Altered Mental Status

1

• Altered Mental Status
• With Loss of Function

2
Neurological Deficit

• Any deficiency in the functioning of the brain or
  nervous system
• Nontraumatic brain injuries

3
Stroke (CVA)/Brain Attack

• Most common condition causing altered mental
  status
• Interruption of blood flow to the brain
• Aphasia (loss of speech)
• Anesthesia (loss of sensory function)
• Plegia (paralysis)(loss of function)
• Paresis (weakness) (loss of function)
• Most common cause of death
• More than half victims die
• Others suffer permanent neurological damage

4
Stroke (CVA)/Brain Attack Cont..

• Most often affect the elderly
• Atherosclerosis
• Arteriosclerosis
• Hypertension
• Episodes of TIAs

5
Signs Symptoms

• Loss of speech, sensory motor function
• Decreased LOC.
• Severe headache
• Drooping eyelid and mouth on one side
• Monoplegia (one extremity)
• Hemiplegia (one side of the body)
• Dysphasia (difficulty speaking or swallowing)
• Dyspnea
• Possible seizures

6
Transient Ischemic Attack (TIA)

• Mini-stroke
• Signs symptoms often disappear within 24 hours
  with no permanent disability
• Ischemia - oxygen deficit in the tissues
• Most commonly signs and symptoms last for
  approximately 5 to 10 minutes. Unusual to last
  longer than 30 minutes
• Approximately 1/3 who suffer TIA will have a
  stroke

7
Occlusive Strokes

• Thrombosis
• Embolism

8
Thrombosis

• Thrombosis - process of clot formation
• Thrombus - clot at the site of occlusion
• Atherosclerosis (plaque deposits)
• Hypertension( wearing out of the walls, plaque)
• Builds up over a loner period of time
• Onset of signs and symptoms slower than
  embolic-type
• Most common type of stroke
• Most commonly occurs at night when patient
  awakens with loss of speech, motor, and sensory
  functions

9
Embolism

• Clot travels from one area of the body, usually
  the neck or heart and lodges in the cerebral
  artery.
• Blood clot
• Air bubbles
• Tumor fragments
• Fat particles
• Most often occurs when patient is awake and
  active
• Sudden onset of signs symptoms
• Headache, seizure activity, brief periods of
  unresponsiveness are more common

10
Hemorrhagic Stroke

• Rupture of an artery causing bleeding within the
  brain
• Hypertension - causes wall to weaken(aneurysm)
• Congenital defect
• Onset sudden
• Severe headache (worst headache I ever had)
• May or may not have mental distortion
• Seizures and stiff neck are also common

11
Scene Size-up

• Scan the scene for clues of medical or trauma
• Look for evidence of drug paraphernalia, alcohol,
  or prescription drugs.
• Note patients cloths (bed clothes)
• Look for bucket or ice pack near the bed
• NV or headache

12
Initial Assessment

• Establish airway
• Suction (lost ability to swallow due to
  paralysis)
• Establish positive pressure ventilation with
  BigOs
• NPA or OPA
• It is possible for patient to feel pain but not
  be able to move in response to it

13
Focused History/Physical Exam

• If patient is unresponsive
• Perform physical exam
• Obtain baseline vitals
• SAMPLE history
• If patient is responsive
• Perform SAMPLE history
• Physical exam
• Baseline vitals

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Focused History/Physical Exam Cont..

• Assessment will be rapid rather than focused
• Assess speech
• Assess face for drooping and pupils for equality
• Assess grip strength bilaterally
• Baseline vitals every 5 minutes document
• Remember hypertension is a good indicator

15
SAMPLE History

• Medic alert tags
• Determine response to commands
• Blink yes or no
• Squeeze your finger if patient understands
• Any recent history of trauma to the head
• Any history of previous stroke
• Any seizure activity prior to arrival
• What was the patient doing at time of onset
• Any history of diabetes
• Any complaint of headache or stiff neck

16
Other Questions

• Any anticoagulant drugs
• History of hypertension
• Has patient taken any amphetamines, cocaine, or
  other stimulant drugs
• Was onset gradual or sudden
• Did signs symptoms get progressively worse or
  better
• Any paralysis or weakness progressing to other
  areas

17
Detailed Ongoing Assessment

• Do a detailed exam if time permits
• Perform ongoing assessment every 5 minutes
• Document and record any changes and all vitals

18
Emergency Treatment

• Ensure airway
• Oxygen therapy NR mask or positive pressure
  ventilations with Big Os
• Position patient
• Altered mental status left lateral recumbent
• Responsive supine semi-fowlers or fowlers
• Protect paralyzed extremities
• Transport