Chapter 12 Neurologic Emergencies. Chapter 12: Neurologic Emergencies 2 Describe the causes of...

Chapter 12

Neurologic Emergencies

2

Chapter 12: Neurologic Emergencies

• Describe the causes of stroke, including the two major types.

• Obtain and interpret the key vital signs in the stroke patient, including the time of onset of the symptoms.

• Identify the signs and symptoms of stroke

• Describe the significance of a transient ischemic attack (TIA).

Objectives (1 of 3)

3


• Define seizure, including the two major types of seizure.

• Explain the importance of recognizing seizures.

• Discuss the differences between unresponsiveness and disorientation.

Objectives (2 of 3)

4


• Demonstrate the steps in the emergency care for the patient who has had a stroke.

• Demonstrate testing for aphasia, facial weakness, and motor weakness.

• Demonstrate the steps in the emergency care for the patient who has had a seizure.

• Demonstrate the steps in the emergency care for the patient who is unresponsive.

Objectives (3 of 3)

5


Brain Structure and Function

6


The Spinal Cord

7


Common Causes of Brain Disorder

• Cerebrovasuclar accident (CVA)

– Interruption of blood flow to the brain that results in the loss of brain function

• Stroke

– The loss of brain function that results from a CVA

8


Hemorrhagic Stroke

• Results from bleeding in the brain

– Arterial rupture

• High blood pressure is a risk factor.

• Some people are born with aneurysms.

9


Ischemic Stroke• Results when blood flow to a particular

part of the brain is cut off by a blockage inside a blood vessel

• Thrombosis

– Clotting of the cerebral arteries

• Cerebral embolism

– Blockage by a clot formed elsewhere in the body

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Transient Ischemic Attack (TIA)

• A TIA is a “mini-stroke.”

• Stroke symptoms go away within 24 hours.

• Every TIA is an emergency.

• TIA may be a warning sign of a larger stroke.

• Patients with possible TIA should be evaluated by a physician.

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Seizures

• Generalized (grand mal) seizure

– Unconsciousness and generalized severe twitching of the body’s muscles that lasts several minutes

• Petit mal seizure

– Seizure characterized by a brief lapse of attention

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Characteristics of Seizures

• Seizures may occur on one side or gradually progress to a generalized seizure.

• Usually last 3 to 5 minutes and are followed by postictal state

• Seizures recurring every few minutes are known as status epilepticus.

13


Causes of Seizures

• Congenital (epilepsy)

• Structural problems in the brain (tumor, scar, infection)

• Metabolic disorders

• Chemical disorders (poison, drugs)

• Sudden high fever (febrile)

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Recognizing Seizures

• Cyanosis

• Abnormal breathing

• Possible head injury

• Loss of bowel and bladder control

• Severe muscle twitching

• Post-seizure state of unresponsiveness with deep and labored respirations

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Postictal State

• Patient may have labored breathing.

• Patient may have hemiparesis: weakness on one side of the body.

• Patient may be lethargic, confused, or combative.

• Consider underlying conditions.

– Hypoglycemia

– Infection

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Altered Mental Status (AMS)

• Hypoglycemia

• Hypoxemia

• Intoxication

• Drug overdose

• Unrecognized head injury

• Brain infection

• Body temperature abnormalities

• Brain tumors

• Glandular abnormalities

• Poisoning

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Hypoglycemia

• Can mimic stroke or seizure

• Will not generally improve after a seizure

• May exhibit a lower level of responsiveness than a stroke patient

• Look for medical bracelet or medications that indicate diabetes.

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Signs and Symptoms of Brain Disorders

• Many different disorders can affect:

– Level of consciousness

– Speech

– Voluntary muscle control

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Signs and Symptoms of Stroke

• Left Hemisphere– Aphasia: Inability to speak or understand speech– Receptive aphasia: Ability to speak, but unable

to understand speech– Expressive aphasia: Inability to speak correctly,

but able to understand speech• Right Hemisphere

– Dysarthria: Able to understand, but hard to be understood

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Conditions that Stroke May Mimic

• Hypoglycemia

• Postictal state

• Subdural or epidural bleeding

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Assessing the Stroke Patient

• Initial assessment– Check and care for ABCs. – Obtain history if possible.– Administer oxygen and manage airway.

• Focused history and physical exam– Perform neurologic exam.– Use the Cincinnati Stroke Scale.

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Cincinnati Stroke Scale

• Facial droop– Abnormal if asymmetrical

• Arm drift– Abnormal if arms do not move equally

• Speech– Abnormal if words are slurred or

confused

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Transport Considerations

• Place the patient in a comfortable position.

– Usually on one side

– Paralyzed side down and well protected

• Elevate patient’s head about 6".

• Continue giving oxygen and monitor vital signs.

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Assessing the Seizure Patient • Initial assessment

– Focus on ABCs– Expect rapid, deep respirations if the

patient is postictal.

• Focused history and physical exam– Obtain SAMPLE history.– Observe patient for recurrent seizures.

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Assessing a Patient with AMS• Use AVPU scale to classify severity.

• Consider underlying conditions.

• Monitor for depressed respirations.

• Ensure that basic airway maneuvers are followed.

• Arrange for prompt transport to hospital, monitor the patient.

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Emergency Medical Carefor Stroke

• Patient needs to be evaluated by computed tomography (CT).

• Recognizing the signs and symptoms of stroke can shorten the delay to CT.

• Treatment needs to start within 3 to 6 hours of onset.

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Emergency Medical Carefor Seizure

• Most patients should be evaluated by a physician after a seizure.

• With severe injury, suspect spinal injury.

• Attempt to lower body temperature if febrile seizure occurs.

• Patient and family may be frightened.

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Chapter 12 Neurologic Emergencies. Chapter 12: Neurologic Emergencies 2 Describe the causes of...

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