Neurologic Emergencies Chapter 11 Neurologic Emergencies

Lesson 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.

Anatomy and Physiology

The Unresponsive Victim (1 of 4) Causes and treatment for unresponsive conditions What 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.

The Unresponsive Victim (2 of 4) Causes and treatment for unresponsive conditions What to do: Evidence of head injury Protect 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.

The Unresponsive Victim (3 of 4) Causes and treatment for unresponsive conditions What to do: No evidence of head injury Roll 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.

The Unresponsive Victim (4 of 4) Causes and treatment for unresponsive conditions Long-term care Do 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.

The 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.

The 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.

The Responsive Victim (3 of 3) What to look for: Look for blood or clear fluid coming from the nose or ears. Assess for paralysis.

Head Injury (1 of 15) Concussion Brief disruption of brain function due to a blow to the head Anyone who has been unresponsive from a head injury should not walk or be left unattended.

Head Injury (2 of 15) Concussion What to look for: No loss or brief loss of consciousness Visual changes Nausea, dizziness, headache

Head 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.

Head 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.

Head 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.

Head Injury (6 of 15) Head injury with delayed deterioration What to look for: Decreased level of responsiveness Severe, progressive headache not relieved by medication Repeated vomiting Altered behavior

Head 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.

Head 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.

Head Injury (9 of 15) Severe, diffuse brain injury What to look for: Deeply unresponsive from time of injury Obstructed airway and impaired breathing Changes in responsiveness

Head Injury (10 of 15) Severe, diffuse brain injury What to look for: Good signs Responsive victim Normal body movement Normal blink reactions

Head Injury (11 of 15) Severe, diffuse brain injury What to look for: Bad signs Enlarged pupils that do not react to light Unequal pupils Slowed pulse rate Irregular breathing Rising body temperature Loss of feeling One-sided weakness Paralysis

Head 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.

Head 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

Head Injury (14 of 15) Skull fractures What to look for: Broken bone edges in the wound Clear or blood-tinged fluid from the nose or ear without apparent injury

Head 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.

Other Neurologic Problems (1 of 19) Stroke Caused by blockage of a blood vessel or bleeding in the brain Transient 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.

Other Neurologic Problems (2 of 19) Stroke What to look for: Altered responsiveness Numbness, weakness, paralysis of face, arm, or leg (usually on one side) Turning of the head and eyes to one side Noisy breathing or drooling Visual changes

Other Neurologic Problems (3 of 19) Stroke What to look for: Loss of balance or coordination Difficulty speaking Sudden, severe, unexplained, long-lasting headache Convulsions History of diabetes, hypertension, heart disease, or previous strokes

Other Neurologic Problems (4 of 19) Stroke What to do: Place victim in recovery position. Allow responsive victims to assume a position of comfort. Offer clear liquids with caution. Evacuate.

Other Neurologic Problems (5 of 19) Seizures Caused 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.

Other Neurologic Problems (6 of 19) Seizures Partial seizures Momentary lack of awareness Involuntary movement of a body part Sensation of numbness or tingling Abnormal vision or smell

Other Neurologic Problems (7 of 19) Seizures Generalized seizures Frequently preceded by an aura Start with a sudden spasm of body muscles Causes victim to cry out and fall to the ground

Other Neurologic Problems (8 of 19) Seizures What 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.

Other Neurologic Problems (9 of 19) Simple fainting Common, benign, usually brief form of rapid drop in blood pressure Result of inadequate blood flow to brain and loss of normal responsiveness Can have a physical or emotional cause

Other Neurologic Problems (10 of 19) Simple fainting What to look for: Visual disturbances (seeing spots), dizziness, feeling too hot or too cold, nausea Paleness with cold, clammy skin Passing out, slumping, or falling down

Other Neurologic Problems (11 of 19) Simple fainting What to do: Person who is about to faint Prevent 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.

Other Neurologic Problems (12 of 19) Simple fainting What to do: Person who has fainted Check 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.

Other Neurologic Problems (13 of 19) Headache Most 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.

Other Neurologic Problems (14 of 19) Headache What to look for: Head trauma Tenderness over scalp, neck, and shoulders Unequal pupil size Double vision Impaired sensation/movement of extremities

Other Neurologic Problems (15 of 19) Headache What to look for: Fever Severe neck stiffness Impaired balance Suspect 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

Other Neurologic Problems (16 of 19) Headache What to do: Give nonprescription medication. Descend to an appropriate altitude. If cause appears serious, evacuate.

Other Neurologic Problems (17 of 19) Migraine Periodic, 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.

Other Neurologic Problems (18 of 19) Diabetes Low 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.

Other Neurologic Problems (19 of 19) Diabetes High blood sugar (hyperglycemia): Caused by too much insulin Excessive thirst Large urine output Exhaustion Fruity smell to breath Very dangerous condition Evacuate immediately.