1. NEUROLOGICAL EMERGENCIES
SCFD EMS
NEUROLOGICAL EMERGENCIES
Updated 04/2017 by J. GOODREAU

2. Types of Neurological Emergencies
COMA/ ALOC
SEIZURES
STOKE (CVA/ TIA)
SYNCOPE/ NEAR SYNCOPE
DIABETES
BEHAVIORAL

3. Pathophysiology CENTRAL NERVOUS SYSTEM (CNS)
CONSIST OF BRAIN AND SPINAL CORD
GUIDES MOVEMENT AND REGISTERS SENSE
PERIPERAL NERVOUS SYSTEM (PNS)
CONDCUT INFORMATION TO AND FROM THE CENTERAL NERVOUS SYTEM.
SOMATIC (VOLUNTARY CONTROL)
SENSORY (TASTE AND TOUCH)
AUTONOMIC (INVOLUNTRAY RESPONSE)
SYMPATHETIC “FIGHT OR FLIGHT”
PARASYMPATHETIC “FEED OR BREED”

4. Neurological ASSESSMENT
DETERMINE PATIENTS LOC:
AVPU
A/O STATUS
GCS
ARE THEY BASELINE?
NORMALLY ALERED, UNRESPONSIVE, NON-VERBAL?
PUPILS:
EQUAL
REACTIVE
PINPOINT
DILATED
UNEQUAL

5. Neurological ASSESSMENT
A/O STATUS:
NAME
LOCATION
TIME
EVENT
A= AWAKE/ TRACKING V= ALERT TO VERBAL P= ALERT TO PAIN U = UNRESPONSIVE
GCS RANGES 3 (UNRESPONSIVE) TO 15 (A/OX4)

6. Neurological ASSESSMENT
GCS MOTOR SCORE 2 3
WORSE
BAD

7. Neurological ASSESSMENT
ASSESS ENVIROMENT AND SURROUNDINGS: POSSIBLITY OF INJURY, GAS LEAK, HEAT/COLD, DIALISYS SHUNTS, MEDICATION BOTTLES, DRUGS AND/OR ALCOHOL
MAKE SURE SCENE IS SAFE!!
DETERMINE LAST KNOWN WELL TIME
A- ALCOHOL/ ACIDOSIS
E- EPILEPSY / SEIZURE
I- INFECTION (OPEN WOUNDS)
O- OVERDOSE OF MEDICATION (ACCIDENTAL OR INTENTIONAL)
U- UNDERDOSE/ UREMIA (METABLOIC INSUFFICENCY)
T- TRAUMA/ TUMOR
I- INSULIN
P- PSYCH/ POISONS
S- STROKE/ SHOCK

8. COMA/ ALOC
ALOC – ANY CHANGE TO AVPU AND/OR A/O STATUS IN WHICH IS BASELINE FOR PATIENT.
SOMEONE WHO NORMALLY IS A/OX4 GCS 15 BUT IS NOW A/OX1 GCS 14 IS ALTERD.
SOMEONE WHO IS NORMALLY A/OX1 GCS 14 SECONDARY TO DEMENTIA IS NOT ALTERD FROM BASELINE
IF THE SAME PERSON WHO IS NORMALLY A/OX1 GCS 14 WITH HX DEMENTIA IS NOW NON-VERBAL, GCS 11 IS ALTERD
COMA – A PERIOD OF UNRESPONSIVNESS IN WHICH PATIENT IS UNRESPONSIVE TO ANY EXTERNAL FACTORS FOR AN
EXTENDED AMOUNT OF TIME.
CAUSES:
AEIOU - TIPS

9. COMA/ ALOC TREATMENT TREATMENT: ABCs SECURE AIRWAY
HEAD TILT vs JAW THRUST
OPA vs NPA
ASSIST VENTILATIONS (MAINTAIN SPO2 >94%)
SUCTION
CONSIDER SMR
VITALS
HX DIABETES AND AWAKE/ ABLE TO SWALLOW
ADMINITER TUBE ORAL GLUCOSE
PRIORITES:
ABCs
AEIOU-TIPS
CONSIDER C-SPINE
ADMINISTER o2
OBTAIN PT HX AND BYSTANDER INFO OF EVENTS

10. SEIZURES
SEIZURE: ABNORMAL EXCESSIVE ELECTRICAL ACTIVITY IN THE BRAIN “BRAIN RESET”
GENERALIZED- LOSS OF CONCIOUSNESS WITH FULL BODY TONIC (MUSCLE CONTRACTION) – CLONIC (MUSLCE SPASMS) ACTIVITY
PARTIAL – CONSCIOUSNESS IS NOT LOST
SIMPLE- AWAKE WITH ISOLATED TWITCHING OF ARMS, FACE, LEGS OR EYES. TINGLING, WEAKNESS OR HALLUCINATIONS
COMPLEX- AWAKE BUT ALTERED AWARENSS: BLANK STARE, CONFUSION, PURPOSELESS BEHAAVIOR, MUMBLING
EPILEPSY- CHRONIC, RECURRENT SEIZURES NOT OTHERWISE PROVOKED BY AN ACUTE INJURY OR MEDICAL EMERGENCY.
STATUS EPILEPTICUS – SEZIURE ACTIVITY LASTING 5 OR MORE MINUTES OR TWO OR MORE SEZIURES WHERE PT REMAINS
UNRESPONSIVE.
STAGES-
AURA-”WARNING” BEFORE A SEZIURE. DÉJÀ VU, PERCIEVED SENSES, NAUSEA, EMETIONS, ABNORMAL SENSATIONS
ICTUS- THE SEIZURE ACTIVITY
POSTICTAL- BODY RELAXES AND RESET. PT MAY BE UNRESPONVIE  ALETERD/ LETHARGIC  FULLY ALERT. MAY HAVE HEADACHE, NUMBNESS, LOSS OF BOWEL OR BLADDER CONTROL

11. Seizure TREATMENT TREATMENT: PRIORITES: ABCs ADMINISTER o2
DURING:
PREVENT INJURY, DON’T PUT ANYTHING IN MOUTH, MOVE FURNITURE AWAY
AFTER:
ABCs
SECURE AIRWAY
HEAD TILT vs JAW THRUST
OPA vs NPA
ASSIST VENTILATIONS (MAINTIAN SPO2 >94%)
SUCTION
CONSIDER SMR
VITALS
COOLING WITH COOL MOIST TOWLES IF FEVER (DON’T ALLOW PT TO SHIVER!)
PRIORITES:
ABCs
ADMINISTER o2
OBTAIN PT HX AND BYSTANDER INFO OF EVENTS
DETERMINE PHYSIOLOGICAL DISTRESS OR POSSIBLE CAUSE
DESCRIPTION OF SEIZURE AND DURATION

12. StRoke (cva/ tia)
CEREBRAL VASCULAR ACCIDENT – CEASED BLOOD FLOW TO AREA OF BRAIN. MAY HAVE “WORST HEADACHE OF MY LIFE”
HEMORRAGIC- LEAKING OR BURST ARTERY IN THE BRAIN. CAUSED BY HTN OR TRAUMA
ISCHEMIC- BLOCKED ARTERY IN THE BRAIN. CAUSED BY BLOOD CLOT.
TRANSIENT ISCHEMIC ATTACK- TEMPORARY DISRUPTION OF BLOOD FLOW TO BRAIN. “WARNING SIGN.”
GENERALIZED- LOSS OF CONCIOUSNESS WITH FULL BODY TONIC (MUSCLE CONTRACTION) – CLONIC (MUSLCE SPASMS) ACTIVITY.
APHAISA- COMMUNICATION DISORDER THAT AFFECTS BRAINS ABILITY TO UNDERSTAND OR SPEAK.
EXPRESSIVE – UNDERTANDS WHATS BEING SAID, UNABLE TO PROPERLY COMMUNICATE BACK
RECEPTIVE – UNABLE TO UNDERSTAND WHATS BEING SAID OR COMMUNICTAED.
WORD SALAD- CONFUSED AND UNINTELLIGBLE MIXUTE OF RANDOM WORDS

13. StRoke (cva/ tia)

14. Seizure TREATMENT PRIORITES: TREATMENT: ABCs ADMINISTER o2
OBTAIN PT HX AND BYSTANDER INFO OF EVENTS
PERFORM STROKE ASSESSMENT
**GET LAST WELL KOWN TIME**
TREATMENT:
ABCs
SECURE AIRWAY
HEAD TILT vs JAW THRUST
OPA vs NPA
ASSIST VENTILATIONS (MAINTAIN SPO2 >94%)
SUCTION
VITALS
KEEP HEAD ELEVATED 45’
PROTECT PARALYZED LIMBS
NOTHING BY MOUTH
AVIOD EXCESSIVE MOVEMENT
**IF EXTENDED ALS RESPONSE AND HX DM, GIVE ORAL GLUCOSE IF PT IS AWAKE AND ABLE TO SWALLOW**

15. Syncope/ near syncope
DECREAESD BLOOD FLOW TO THE ENTIRE BRAIN (LOW BLOOD PRESSURE OR INABLITY OF HEART TO EFFICIENTLY PUMP
BLOOD). USALLY QUICK ONSET AND SHORT DURATION.
SYNCOPE- LOSS OF CONSCIOUNESS AND MUSCLE STRENGTH
NEAR SYNCOPE – PARTIAL LOSS OF CONSIOUNESS STRENGHT
CAUSES- EMOTINAL STRESS, HYPERVENTILTION, SEVER PAIN, POOLING BLOOD IN LEGS, OVERHEATING, DEHYDRATION,
BRADYCARDIA, VAGAL NERVE STIMULATION
SYMPTOMS- HEADACHE, DIZZINESS, BLURRY VISION, SWEATING, BLURRY VISION, CONFSUION, N/V OR FEELIGN WARM.
MAY FALL AND HIT HEAD, CAUSE MVA OR HAVE OTHER TRUMA – BE SURE TO CHECK FOR OTHER INJUIRES!

16. SYNCOPE TREATMENT PRIORITES: TREATMENT: ABCs ADMINISTER o2
OBTAIN PT HX AND BYSTANDER INFO OF EVENTS
TREATMENT:
ABCs
SECURE AIRWAY
HEAD TILT vs JAW THRUST
OPA vs NPA IF EXTENDED UNRESPONSIVNESS
ASSIST VENTILATIONS (MAINTAIN SPO2 >94%)
VITALS
CHECK FOR FURTHER INJURIES

17. BEHAVIORAL
SOME PSYCH DISORDERS MAY CAUSE PT TO BECOME ALTERED AND SHOW SIGNS OF COMBATIVNESS, HALLUCINATIONS, DISORIENTATION AND IRRATIONAL BEHAVIOR
SCHIZO
BIPOLAR
PROTECT YOURSELF, CREW AND BYSTANDERS
INQUIRE WITH PT AND/OR FAMILY OF PSYCH HISTORY AND MEDICATION USE
SPEAK CALMY BUT IN FIRM VOICE
ALWAYS HAVE AT LEAST FOUR PEOPLE (FOR EACH LIMB) IF PATIENT REQUIRES RESTRIANTS
PTSD MENTAL RETARDATION
AUTISM DEPRESSION/ ANXIETY