2Lesson Objectives List the components of the nervous system. Assess and manage an unresponsive victim.Assess and manage a responsive victim.Assess and manage head injuries, including concussions; severe, diffuse brain injuries; and skull fractures.Assess and manage other neurologic problems, including strokes, seizures, fainting, headaches, migraines, and diabetes.
4The Unresponsive Victim (1 of 4) Causes and treatment for unresponsive conditionsWhat to look for:Assess with AVPU scale.With head injury, look for other injuries and assume spinal cord injury.Look for signs of illness if there are no apparent injuries.Signs of seizures.Paralysis.Medical ID tags.
5The Unresponsive Victim (2 of 4) Causes and treatment for unresponsive conditionsWhat to do: Evidence of head injuryProtect the spine.Roll victim onto back for examination.Check breathing and maintain open airway.Stop bleeding.Monitor vital signs.Move victim to safety, comfort, and shelter.
6The Unresponsive Victim (3 of 4) Causes and treatment for unresponsive conditionsWhat to do: No evidence of head injuryRoll victim onto back.Check breathing and maintain an open airway.Place in recovery position when stable.Ensure victim is taking medications properly if there is a history of seizures.
7The Unresponsive Victim (4 of 4) Causes and treatment for unresponsive conditionsLong-term careDo not give pain medications.Do not give food or fluids to an unresponsive victim.Lubricate eyes with eye ointment and tape eyelids shut.Keep victim clean.Turn victim every 2 hours.
8The Responsive Victim (1 of 3) What to look for:Obtain details of the incident.Determine duration of unresponsiveness, if any.Watch for alterations in behavior or level of responsiveness.Monitor for seizures.Obtain history of known diseases.
9The Responsive Victim (2 of 3) What to look for:Look for medical ID tags.Assess for odor of alcohol or sweet smelling breath.Assess level of responsiveness.Check for unequal pupil size.Assess for spinal injury.
10The Responsive Victim (3 of 3) What to look for:Look for blood or clear fluid coming from the nose or ears.Assess for paralysis.
11Head Injury (1 of 15) Concussion Brief disruption of brain function due to a blow to the headAnyone who has been unresponsive from a head injury should not walk or be left unattended.
12Head Injury (2 of 15) Concussion What to look for: No loss or brief loss of consciousnessVisual changesNausea, dizziness, headache
13Head Injury (3 of 15) Concussion What to do: Allow victim to sleep but waken every 2 to 3 hours to check responsiveness.If no symptoms appear 8 hours after injury, wake victim once during the first night.
14Head Injury (4 of 15) Concussion What to do (continued): Seek medical care if victim experiences vomiting, ringing in the ears, impaired balance, loss of taste or smell, or loss of responsiveness after regaining responsiveness.
15Head Injury (5 of 15) Head injury with delayed deterioration Severe injury can bruise the brain or rupture blood vessels.Resulting swelling or bleeding causes increased pressure within the skull.Victim can die unless pressure is released by surgery.
16Head Injury (6 of 15) Head injury with delayed deterioration What to look for:Decreased level of responsivenessSevere, progressive headache not relieved by medicationRepeated vomitingAltered behavior
17Head Injury (7 of 15) Head injury with delayed deterioration What to do:Protect the main airway.Maintain a stable body temperature.Treat the victim as though he or she were unresponsive.Evacuate the victim immediately.
18Head Injury (8 of 15) Severe, diffuse brain injury Caused by initial head injury and subsequent swelling or by hypoxia secondary to inadequate breathing.Generally causes complete unresponsiveness immediately.
19Head Injury (9 of 15) Severe, diffuse brain injury What to look for: Deeply unresponsive from time of injuryObstructed airway and impaired breathingChanges in responsiveness
20Head Injury (10 of 15) Severe, diffuse brain injury What to look for: Good signsResponsive victimNormal body movementNormal blink reactions
21Head Injury (11 of 15) Severe, diffuse brain injury What to look for: Bad signsEnlarged pupils that do not react to lightUnequal pupilsSlowed pulse rateIrregular breathingRising body temperatureLoss of feelingOne-sided weaknessParalysis
22Head Injury (12 of 15) Severe, diffuse brain injury What to do: Clear and maintain airway; start CPR if necessary.Assume spinal cord injuries.Repeat exam to determine progress.Record your observations.Evacuate immediately.
23Head Injury (13 of 15) Skull fractures Closed: No break in the scalp Open: Scalp over fracture is lacerated and brain or its coverings are exposed
24Head Injury (14 of 15) Skull fractures What to look for: Broken bone edges in the woundClear or blood-tinged fluid from the nose or ear without apparent injury
25Head Injury (15 of 15) Skull fractures What to do: Protect depressed area with a doughnut dressing.Cover open wounds with a sterile dressing.Control bleeding by applying a sterile dressing and applying pressure around edges of the wound.Evacuate.
26Other Neurologic Problems (1 of 19) StrokeCaused by blockage of a blood vessel or bleeding in the brainTransient ischemic attack (TIA)Common in older people and those with hardening of the arteries.May occur in young, healthy people due to decompression sickness, head injury, cerebral edema or thickening of the blood due to altitude.
27Other Neurologic Problems (2 of 19) StrokeWhat to look for:Altered responsivenessNumbness, weakness, paralysis of face, arm, or leg (usually on one side)Turning of the head and eyes to one sideNoisy breathing or droolingVisual changes
28Other Neurologic Problems (3 of 19) StrokeWhat to look for:Loss of balance or coordinationDifficulty speakingSudden, severe, unexplained, long-lasting headacheConvulsionsHistory of diabetes, hypertension, heart disease, or previous strokes
29Other Neurologic Problems (4 of 19) StrokeWhat to do:Place victim in recovery position.Allow responsive victims to assume a position of comfort.Offer clear liquids with caution.Evacuate.
30Other Neurologic Problems (5 of 19) SeizuresCaused by sudden, temporary, abnormal electrical discharges in the brain.A victim will be unresponsive following a seizure for minutes to an hour or longer and awakens gradually.Epileptic seizures are rarely medical emergencies.New onset of seizures requires evacuation and immediate medical care.
31Other Neurologic Problems (6 of 19) SeizuresPartial seizuresMomentary lack of awarenessInvoluntary movement of a body partSensation of numbness or tinglingAbnormal vision or smell
32Other Neurologic Problems (7 of 19) SeizuresGeneralized seizuresFrequently preceded by an auraStart with a sudden spasm of body musclesCauses victim to cry out and fall to the ground
33Other Neurologic Problems (8 of 19) SeizuresWhat to do:Protect victim from injury, but do not restrain.Maintain airway when seizure is over.Arrange for privacy.Assess as an unresponsive victim.Keep victim in recovery position until awake and alert.Check history.
34Other Neurologic Problems (9 of 19) Simple faintingCommon, benign, usually brief form of rapid drop in blood pressureResult of inadequate blood flow to brain and loss of normal responsivenessCan have a physical or emotional cause
35Other Neurologic Problems (10 of 19) Simple faintingWhat to look for:Visual disturbances (seeing spots), dizziness, feeling too hot or too cold, nauseaPaleness with cold, clammy skinPassing out, slumping, or falling down
36Other Neurologic Problems (11 of 19) Simple faintingWhat to do: Person who is about to faintPrevent a hard fall.Lay victim flat.Raise the legs 6 to 12 inches.Loosen tight clothing.Place a cool, wet cloth on victim’s forehead.
37Other Neurologic Problems (12 of 19) Simple faintingWhat to do: Person who has faintedCheck breathing.Lay flat and raise legs 6 to 12 inches.Loosen tight clothing.Check for injuries.Place a cool, wet cloth on victim’s forehead.Provide care for unresponsiveness.Do not mistake serious illness for simple fainting.
38Other Neurologic Problems (13 of 19) HeadacheMost are harmless.Usually relieved by rest, avoiding eye strain, and nonprescription medications.Can be caused by altitude, glare, traction on muscles.Can be caused by more serious conditions, such as high altitude cerebral edema.
39Other Neurologic Problems (14 of 19) HeadacheWhat to look for:Head traumaTenderness over scalp, neck, and shouldersUnequal pupil sizeDouble visionImpaired sensation/movement of extremities
40Other Neurologic Problems (15 of 19) HeadacheWhat to look for:FeverSevere neck stiffnessImpaired balanceSuspect serious injury or illness if victim has vomiting, inability to sleep or eat, headache lasts more than a day, is not relieved by medication, or is sudden and severe
41Other Neurologic Problems (16 of 19) HeadacheWhat to do:Give nonprescription medication.Descend to an appropriate altitude.If cause appears serious, evacuate.
42Other Neurologic Problems (17 of 19) MigrainePeriodic, one-sided, throbbing headache accompanied by nausea and vomiting.Frequently preceded by a warning aura.Sufferers often carry medication.Allow victim to rest in a dark area.
43Other Neurologic Problems (18 of 19) DiabetesLow blood sugar (hypoglycemia): Caused by taking too much insulin or by taking insulin and not eating enough food.Exercise lowers blood sugar.Give sugar immediately.
44Other Neurologic Problems (19 of 19) DiabetesHigh blood sugar (hyperglycemia): Caused by too much insulinExcessive thirstLarge urine outputExhaustionFruity smell to breathVery dangerous conditionEvacuate immediately.