1. Chapter 13 Neurologic Emergencies

2. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 2 Describe the causes of stroke and the three conditions that cause blockages. Describe the events that occur during a stroke. Obtain and interpret vital signs in the stroke patient. Objectives (1 of 4)

3. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 3 State the reason stroke must be treated within the first 3 to 6 hours. Identify the signs and symptoms of stroke. Describe the significance of a transient ischemic attack (TIA). Objectives (2 of 4)

4. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 4 Define seizure, including the two major types of seizure. Describe the parts of a seizure. List possible causes of seizures. Explain the importance of recognizing seizures. Objectives (3 of 4)

5. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 5 Describe characteristics of the post-seizure state. Define altered mental status. List possible causes of altered mental status. Objectives (4 of 4)

6. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 6 Brain Structure and Function

7. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 7 The Spinal Cord

8. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 8 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

9. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 9 Hemorrhagic Stroke Results from bleeding in the brain Arterial rupture High blood pressure is a risk factor. Some people are born with aneurysms.

10. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 10 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

11. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 11 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.

12. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 12 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

13. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 13 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.

14. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 14 Causes of Seizures Congenital (epilepsy) High fevers Structural problems in the brain Metabolic disorders Chemical disorders (poison, drugs) Sudden high fever

15. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 15 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

16. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 16 Postictal State Patient may have labored breathing. May have hemiparesis: weakness on one side of the body. Patient may be lethargic, confused or combative. Consider underlying conditions. Hypoglycemia Infection

17. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 17 Altered Mental Status (AMS) Hypoglycemia Hypoxemia Intoxication Drug overdose Unrecognized head injury Brain infection Body temperature abnormalities Brain tumors Glandular abnormalities Poisoning

18. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 18 Signs and Symptoms of Brain Disorders Many different disorders can affect: Level of consciousness Speech Voluntary muscle control

19. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 20 Stroke Mimics Hypoglycemia Postictal state Subdural or epidural bleeding

21. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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. Utilize the Cincinnati Stroke Scale

22. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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 vitals.

24. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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. Provide prompt transport to hospital while monitoring the patient.

26. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 26 Emergency Medical Care for Stroke Patient needs to be evaluated by computed topography (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. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 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. Patient and family may be frightened.

28. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 28 Geriatric Needs Brain shrinks with age. Always consider underlying conditions. Elderly are at higher risk for central nervous system illnesses and injuries.

29. 13: Neurologic Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 29 Pediatric Needs Children can have AMS caused by: Strokes Seizure Other brain emergencies Treat in the same way as adults. Seizures are often febrile. Transport to the hospital.