Post on 03-Jan-2016
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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)
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Chapter 12: Neurologic Emergencies
• 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)
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Chapter 12: Neurologic Emergencies
• 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)
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Chapter 12: Neurologic Emergencies
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
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Chapter 12: Neurologic Emergencies
Hemorrhagic Stroke
• Results from bleeding in the brain
– Arterial rupture
• High blood pressure is a risk factor.
• Some people are born with aneurysms.
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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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.
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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
Signs and Symptoms of Brain Disorders
• Many different disorders can affect:
– Level of consciousness
– Speech
– Voluntary muscle control
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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
Conditions that Stroke May Mimic
• Hypoglycemia
• Postictal state
• Subdural or epidural bleeding
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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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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Chapter 12: Neurologic Emergencies
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.