1. Rehab Careers Stroke, Dizziness or Vestibular disorders

2. Bell Work
1. When estimating the surface area of a burn, what should you use as a unit of measurement?
2. What is the number one rule when you have a penetrating object in a patient?
3. When applying a dressing or splint to an arm, what do you need to leave exposed to help evaluate circulation?

3. Standard
Standard 13 and 14: Identify signs and symptoms as well as normal anatomy and physiology versus pathophysiology for the following injuries/diseases/disorders as they are connected to Rehabilitation Careers. Relate who the appropriate professional would be to provide the care: Neurological disorders such as stroke, dizziness, and/or vestibular disorders Speech disorders and/or swallowing disorders

4. Objectives Understand causes of Stroke Vestibular Disorders
Speech and Swallowing Disorders

5. Altered Mental Status
Altered mental state – any time patients are confused about person, place or time. Amnesia – Failure to remember what just happened (possible head injury) Alzheimer’s Disease- progressive, irreversible deterioration of intellectual function

6. Altered Mental Status
1. Level of consciousness. Is the patient aware of his surroundings? 2. Attention. Is the patient able to focus or concentrate on one task at a time, or is he easily distracted? 3. Memory. Can the patient record data in the brain and repeat it at will? Thorough assessment of memory includes short-term memory, such as the ability to repeat a sequence of objects several minutes after they are first introduced, and long-term memory, such as the names and birth dates of family members or being able to repeat the alphabet.

7. Altered Mental Status
4. Cognitive ability. Can the patient process abstract thoughts coherently, such as explaining, "Why can't pigs fly?" Can he perform simple math or word problems, such as "Subtract 7 from 100 as many times as you can," or "Spell the word world backward?“ 5. Affect and mood. Affect is an objective assessment of the patient's demeanor and reaction to stimuli, while mood is a more subjective assessment of the patient's emotional state. Are both of them appropriate for the patient's current situation?

8. Altered Mental Status
6. Probable cause of the present condition. What is the underlying pathophysiology causing the patient's altered mental state? One commonly used mnemonic is AEIOUTIPS: Page 601 in book!
Alcohol,
Epilepsy
Insulin
Overdose, opioids or oxygen deprivation;
Uremia
Trauma
Infection, inherited defects;
Psychosis
Stroke, shock

9. Altered Mental Status Assessment
AVPU Assessment when doing initial assessment
(Alert, Voice, Pain, Unresponsive)

10. Stroke Occurs when the blood supply to the brain is interrupted due to
Thrombus – blood clot
Hemorrhage: Can be internal or external, a copious or heavy discharge of blood from the blood vessels
Embolus – free flowing clot
Aneurysm – bulging or burst blood vessel, most common in the: brain, aorta, legs or spleen.

11. Common Blood Vessel Disorders
Figure 15.6

12. Stroke: Cerebrovascular Accident (CVA)
1. Ischemic Stroke: Cerebral Thrombosis (Clot)
Blockage in arteries supplying oxygenated blood will result in damage to affected parts of the brain.
2. Hemorrhage Stroke: (Rupture of cerebral vessels)
An aneurysm or other weakened area of an artery ruptures. This has two effects:
An area of the brain is deprived of oxygenated blood.
Pooling blood puts increased pressure on the brain, displacing tissue and interfering with function. Cerebral hemorrhage is often associated with arteriosclerosis and hypertension.
Signs and Symptoms of Stroke
Headache
Confusion and/or dizziness
Loss of function or paralysis of extremities (usually on one side of the body)

13. Thrombolysis (Ischemic)
If victim reaches an emergency room and is diagnosed quickly, thrombolysis can be performed
Thrombolysis involves injecting an agent such as tissue plasminogen activator (TPA) to dissolve the clot and restore some blood flow

14. Scan 15.1 Altered Mental Status—Stroke: Cerebrovascular Accident

15. Stroke Video

16. Altered Mental Status–Stroke: Cerebrovascular Accident
Signs and Symptoms of Stroke
Numbness (usually limited to one side of the body)
Collapse
Facial paralysis and loss of expression (often to one side of the face)
Impaired speech
Unequal pupil size
Impaired vision
Rapid or slow pulse
Abnormal respirations
Nausea, vomiting
Convulsions
Loss of bladder and bowel control
High blood pressure (may have history of hypertension)

17. Scan 15.1 Altered Mental Status–Stroke: Cerebrovascular Accident

18. Stroke: Cerebrovascular Accident
Emergency Care of Stroke Patients
Ensure an open airway.
Administer oxygen per local protocols.
Keep the patient calm.
Monitor vital signs.
Give nothing by mouth.
Provide care for shock.
Place the patient into the recovery position on affected side to protect extremities.

19. TIA: Transient Ischemic Attack
Decreased blood flow to the brain that is only temporary.
Symptoms usually resolve in 24 hours
“Mini- Stroke”

20. Stroke Assessment
Perform Cincinnati Prehospital Stroke Scale – Page 606
Pronator Drift
Facial Droop
Expressive Aphasia (speak inappropriate words)
Receptive Aphasia (Can’t understand words spoken)

21. Work it out! Diagnosis of the Day: Case 1
What is the medical term for one-sided weakness? (you may need to research this)
What is the difference between hemorrhagic and ischemic stroke?
What is tPA? What type of stroke is it for? And what is the timeframe for giving it?
What is mechanical thrombectomy?
What does occlusion of the basilar artery mean?

22. Case Scenario Answers
1. Hemiparesis or one-sided (“hemi”) weakness (“paresis) affects about 8 out of 10 stroke survivors, causing weakness or the inability to move one side of the body.  
One-sided weakness can affect your arms, hands, legs and facial muscles. 
Injury to the left side of the brain, which controls language and speaking, can result in right-sided weakness.
Left-sided weakness results from injury to the right side of the brain, which controls our nonverbal communication and certain types of behavior.
2. Ischemic Stroke: happens when a clot blocks a vessel supplying blood to the brain. It's the most common type, accounting for 87% of all strokes. The treatment goal is to bust or remove the clot.
Hemorrhagic stroke: is caused by a rupture in a blood vessel within the brain. Fewer strokes happen as the result of a rupture. The treatment goal is to stop the bleeding.

23. 3. tPA is a medication that dissolves blood clots.
Case Scenario Answers
3. tPA is a medication that dissolves blood clots.
It is called a thrombolytic agent or more commonly referred to as the “clot buster.”
It is an intravenous or IV medication usually given through a catheter inserted into a vein in the arm.
Only for Ischemic Strokes
Must inject Within three hours of having a stroke or up to 4.5 hours in certain eligible patients.

24. Case Scenario Answers
4. Physical removal of a large blood clot is called a mechanical thrombectomy. 5. Patients with acute occlusion of the basilar artery will present with sudden and dramatic neurological impairment, the exact characteristics of which will depend on the site of occlusion

25. Bell Work 4-11-18 What is a free flowing blood clot?
A bulging or burst blood vessel would be classified as?
What are some symptoms of stroke victims?
As a first responder, what do you do if you suspect stroke?

26. Vestibular Disorders
The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease, aging, or injury, vestibular disorders can result, and are often associated with one or more of these symptoms, among others: Vertigo and dizziness.

27. Vestibular Disorders
Dizziness is a sensation of lightheadedness, faintness, or unsteadiness.
Vertigo has a rotational, spinning component, and is the perception of movement, either of the self or surrounding objects. 

28. Vestibular Disorders Most Common is MÉNIÈRE’S DISEASE
abnormally large amounts of a fluid called endolymph collecting in the inner ear.
can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age
The exact cause a not yet known.
Many theories include: circulation problems, viral infection, allergies, an autoimmune reaction, migraine, and the possibility of a genetic connection.

29. Swallowing Disorders or Dysphagia
More likely in the elderly
Do to conditions like: Nervous system disorders, such as Parkinson's disease and cerebral palsy
Problems with your esophagus or GERD 
Stroke
Head or spinal cord injury

30. Swallowing Disorders
Medicines can help some people, while others may need surgery.
Swallowing treatment with a speech-language pathologist can help.
Some change diet or hold head or neck in a certain way when they eat. In very serious cases, people may need feeding tubes.

31. What would be some complications from Dysphagia?

32. Complications
Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in adequate nourishment and fluids.
Aspiration pneumonia. Food or liquid entering your airway when you try to swallow can cause aspiration pneumonia, because the food can introduce bacteria to the lungs.
Choking. When food becomes impacted, choking can occur. If food completely blocks the airway, and no one intervenes with a successful Heimlich maneuver, death can occur.

33. Speech Disorders: Aphasia
Expressive Aphasia:
Receptive Aphasia:

34. Therapies

35. Speech Disorders
Apraxia is a motor speech disorder that makes it hard to speak. It can take a lot of work to learn to say sounds and words better. Something in brain does not allow messages to get to his mouth. Most of the time, the cause is unknown.
Dysarthria is a speech disorder caused by muscle weakness. It can make it hard for you to talk. People may have trouble understanding what you say.

36. Speech Disorders
Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called "disfluencies." Most people produce brief disfluencies from time to time. Cause unknown

37. Work it out
EMS book page 622, 1-6

38. Bell Work

39. New Stroke Research https://www.youtube.com/watch?v=-ZwCDT50PJI
Drug is called Etanercept
Journal Entry: Write 2 paragraphs (5-7 sentences each) in notebook about your opinion of the drug Etanercept and if you think the doctor should be offering to patients for such a high cost.