat the arm drift test.

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

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

B. the right side of the body.

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

C. are usually benign but should be evaluated.

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: Select one: A. assist her ventilations with a bag-valve mask. B. insert an oral airway, apply oxygen, and transport. C. suction her oropharynx and transport immediately. D. administer one tube of oral glucose and transport.

C. suction her oropharynx and transport immediately.

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

Cincinnati Prehospital Stroke Scale

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

D. A seizure that begins in one extremity

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

D. recovery position and transport.

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. cover the child with wet towels and give oxygen via nasal cannula. B. call medical control and request permission to give the child aspirin. C. advise the mother to take her child to the doctor the following day. D. transport the child to the hospital and reassure the mother en route.

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

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

Ischemic stroke occurs when blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel.

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

Neglect is a symptom when a patient with right hemisphere strokes may forget about injuries on the left side of the body.

febrile seizures

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

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

Speech Facial movement Arm movement

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

Status epilepticus is characterized by seizures that recur every few minutes or last longer than 30 minutes.