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Neurologic Emergencies

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Presentation on theme: "Neurologic Emergencies"— Presentation transcript:

1 Neurologic Emergencies
Chapter 12 Neurologic Emergencies

2 Objectives (1 of 3) 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).

3 Objectives (2 of 3) Define seizure, including the two major types of seizure. Explain the importance of recognizing seizures. Discuss the differences between unresponsiveness and disorientation.

4 Objectives (3 of 3) 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.

5 Brain Structure and Function

6 The Spinal Cord

7 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

8 Hemorrhagic Stroke Results from bleeding in the brain Arterial rupture
High blood pressure is a risk factor. Some people are born with aneurysms.

9 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

10 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.

11 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

12 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.

13 Causes of Seizures Congenital (epilepsy)
Structural problems in the brain (tumor, scar, infection) Metabolic disorders Chemical disorders (poison, drugs) Sudden high fever (febrile)

14 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

15 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

16 Altered Mental Status (AMS)
Hypoglycemia Hypoxemia Intoxication Drug overdose Unrecognized head injury Brain infection Body temperature abnormalities Brain tumors Glandular abnormalities Poisoning

17 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.

18 Signs and Symptoms of Brain Disorders
Many different disorders can affect: Level of consciousness Speech Voluntary muscle control

19 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

20 Conditions that Stroke May Mimic
Hypoglycemia Postictal state Subdural or epidural bleeding

21 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.

22 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

23 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.

24 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.

25 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.

26 Emergency Medical Care for 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.

27 Emergency Medical Care for Seizure
Most patients should be evaluated by a physician after a seizure. With severe injury, suspect spinal injury. Attempt to lower body temperature if febrile seizure occurs. Patient and family may be frightened.


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