1. Neurologic Emergencies EMS LECTURE (6) 2015 -2016 Dr. Samah Mohammed

2. Out lines 1.Introduction. 2.Definition of nervous system. 3.Structure of neuron. 4.Path physiology. 5.Neurological emergencies. 6.Patient assessment.

3. INTRODUCTION Three of the top 15 causes of death in 2007 were neurologic in nature. – Prevalence: number of people in a given population with a particular disease – Incidence: number of people diagnosed with a particular disorder in a one-year period

4. Nervous System Nervous system defined as:- Allows for communication between cells through sensory input, integration of data, and motor output. 2 cell types: neurons and neuralgia 2 divisions:  Central nervous system (CNS): Brain and spinal cord.  Peripheral nervous system (PNS): Nerves and ganglia (cell bodies).

5. Structure of the Nervous System Each neuron contains: 1.Cell body: with nucleus. 2.Dendrites : fibers that receive messages from other neurons. 3.Axons : fibers that send messages to other neurons. 4. Axon Terminals: – Transmit information

6. Neurons and Impulse Transmission Synapses: slight gap between each cell. Neurotransmitters: connects synapse to next cell. – Relay electrically conducted signals

7. Nervous System Organization 1. Central Nervous System (CNS) – Spinal Cord – simple decisions & information transmission. – Brain – “complex” decisions. 2. Peripheral Nervous System (PNS) Somatic Nervous System: the nerves that convey messages from the sense organs to the CNS and from the CNS to the muscles and glands (voluntary movement). Autonomic Nervous System: neurons that control the heart, the intestines, and other organs (involuntary movement). Sympathetic : increases ( HR, RS, B/P) acts in emergency as fear and anxiety. Parasympathetic: decrease (HR, RS, B/P) acts in rest as diet, and elimination.

8. Central Nervous System (CNS) Brain Lobes 1.Occipital lobe: scans through images. 2.Temporal lobe: attaches image to name. 3.Frontal lobe: controls voluntary motion. 4.Parietal lobe: perceives touch and pain. 1.Cerebrum : largest part of human brain. - Responsible for: A.Thought B.Language C.Senses D.Memory E.Voluntary movement

9. The CNS: Brain 2. Cerebellum : at base of brain -Responsible for: A.Muscle coordination B.Balance C.Posture 3.Brain Stem : connects brain to spinal cord -Responsible for: 1.Breathing 2.Swallowing 3. Heartbeat 4.Blood pressure

10. Spinal cord The Spinal Cord: part of the CNS found within the spinal column. The spinal cord communicates with the sense organs and muscles below the level of the head. 31 pairs & their branches carries messages to & from the spinal cord Both sensory and motor nerves  8 Cervical  12 Thoracic  5 Lumbar  5 Sacral  1 Coccygeal

11. Peripheral Nervous System

12. Common Neurologic Emergencies There are many types of disease as:- 1.Stroke, Headache, Coma, Dementia. 2.Seizures, 3.Multiple Sclerosis. 4.Cerebral Palsy, Alzheimer’s Disease. 5.Hydrocephalus, Epilepsy. 6.Peripheral Neuropathy. 7.CNS Infections/Inflammation. 8.Cranial Nerve Disorders. 9.Parkinson’s Disease.

13. Stroke Stroke defined as: Disruption of blood flow in brain May be leading to death. Hemorrhage: bleeding in brain, blood vessel ruptures can be from traumatic injury to blood vessel or “aneurysm” weakening of blood vessel wall, balloon like And rupture. Causes: infections, toxins, Smoking, developmental abnormality.

14. Stroke Signs and symptoms: 1.Headache. 2.Sudden blindness. 3.Sudden unilateral Paresthesia. 4. Difficulty thinking. 5. Seizures. 6. Coma. 7. Hypertension. Management 1.Administer fluids as needed. 2.Elevate the patient’s head 30° 3.Ensure airway is clear. 4.Watch for seizures. 5.Monitor blood pressure

15. Common Types OF Headaches Head /ache defined as: Pain of head. 1. Tension headaches: Stress causes residual muscle contractions. Pain is generally felt on both sides of the head. Usually a dull ache or a squeezing pain. 2. Migraine headaches:  Caused by changes in the size of blood vessels at the base of the brain.  Pain is generally unilateral and focused. Types of headache

16. Common Types Of Headaches 3. Cluster headaches – Begins as minor pain around one eye and spreads to one side of the face. – 30–45 minutes each 4. Sinus headaches – Inflammation /infection within sinus cavities. – Pain is located in superior portions of the face. – May be accompanied by postnasal drip, sore throat, and nasal discharge.

17. Management of Headaches 1.Maintain life style as diary food. 2.Medications (purpose, side effects) 3.Stress reduction  Dark quiet room, relaxation 4.Regular exercise 5.Treat for trauma or injury if present. 6.Ask what medications patient has taken for pain management: Ketofen and Morphine. Medication for nausea and vomiting Oxygen as needed.

18. Seizure Definition of seizure: brain dysfunction manifested by stereotyped alteration in behavior” (Convulsion). Causes: CNS impairment, Congenital, Head trauma, Stroke, Mass (tumor/abscess), Meningitis, Hypo/hyperglycemia, Hepatic coma, Hypoxia, Hyperthermia, and Drug overdose. Characterized by severe tension of all of the body’s muscles. Will last for several minutes or longer.

19. Types of Seizure 1.Partial Electrical discharges in a relatively small group of dysfunctional neurones in one cerebral. + / - LOC ( level of consciousness) – Simple partial Motor Autonomic Psychological – Complex partial Simple partial with impaired consciousness 2. Generalized Diffuse abnormal electrical discharges involved –No warning – Always LOC Called Absence seizure

20. Management of Seizures 1. Ensure airway protection/ position to prevent aspiration Do not place anything in the mouth except when to suction When the patient stops convulsing, place patient in lateral position. Begin supplemental oxygen 2. Assess safety of patient Ensure lights in room are on Remove any object within reach of patient that could cause injury Loosen clothing Side rails should be up if patient is in bed Do not try to “hold the patient down” 3. Obtain vitals including pulse oxiemeter and monitor. Order diagnostic labs. Most seizures medical intervention in 1-3 minutes

21. Patient Assessment Patient assessment steps 1.Scene size-up. 2.Primary assessment. 3.History taking. 4.Secondary assessment. 5.Reassessment.

22. Scene Size-up 1.Follow up Standard precautions for protection. A.( gloves, apron, helmets,……………….ect). B.Ensure that you have the correct PPE. 2.Scene safety and secure. 3.Gather basic information about the call. a)Determine if you need additional resources or equipment. b)Determine number of patients.

23. Primary Assessment 1. Form a general impression.  If unresponsive, pulse less, or a pneic, assess for use of AED.  A seizure in progress, Severe head injury, Cerebral hypoxia 2. Airway and breathing – If difficulty breathing: apply oxygen via non re breathing mask; if not breathing: give 100% oxygen via bag-mask device. 3. Circulation – Check skin color, temperature, central pulse, HR. 4. Transport decision – Transport in a stress-relieving manner.

24. History Taking Investigate the chief complaint (e.g., chest pain, difficulty breathing). – Ask about recent trauma. Obtain a SAMPLE history from a conscious patient. – Use OPQRST. – Drug use and exposure to toxins If patient has had a seizure: a.Look for obvious explanations. For headache, determine:  The patients level of stress  The likelihood of infection  History of headaches

25. Secondary Assessment 1. Physical examination  Focus on cardiac and respiratory systems. (Circulation, Respirations)  From head to toes  Check AVPU  Glasgow Coma Scale (GCS)  Gait and posture 2. Vital signs – Obtain a complete set of vital signs, Skin temperature, color, Pupil size and reactivity. – If available, use pulse oximetry

26. Secondary Assessment 1.Hallucinations: feelings of sound, sight, touch, and taste that are entirely within patients mind. 2.Delusions: Thoughts abilities are not based in a common reality. 3.Psychosis: inability to determine what is real and what is inside patients mind ensure your safety. 4. Hemiparesis and hemiplegia: – Hemiparesis: weakness of one side of the body. – Hemiplegia: paralysis of one side of the body.

27. Reassessment Neurological emergencies is always: 1. Reassess vital signs every 5 min. A.Give oxygen. B.Assist unconscious patients with breathing. C.Follow local protocol for administration medication D.If cardiac arrest occurs, perform CPR immediately until an AED is available. E.Alert emergency department about patient condition and estimated time of arrival. F.Report to hospital while en route.

28. Reassessment If ventilation is poor attempt insert a nasotracheal airway. Ensure that pulse oximeter reading is 95%, 2. Provide rapid patient transport. 3. Communication and documentation Time the patient was last seen healthy Findings of neurologic examination Anticipated time of arrival at the hospital 4. Document assessment and interventions.  Time of the onset  Any change in patient during transport  Reason for choice of hospital

29. Thank you