Neurologic Emergencies

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Chapter 12

• Neurologic Emergencies

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Objectives (1 of 3)

• Describe the causes of stroke, including the two
  major types.
• Obtain and interpret the key vital signs in the
  stroke patient, including the time of onset of
  the symptoms.
• Identify the signs and symptoms of stroke
• Describe the significance of a transient ischemic
  attack (TIA).

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Objectives (2 of 3)

• Define seizure, including the two major types of
  seizure.
• Explain the importance of recognizing seizures.
• Discuss the differences between unresponsiveness
  and disorientation.

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Objectives (3 of 3)

• Demonstrate the steps in the emergency care for
  the patient who has had a stroke.
• Demonstrate testing for aphasia, facial weakness,
  and motor weakness.
• Demonstrate the steps in the emergency care for
  the patient who has had a seizure.
• Demonstrate the steps in the emergency care for
  the patient who is unresponsive.

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Brain Structure and Function
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The Spinal Cord
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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

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Hemorrhagic Stroke

• Results from bleeding in the brain
• Arterial rupture
• High blood pressure is a risk factor.
• Some people are born with aneurysms.

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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

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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.

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Seizures

• Generalized (grand mal) seizure
• Unconsciousness and generalized severe twitching
  of the bodys muscles that lasts several minutes
• Petit mal seizure
• Seizure characterized by a brief lapse of
  attention

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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.

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Causes of Seizures

• Congenital (epilepsy)
• Structural problems in the brain (tumor, scar,
  infection)
• Metabolic disorders
• Chemical disorders (poison, drugs)
• Sudden high fever (febrile)

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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

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Postictal State

• Patient may have labored breathing.
• Patient may have hemiparesis weakness on one
  side of the body.
• Patient may be lethargic, confused, or combative.
• Consider underlying conditions.
• Hypoglycemia
• Infection

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Altered Mental Status (AMS)

• Hypoglycemia
• Hypoxemia
• Intoxication
• Drug overdose
• Unrecognized head injury

• Brain infection
• Body temperature abnormalities
• Brain tumors
• Glandular abnormalities
• Poisoning

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Hypoglycemia

• Can mimic stroke or seizure
• Will not generally improve after a seizure
• May exhibit a lower level of responsiveness than
  a stroke patient
• Look for medical bracelet or medications that
  indicate diabetes.

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Signs and Symptoms of Brain Disorders

• Many different disorders can affect
• Level of consciousness
• Speech
• Voluntary muscle control

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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

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Conditions that Stroke May Mimic

• Hypoglycemia
• Postictal state
• Subdural or epidural bleeding

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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.
• Use the Cincinnati Stroke Scale.

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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

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Transport Considerations

• Place the patient in a comfortable position.
• Usually on one side
• Paralyzed side down and well protected
• Elevate patients head about 6".
• Continue giving oxygen and monitor vital signs.

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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.

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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.
• Arrange for prompt transport to hospital, monitor
  the patient.

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Emergency Medical Carefor Stroke

• Patient needs to be evaluated by computed
  tomography (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.

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Emergency Medical Carefor 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 occurs.
• Patient and family may be frightened.