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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ.

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Presentation on theme: "Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ."— Presentation transcript:

1 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 3 Medical Emergencies

2 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 3 Neurology

3 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Anatomy and Physiology Pathophysiology General Assessment Findings Management of Specific Nervous System Emergencies

4 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Anatomy and Physiology

5 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Anatomy and Physiology The Central Nervous System –The Neuron –Protective Structures –The Brain –The Spinal Cord

7 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Neuron –Dendrites –Axons –Synapse –Neurotransmitters Central Nervous System

8 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Central Nervous System Protective Structures –The Skull Cranium

9 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Protective Structures –The Spine 33 vertebrae Spinal canal Central Nervous System

10 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Protective Structures –The Meninges 3 layers Cerebrospinal fluid Central Nervous System

11 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Brain –Divisions of the Brain –Areas of Specialization Central Nervous System

12 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Brain Click here to view an animation on the brain.here

13 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Central Nervous System The Brain –Vascular Supply Carotid system Vertebro- basilar Circle of Willis

14 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Central Nervous System The Spinal Cord –Dorsal Roots Afferent fibers –Ventral Roots Efferent fibers –Dermatome

16 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cranial Nerves Click here to view the Cranial Nerves illustration.here

18 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Autonomic Nervous System

20 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology

21 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology Structural Lesions –Brain tumor (neoplasm) –Degenerative disease –Intracranial hemorrhage –Parasites –Trauma

23 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology Toxic-Metabolic States –Anoxia (lack of oxygen) –Diabetic ketoacidosis –Hepatic failure –Hypoglycemia –Renal failure –Thiamine deficiency –Toxic exposure (e.g., cyanide, organophosphates)

24 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment Findings

28 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Patterns –Any of five abnormal respiratory patterns may be observed General Assessment Findings

31 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment Findings Cardiovascular Assessment –Heart rate –ECG –Bruits –Jugular venous distention Nervous System Status –Sensorimotor Evaluation –Motor System and Cranial Nerve Status

32 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Posturing

34 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nervous System Status Motor System Status –Muscle tone –Muscle strength –Flexion/extension –Coordination –Balance Cranial Nerve Status

35 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Glasgow Coma Scale

37 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Glasgow Coma Scale

38 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Glasgow Coma Scale

39 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment Findings Vital Signs –Cushing’s Reflex

40 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment Findings Other Assessment Tools –Capnography –Pulse Oximeter –Blood Glucometer –CO Oximetry Geriatric Considerations in Neurological Assessment Ongoing Assessment

41 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Management of Specific Nervous System Emergencies

42 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status AEIOU-TIPS Assessment Management –Initial Assessment –IV Access –Treatable Causes Hypoglycemia, narcotic overdose, suspected alcoholic

44 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ AEIOU TIPS A = acidosis or alcohol E = epilepsy I = infection O = overdose U = uremia T = trauma I = insulin P = psychosis S = stroke

45 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stroke and Intracranial Hemorrhage Occlusive Strokes –Embolic and Thrombotic Strokes Hemorrhagic Strokes

48 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stroke and Intracranial Hemorrhage Signs –Facial Drooping –Headache –Aphasia/Dysphasia –Hemiparesis –Hemiplegia –Paresthesia –Gait Disturbances –Incontinence Symptoms –Confusion –Agitation –Dizziness –Vision Problems

49 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Prehospital Stroke Screens

50 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Prehospital Stroke Screens

51 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Suspected Stroke Algorithm Click here to view the Suspected Stroke Algorithm illustration.here 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Seizures Generalized Seizures –Tonic-Clonic 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Seizures Generalized Seizures (cont.) –Pseudoseizures Hysterical seizures Stems from psychological disorders Can often be interrupted with a terse command

56 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Seizures Assessment –Ascertain exactly what the patient may recall or what bystanders witnessed Other problems mimic seizure –Differentiating Between Syncope and Seizure

58 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Seizures

60 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Seizures Management (cont.) –Position the patient –Suction if required –Monitor cardiac rhythm –Treat prolonged seizures Anticonvulsant medication –Provide a quiet atmosphere –Transport

61 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Headache Types –Vascular Migraines 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ “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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ “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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Neoplasms Tumors –Benign –Malignant Assessment –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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Neoplasms Assessment (cont.) –History 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Brain Abscess Abscess –Collection of Pus Assessment –Signs and Symptoms Lethargy, hemiparesis, nuchal rigidity Headache, nausea, vomiting, seizures Management –Similar to Neoplasm

73 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Low Back Pain Causes –Disk Injury –Vertebral Injury –Cysts and Tumors –Other Causes Back Pain and Non-Traumatic Spinal Disorders

77 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Anatomy and Physiology Pathophysiology General Assessment Findings Management of Specific Nervous System Emergencies


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