Neurological Emergencies. 4 Dr. Maha Al Sedik 2015 Medical Emergency I
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Neurological Emergencies. 4Dr. Maha Al Sedik2015Medical Emergency Iis a state of unconsciousness in which a person: cannot be awakened; fails to respond normally to painful stimuli, light, or sound; and, does not initiate voluntary actions.Coma
ComaPathophysiology:History of present illness is vital to determine the underlying cause. Determine when the patient was last seen normal. Evaluate the speed of onset.
is aneurologicalscalethat aims to give a reliable recording about the conscious state of a person.A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and15.Glasgow Coma Scale (GCS)Best eye response (E) Best verbal response (V) Best motor response (M) 4 Eyes opening spontaneously 5 Oriented 6 Obeys commands 3 Eye opening to speech 4 Confused 5 Localizes to pain 2 Eye opening in response to pain3 Inappropriate words 4 Withdraws from pain 1 No eye opening 2 Incomprehensible sounds 3 Abnormal Flexion1 None 2 Abnormal Extension 1 No motor response Glasgow Coma Scale (GCS)
brain injury is classified as:Severe, with GCS < 8-9.Moderate, GCS 8 12 .Minor, GCS 13.Normal : 14 - 15ManagementSupport vital functions ( ABC ).Special attention to the history about the cause.Administer naloxone if you suspect narcotic overdose.Patients may need:Urine and blood analysis.Radiography.Computed tomography.Magnetic resonance imaging.SeizuresIncidence:Account for up to 30% of EMS calls.In the United States, it is estimated that 4 million people have epilepsy.
PathophysiologySudden firing of neurons.Signs and symptoms include:Muscle spasms.Increased secretions.Cyanosis.13
If a seizure continues for a long time:Cerebral glucose and oxygen supplies can be depleted.There can be serious, long term effects, including death. Try to determine the cause of the seizure.Medication compliance.Fever.Congenital. Tumor.
Absence seizures (petit mal seizures)Typical patient: child.Patient stops and freezes mid action.Usually no longer than several seconds.Pseudo seizures:Cause is of psychiatric origin.Triggered by emotional event, stress, lights, or pain. partial seizures:Only a limited part of the brain is involved. Simple partial seizures involve one part of the body.generalized seizures ( grand mal seizures ):Full body continuous strong jerking movements. It may be caused by psychological trauma.The patient is not pretending. Other problems associated with the seizure:Patients who have fallen during a seizure may have a head injury.Patients having a generalized seizure may also experience incontinence.Decrease in the oxygen and glucose demand of the brain.Management: Remain calm.Prevent the patient from becoming injured.Do not place anything in the patients mouth.Loosen the tie. Let the patient to lie in a recovery position.Correct hypoglycemia as needed.Ventilatory assistance may be necessary.All patients should be transported. Be prepared to administer diazepam or lorazepam.
Pathophysiology:Seizure that lasts longer than 4 to 5 minutes or consecutive seizures without a return to consciousness between seizures. Refer to local guidelines regarding intervention.Nearly 20% of patients die.May result in neurons being damaged or killed.Goal: stop seizure and ensure adequate ABCs.Status epilepticsManagementAdminister a benzodiazepine.Be prepared to control airway and ventilation.Reference:AAOS Emergency Care in the Streets 7th Edition, CarolineJones & Bartlett, 2012; ISBN 13: 978-1-469-0922-1Premier Online Package