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Paramedic Care: Principles & Practice Volume 3 Medical Emergencies

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Presentation on theme: "Paramedic Care: Principles & Practice Volume 3 Medical Emergencies"— Presentation transcript:

1 Paramedic Care: Principles & Practice Volume 3 Medical Emergencies

2 Chapter 3 Neurology

3 Topics Anatomy and Physiology Pathophysiology
General Assessment Findings Management of Specific Nervous System Emergencies

4 Anatomy and Physiology

5 Anatomy and Physiology
The nervous system consists of two main divisions: Central Nervous System Brain and spinal cord The peripheral nervous system Somatic Autonomic

6 Anatomy and Physiology
The Central Nervous System The Neuron Protective Structures The Brain The Spinal Cord

7 Central Nervous System
The Neuron Dendrites Axons Synapse Neurotransmitters

8 Central Nervous System
Protective Structures The Skull Cranium

9 Central Nervous System
Protective Structures The Spine 33 vertebrae Spinal canal

10 Central Nervous System
Protective Structures The Meninges 3 layers Cerebrospinal fluid

11 Central Nervous System
The Brain Divisions of the Brain Areas of Specialization

12 Click here to view an animation on the brain.

13 Central Nervous System
The Brain Vascular Supply Carotid system Vertebro-basilar Circle of Willis

14 Central Nervous System
The Spinal Cord Responsible for Conducting impulses to and from the peripheral nervous system Reflexes 31 pair of nerves exit spinal cord

15 Central Nervous System
The Spinal Cord Dorsal Roots Afferent fibers Ventral Roots Efferent fibers Dermatome

16 Anatomy and Physiology
The Peripheral Nervous System Consists of cranial nerves and peripheral nerves Automatic and voluntary functions Categories of peripheral nerves Somatic sensory Somatic motor Visceral (autonomic) sensory Visceral (autonomic) motor

17 Click here to view the Cranial Nerves illustration.

18 The Autonomic Nervous System
The Sympathetic Nervous System “Fight-or-flight” Neurotransmitters epinephrine and norepinephrine The Parasympathetic Nervous System “Feed-or-breed” or “rest-and-repair” Mediated by the neurotransmitter acetylcholine

19 Autonomic Nervous System

20 Pathophysiology

21 Pathophysiology Alteration in Cognitive Systems
Altered forms of consciousness result from dysfunction or interruption of the CNS Alterations may vary Minor thought disturbances Coma Two mechanisms capable of producing alterations in mental status Structural lesions Toxic-metabolic states

22 Pathophysiology Structural Lesions Brain tumor (neoplasm)
Degenerative disease Intracranial hemorrhage Parasites Trauma

23 Pathophysiology Toxic-Metabolic States Anoxia (lack of oxygen)
Diabetic ketoacidosis Hepatic failure Hypoglycemia Renal failure Thiamine deficiency Toxic exposure (e.g., cyanide, organophosphates)

24 Causes of Altered Mental Status
Drugs Depressants (including alcohol) Hallucinogens Narcotics Cardiovascular Anaphylaxis Cardiac arrest Stroke Dysrhythmias Hypertensive encephalopathy Shock Respiratory COPD Inhalation of toxic gas Hypoxia Infectious AIDS Encephalitis Meningitis

25 Pathophysiology Peripheral Nervous System Disorders Mononeuropathy
Caused by localized conditions such as trauma, compression, or infections Carpal tunnel syndrome Polyneuropathy Demyelination or degeneration of peripheral nerves Leads to sensory, motor, or mixed sensorimotor deficits

26 Pathophysiology Autonomic System Disorders
Frequently a result of another condition Conditions that affect the integrity of an individual are accompanied by some changes in autonomic nervous system functioning Body’s internal maintenance dependent on the ANS

27 General Assessment Findings

28 General Assessment Findings
Scene Size-up and Initial Assessment AVPU General Appearance Speech Skin and Facial Drooping Mood, Thought, Perception, Judgment, Memory, and Attention Attempt to correct life threats

29 General Assessment Findings
Focused History and Physical Exam History-Taking Trauma-related or medical problem Underlying medical problems Environmental clues Physical Exam Face, eyes, nose, and mouth

30 General Assessment Findings
Respiratory Patterns Any of five abnormal respiratory patterns may be observed

31 General Assessment Findings
Cardiovascular Assessment Heart rate ECG Bruits Jugular venous distention Nervous System Status Sensorimotor Evaluation Motor System and Cranial Nerve Status

32 Nervous System Status Sensorimotor Evaluation
To document loss of sensation and/or motor function Decorticate and decerebrate posturing are ominous signs of deep cerebral or upper brainstem injury

33 Posturing

34 Nervous System Status Motor System Status Cranial Nerve Status
Muscle tone Muscle strength Flexion/extension Coordination Balance Cranial Nerve Status

35 Nervous System Status Further Mental Status Assessment
Glasgow Coma Scale Three components Eye opening Verbal response Motor response May be used on adult or pediatric patient Simple tool for evaluating and monitoring

36 Glasgow Coma Scale

37 Glasgow Coma Scale

38 Glasgow Coma Scale

39 General Assessment Findings
Vital Signs Cushing’s Reflex

40 General Assessment Findings
Other Assessment Tools Capnography Pulse Oximeter Blood Glucometer CO Oximetry Geriatric Considerations in Neurological Assessment Ongoing Assessment

41 Management of Specific Nervous System Emergencies

42 Management of Specific Nervous System Emergencies
General Principles Airway and Breathing Circulatory Support Pharmacological Intervention Dextrose, thiamine, naloxone, and diazepam Psychological Support Transport Considerations Computerized tomography (CT) or magnetic resonance imaging (MRI)

43 Altered Mental Status AEIOU-TIPS Assessment Management
Initial Assessment IV Access Treatable Causes Hypoglycemia, narcotic overdose, suspected alcoholic

44 AEIOU TIPS A = acidosis or alcohol E = epilepsy I = infection
O = overdose U = uremia T = trauma I = insulin P = psychosis S = stroke

45 Altered Mental Status Chronic Alcoholism
Wernicke’s Syndrome Korsakoff’s Psychosis Increased Intracranial Pressure Hyperventilation 20 breaths per minute Overventilation will lead to alkalosis Mannitol

46 Stroke and Intracranial Hemorrhage
General term that describes injury or death of brain tissue Usually due to interrupted blood flow “Brain attack” Transport considerations CT Neurological services Fibrinolytics available Warrants rapid recognition and prompt transport

47 Stroke and Intracranial Hemorrhage
Occlusive Strokes Embolic and Thrombotic Strokes Hemorrhagic Strokes

48 Stroke and Intracranial Hemorrhage
Signs Facial Drooping Headache Aphasia/Dysphasia Hemiparesis Hemiplegia Paresthesia Gait Disturbances Incontinence Symptoms Confusion Agitation Dizziness Vision Problems

49 Prehospital Stroke Screens

50 Prehospital Stroke Screens

51 Stroke and Intracranial Hemorrhage
Transient Ischemic Attacks Indicative of carotid artery disease Symptoms of neurological deficit: Symptoms resolve in less than 24 hours No long-term effects Evaluate through history taking: History of hypertension, prior stroke, or TIA Symptoms and their progression

52 Stroke and Intracranial Hemorrhage
Management Scene safety and standard precautions Maintain the airway Support breathing Obtain a detailed history Position the patient Determine the blood glucose level Establish IV access Monitor the cardiac rhythm Protect paralyzed extremities

53 Suspected Stroke Algorithm
Click here to view the Suspected Stroke Algorithm illustration. Reproduced with permission from “2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Care,” Circulation 2005, Volume 112, IV-112 © 2005 American Heart Association.

54 Seizures Generalized Seizures Tonic-Clonic Absence Aura
Loss of consciousness Tonic phase Hypertonic phase Clonic phase Postseizure Postictal Absence Petit-mal 10- to 30-second loss of consciousness or awareness Eye or muscle twitching

55 Seizures Generalized Seizures (cont.) Pseudoseizures
Hysterical seizures Stems from psychological disorders Can often be interrupted with a terse command

56 Seizures Partial Seizures Simple Partial Seizures
Involve one body area Can progress to generalized seizure Complex Partial Seizures Characterized by auras Typically 1–2 minutes in length Loss of contact with surroundings

57 Seizures Assessment Ascertain exactly what the patient may recall or what bystanders witnessed Other problems mimic seizure Differentiating Between Syncope and Seizure

58 Seizures Patient History History of Seizures History of Head Trauma
Any Alcohol or Drug Abuse Recent History of Fever, Headache, or Stiff Neck History of Heart Disease, Diabetes, or Stroke Current Medications Phenytoin (Dilantin), phenobarbitol, valproic acid (Depakote), or carbamazepine (Tegretol) Physical Exam Signs of head trauma or injury to tongue Alcohol or drug abuse

59 Seizures Management Scene safety and standard precautions
Maintain the airway Administer high-flow, high-concentration oxygen Establish IV access Treat hypoglycemia if present Do not restrain the patient Protect the patient from the environment Maintain body temperature

60 Seizures Management (cont.) Position the patient Suction if required
Monitor cardiac rhythm Treat prolonged seizures Anticonvulsant medication Provide a quiet atmosphere Transport

61 Seizures Status Epilepticus Two or More Generalized Seizures
Seizures occur without a return of consciousness Management Management of airway and breathing is critical Establish IV access and cardiac monitoring Administer 25 g 50% dextrose if hypoglycemia is present Administer 5–10 mg diazepam IV Monitor the airway closely

62 Syncope A sudden, temporary loss of consciousness Assessment
Cardiovascular: Dysrhythmias or mechanical problems Noncardiovascular: Metabolic, neurological, or psychiatric condition Idiopathic: The cause remains unknown even after careful assessment Extended unconsciousness is NOT syncope

63 Syncope Management Scene safety and standard precautions
Maintain the airway Support breathing Check circulatory status Monitor mental status Establish IV access Determine blood glucose level Monitor the cardiac rhythm Reassure the patient and transport

64 Headache Types Vascular Migraines Cluster
Throbbing pain, photosensitivity, nausea, vomiting, and sweats; more frequent in women May last for extended periods of time Cluster One-sided with nasal congestion, drooping eyelid, and irritated or watery eye; more frequent in men Typically last 1–4 hours

65 Headache Types Tension Organic
Occur due to tumors, infection, or other diseases of the brain, eye, or other body system Headaches associated with fever, confusion, nausea, vomiting, or rash can be indicative of an infectious disease

66 Headache Assessment What was the patient doing at the onset of pain?
Does anything provoke or relieve the pain? What is the quality of the pain? Does the pain radiate to the neck, arm, back, or jaw? What is the severity of the pain? How long has the headache been present?

67 Headache Management Scene safety and standard precautions
Maintain the airway Position the patient Establish IV access Determine blood glucose level Monitor the cardiac rhythm Consider medication Antiemetics or analgesics Reassure the patient and transport

68 “Weak and Dizzy” Assessment Symptomatic of Many Illnesses
Focused Assessment Include a detailed neurological exam Specific signs and symptoms: Nystagmus Nausea and vomiting Dizziness

69 “Weak and Dizzy” Management Scene safety and standard precautions
Maintain airway and administer high-flow, high-concentration oxygen Position of comfort Establish IV access and monitor cardiac rhythm Determine blood glucose level Consider medication: Antiemetic Transport and reassure patient

70 Neoplasms Tumors Assessment Benign Malignant Signs and Symptoms
Recurring or severe headaches Nausea and vomiting Weakness or paralysis Lack of coordination or unsteady gait Dizziness, double vision Seizures without a prior history of seizures

71 Neoplasms Assessment (cont.) Management History Scene size-up and BSI
Surgery, chemotherapy, radiation therapy, or holistic therapy Experimental treatments Management Scene size-up and BSI Maintain airway and administer high-flow, high-concentration oxygen Position of comfort Establish IV access and monitor cardiac rhythm Consider medication administration: Analgesics, antiseizure meds, anti-inflammatory meds Transport and reassure patient

72 Brain Abscess Abscess Assessment Management Collection of Pus
Signs and Symptoms Lethargy, hemiparesis, nuchal rigidity Headache, nausea, vomiting, seizures Management Similar to Neoplasm

73 Degenerative Neurological Disorders
Types of Disorders Alzheimer’s Disease Most frequent cause of dementia in the elderly Results in atrophy of the brain due to nerve cell death in the cerebral cortex Muscular Dystrophy Characterized by progressive muscle weakness Multiple Sclerosis Unpredictable disease resulting from deterioration of the myelin sheath Dystonias

74 Degenerative Neurological Disorders
Types of Disorders (cont.) Parkinson’s Disease Tremor, rigidity, bradykinesia, postural instability Central Pain Syndrome Bell’s Palsy Amytrophic Lateral Sclerosis Myoclonus Spina Bifida Poliomyelitis

75 Degenerative Neurological Disorders
Assessment Obtain history Exacerbation of chronic illness or new problem? Management Special Considerations Mobility, communication, respiratory compromise, and anxiety Interventions Determine blood glucose level Establish IV access Monitor cardiac rhythm Transport and reassure the patient

76 Back Pain and Non-Traumatic Spinal Disorders
Low Back Pain Causes Disk Injury Vertebral Injury Cysts and Tumors Other Causes

77 Back Pain and Non-Traumatic Spinal Disorders
Assessment Evaluate history Speed of onset Risk factors such as vibration or repeated lifting Determine if pain is related to a life-threatening problem Management Consider c-spine Immobilize if in doubt Consider analgesics

78 Summary Anatomy and Physiology Pathophysiology
General Assessment Findings Management of Specific Nervous System Emergencies


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