EMT Orange Book Ch 15

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.

Partial Seizure

A seizure affecting a limited portion of the brain or one side of the brain.

Febrile Seizures

This is a type of seizure that is associated with fevers in children 6months- 5 years of age.

A ________ is usually a warning sign that a larger, significant stroke may occur in the future

Transient ischemic attack

A cerebral embolism is an obstruction of a cerebral artery caused by a clot that was formed somewhere else and traveled to the brain

True

A key piece of information to document is the time of onset of the patients signs and symptoms

True

A patient having a seizure may become cyanotic a lack of O2

True

Patient with a decreased level of consciousness should not be given anything by mouth

True

Patients who have had a stroke can lose their airway or stop breathing without warning.

True

Patients with a stroke affecting the right hemisphere of the brain can usually understand language, but their speech may be slurred

True

Patients with migraine headaches are sometimes sensitive to light and sound

True

Psychological problems and complications of medications can cause altered mental status

True

Serious conditions that include headache as a symptom are hemorrhagic stroke, brain tumors, and meningitis

True

People with ______ have a higher risk of hemorrhagic stroke

Uncontrolled hypertension

Patients who are at the highest risk of hemorrhagic stroke are those who have?

Untreated hypertension

Hemiparesis

Weakness on one side of the body

Tonic-clonic-seizure

A type of seizure that features rhythmic back and forth motion of an extremity and body stiffness

S/Sx of possible seizure activity including all the following Except:

A. Altered mental status B. Incontinence C. muscle rigidity and twitching D. Petechiae Answer is D, petechiae

An area of swelling or enlargement in a weakened arterial wall is called

A. An aneurysm B. Atherosclerosis C. An embolism D. A thrombus Answer is A, aneurysm

Common causes of altered mental status includes all of the following Except:

A. Body temp abnormalities B. hypoxia C. unequal pupils D. hypoglycemia Answer is C, unequal pupils

The most basic functions of the body, such as breathing, BP, and swallowing, are controlled by the?

A. Cerebral Cortex B. Cerebellum C. Brain Stem D. Cerebrum Answer is C, brain stem

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

A. Cerebral Vasodilation B. An embolism C. A thrombus D. An acute arterial rupture Answer is A, Cerebral vasodilation

Muscle control and body coordination are controlled by the:

A. Cerebrum B. Brain stem C. Cerebellum D. Cerebral Cortex Answer is A, Cerebellum

The three major parts of the brain are the?

A. Cerebrum, cerebellum, and brain stem B. Brain stem, midbrain, and spinal cord C. Cerebellum, medulla, and occiput D. Midbrain, cerebellum, and spinal cord Answer is A, Cerebrum, cerebellum. and brain stem

A patient without a history of seizures experiences a sudden convulsion. The Least likely cause of the seizure is:

A. Intracranial bleeding B. A serious infection C. Epilepsy D. A brain tumor Answer is C, Epilepsy

Which of the following is Not an assessment parameter included in the Cincinnati Prehospital Stroke Scale?

A. Memory B. Speech C. Facial Droop D. Arm Drift Answer is A, memory

A generalized seizure is characterized by:

A. Severe twitching of all the body's muscles B. A core body temp of greater than 103 degrees C. A blank stare and brief lapse of consciousness D. Unconsciousness for greater than 30 minutes Answer is A, severe twitching of all the body's muscles

When obtaining medical history information from the family of a suspected stroke patient, it is Most important to determine:

A. The patients overall medical compliance B. If there is a family history of a stroke C. When the patient last appeared normal. D. If the pt has been hospitalized before Answer is C, when the pt last appeared normal

The left cerebral hemisphere controls?

A. The right side of the face B. Breathing and blood pressure C. Heart rate and pupil reaction D. The right side of the body Answer is D, the right side of the body

You are caring for a 70 year old female with S/Sx of an acute stroke. She is conscious, has secretions in her mouth, and is breathing at a normal rate with adequate depth. You should:

A. Use a bag-mask device to assist her ventilations. B. Suction her oropharynx and apply 100% O2 C. Place her on her side and prepare for rapid transport. D. Insert an oral airway, apply O2, and transport. Answer is B, suction and apply 100%

Febrile Seizures:

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

A patient who is experiencing aphasia is:

A. experiencing a right hemisphere stroke B. usually conscious but has slurred speech C. Not able to swallow without choking D. unable to produce or understand speech. Answer is D, unable to produce or understand speech.

A patient who is possibly experiencing a stroke is Not eligible for thrombolytic therapy if he or she:

A. has a GCS score that is less than 8 B. has had a prior heart attack C. has bleeding within the brain D. is older than 60 years old Answer is C, has bleeding within the brain

When assessing a patient with a possible CVA, you should check the ______ first.

Airway

Stroke

An interruption of blood flow to the brain that results in the loss of brain function; also called a Cerebrovascular Accident

When blood flow to a part of the brain is cut off by a blockage inside a blood vessel, the result is

An ischemic stroke

Right-sided facial droop is most likely an indication of a problem in the right cerebral hemisphere

False, pg 572

The postictal state following a seizure commonly lasts only about 3 to 5 minutes

False, pg 572

All seizures involve muscle twitching and general convulsions

False, pg 573

Hemiparesis is the inability to speak or understand speech

False, pg 576

Hyperglycemia should be considered in a patient following a MVC with altered mental status

False, pg 577

Letting the hospital know the specifics regarding the patients neurologic symptoms is generally not important

False, pg 584

You should wait until you get an accurate pulse oximeter reading on a seizure patient before administering O2

False, pg 584

A _____ is typically characterized by unconsciousness and a generalized severe twitching of all of the body's muscle that lasts several minutes or longer

Generalized seizure

Seizure

Generalized, uncoordinated muscular activity associated with loss of consciousness; a convulsion

The principal difference between a patient who has had a stroke and s patient with hypoglycemia almost always has to do with the:

Mental status

______ are the second most common type of headache and are thought to be caused by changes in blood vessel size in the base of the brain

Migraine headaches

Dysarthria

Slurred speech

At each vertebra in the neck and back, ______ nerves, called spinal nerves, branch out from the spinal cord and carry signals to and from the body.

2 nerves

A TIA, or mini-stroke, is the name to a stroke when symptoms go away on their own in less than:

24 hours

Which of the following medications is Not used to treat patients with a history of seizures?

A Phenobarbital B. Carbamazepine or Tegretol C. Hydromorphone or Dilaudid D. Phenytoin or Dilantin Answer is C, Dilaudid

All of the following are associated with altered mental status Except

A. coma B. seizure C. incontinence D. intoxication Answer is C, incontinence

The plaque that builds up in atherosclerosis obstructs blood flow and interferes with the vessels ability to:

A. constrict B. dilate C. diffuse Answer is B, dilate

Treatment for this patient should include all the following Except:

A. providing high flow O2 B. providing rapid transport C. continuously talking to the patient D. providing oral glucose Answer id D,

Which mnemonic is used to check a patients mental status?

AVPU

The ______ controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction

Brain stem

How would you Best determine the likelihood of the patient having a stroke?

By using the Cincinnati Stroke Scale

Thrombosis

Clotting of the cerebral arteries that may result in the interruption of cerebral blood flow and subsequent stroke.

Brain Stem

Controls basic functions of the body, such as breathing and blood pressure The Medulla Oblongata. regulates heart rate and breathing. houses cranial nerves 9 and 12. connects brain to spinal cord

Cerebellum

Controls muscles, balance and body coordination

When assessing a patient with a history of seizure activity, it is important to:

Determine whether this episode differs from any previous seizures

Hemorrhagic stroke is the most common type of stroke

False, pg 571

Patients who have bleeding in their brain may have very low blood pressure

False, pg 572

Patients with a subarachnoid hemorrhage typically complain of a sudden severe.

Headache

The following conditions may simulate a stroke Except:

Hyperglycemia

Consider the possibility of _____ in a patient who has had a seizure.

Hypoglycemia

Headaches, vomiting, altered mental status, and seizures are all considered early signs of?

Increased intracranial pressure

You ask the patient "what day is it today"? her replay is butterfly, which area of the brain is likely affected?

Left hemisphere

Incontinence

Loss of bladder and/or bowel control; may be the result of a generalized seizure

Hemorrhagic Stroke

One of the two main types of stroke; occurs as a result of bleeding inside of the brain

Ischemic Stroke

One of the two main types of stroke; occurs when blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel.

Cerebrum

Part of the brain located above the cerebellum; divided into right and left hemispheres. 80% of Brain mass. Higher level brain functions; thoughts, emotions, memory, reasoning, language, and processing of sensory information.

Patients with a decreased LOC

should not be given anything by mouth

Aura

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

Coma

A state of deep and often prolonged unconsciousness from which one cannot be roused

Aneurysm

A swelling or enlargement of a part of an artery, resulting from weakening of the arterial wall.

Embolus

A clot that forms in a remote area and breaks lose and travels through the bloodstream.

Hypoglycemia

A condition caused by a low blood glucose level

Status Epilepticus

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

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.

Cerebrovascular Accident, CVA

A interruption blood flow to the brain that results in the loss of brain functions and can cause: paralysis, speech problems, vision problems, possible seizure, difficulty swallowing, headache, unconsciousness. Also called a stroke

Ischemic

A lack of O2 in the cells of the brain that causes them to not function properly

Generalized Seizures

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

Which of the following would Not be pertinent information regarding her condition?

Asking the patient about childhood illnesses.

If the receiving facility told you the cause of her stroke was due to a build up of calcium and cholesterol, forming a plaque inside the walls of her blood vessels, you would know that this patient has:

Atherosclerosis

Hypoglycemia can mimic conditions such as:

Strokes

Headaches caused by muscle contractions in the head and neck are typically associated with:

Tension headaches

A low O2 level can affect the entire brain, often causing anxiety, restlessness, and confusion

True

Febrile seizure result from sudden high fevers and are generally well tolerated by children

True

Aphasia

The inability to understand and or produce speech