Chapter 18 EMT Basic

contralateral

left side of brain works on the right side for movement

right hemisphere of brain

visual and spatial reasoning

left hemisphere of brain

interprets peoples behavior speech understanding

aphasia

impairment of language due to language in wernicke's or broca's area

what can increase ICP (name 7)

• swelling of brain - accumulation of blood within skull - cheyne-stokes respirations - ataxic respirations - cushing reflex - tumor - head trauma - hemorrhagic stroke - headache - vomit - altered mental status - seizures

decompensated shock

late stage when blood pressure is falling pulse will increase respirations will increase

what is the fifth leading cause of death and leading cause of adult disability in the US

stroke

common population for stroke

geriatric patients

contributing factors for stroke

family history and race

seizures may occur as a result of

- recent or prior head injury - tumor - metabolic problems - fever - genetic disposition

possible causes of altered mental status

- intoxication - head injury - hypoxia - stroke - metabolic disturbances - brain infection - body temperature abnormalty - brain tumor - overdose - poisoning

largest part of brain

cerebrum

what is the brain

- body's computer - controls breathing, speech, and all body functinos

functions that brainstem controls

breathing, blood pressure, swallowing, pupil constriction

two hemispheres of cerebrum

left and right

what is at each vertebra in neck and back

two nerves branch out (spinal nerves) which carry signals to and from the body

coma

state of profound unconsciousness and can lead to permanent brain damage

if disorder in heart and lungs

entire brain will be affected

if problem with brain

only one side of body will be affected becasue contralateral

what is the brain sensitive to changes in

oxygen, glucose, temperature

what can neurologic disorders affect

patient's LOC, speech, and voluntary muscle control

what parts of the body have no pain receptors

brain and skull

headache pain felt

• felt from surrounding areas such as scalp, meninges, large blood vessels, muscles at head, neck and face

most common types of headaches

tension headaches, sinus headaches, migraines

tension headaches caused by

contractions in head and neck

what do tension headaches attribute to

stress

tension headaches signs and symptoms

squeezing, dull, or aching pain

what is migraine headaches caused by

changes in blood vessel size in base of brain

migraine headache pain

pounding, throbbin, and pulsating

what is migraine headaches associated with

neause and vomiting with visual changes

visual changes in migraines

flashing lights or partial visual loss

how long can migraine headaches last

several hours or days

who is 3x more likely to experience migraines

women

sinus headaches caused by

pressure that is the result of fluid accumulation in sinus cavities

when do sinus headaches have increased pain

bending over or head is moved forward

sinus headaches symptoms

nasal congestion, cough, and fever

serious conditions with headache

hemorrhagic stroke, brain tumor, and meningitis

when are headaches life-threatening

fever, stiff neck, seizures, arm, head trauma

hemorrhagic stroke

• blood from ruptured blood vessels swells and irritate brain tissues

• localized then become more diffused as irritation spreads

• bleeding inside brain -> cerebral hemorrhage

signs and symptoms of hemorrhagic stroke

- severe headache - seizures - altered mental status

stroke aka

cerebrovascular accident

stroke

- interruption of blood flow to area within brain - results in loss of brain function and brain cells die within minutes

two types of stroke

ischemic and hemorrhagic

treating altered mental status

- determine cause - spnial restriction - airway and ventilation - transport

if patient refuses transport after seizure

- contact medical control - follow local protocols - keep trying to convince

questions to ask yourself if someone refuses transport

- GCS is less than 15? - no trauma or seizure? - happened in past? - usual? - on meds?

treatment of seizures

- XABC - protect from harm - suction, oxygen - don't restrain in stretcher and use padding

treating stroke

- XABCs - rapid transport - oxygen >94% - suction if difficulty swallowing

when is oxygen therapy recommended for stroke

- patient is in respiratory distress or hypoxic

fibrinolyctic therapy

bloodclot-dissolving drugs that can reverse stroke symptoms or stop stroke from happening 3-6 hours before

when not to give fibrinolyctic therapy

hemorrhagic strokes

what does ischemic stroke result from

thrombosis or embolus

symptoms of ischemic stroke

range from nothing at alll to copmlete paralysis

cause of ischemic stroke

- atherosclerosis in blood vessels -> occlusion of artery and blood clot - rupture in carotid artery -> can be small but can still embolize deep into brain

thrombosis

clot forms at site of blockage

embolus

blood clot forms in a remote area and traavels to site of blockage -> leads to stroke

ischemic stroke

- blood flow to a specific part of brain is stopped by blood clot inside blood vessel - most common, accounting for 87% of strokes

who is prone to ischemic strokes

people with afib and often take blood thinners to reduce risk

who is at high risk of hemorrhagic stroke

experiencing stress or exertion

who is at highest risk of hemorrhagic stroke

- natural, very high blood pressure - weaken blood vessels and increased ICP if vessel ruptures

aneurysm

swelling or enlargement of wall of an artery resulting from a defect or weakening of arterial wall

subarachnoid space

area between two coverings of the brain

symptoms of hemorrhagic stroke

- sudden severe headache

what is aneurysm caused by

irritation of blood on brain tissues after artery swells or ruptures

berry aneurysm

- tiny balloon that juts out from artery -> weakness of blood vessel - if ruptures, blood spurts into subarachnoid space and hemorrhage

what does berry aneurysm result from

young patient hemostroke

transient ischemic attack

- hard to differentiate between stroke - stroke like symptoms - go away in less than 24 hours - warning sign of a larger stroke to come

what fraction of patients who have a TIA will experience a stroke

1/3

signs and symptoms of stroke

- facial drooping - sudden weakness or numbness in body - decreased or absent movement and sensation in one side of body - ataxia and loss of balance

ataxia

lack of muscle coordination

dysarthria

slurred speech

stroke in left cerebral hemisphere

- aphasia - paralysis on right side of body

stroke on right hemisphere

- paralysis on left side of body - understand language and able to speak - neglect - delay seeking help

neglect

patients are oblivious to problem

two causes of high blood pressure

- cause of the bleeding - caused by the bleeding such as compensatory response

dura

- leathery covering of brain that lies next to skull

epidural bleeding

fracture of temples -> artery bleed on dura and increase ICP

subdural bleeding

bleeding in veins below dural

subdural or epidural bleeding

collection of blood hear skull that presses on brain

postictal state

- period after seizure 5-30 minutes - labored breathing and AMS -> patient ergains LOC - muscles relax

seizures

neurologic episode caused by surge of electrical activity in brain

two basic pairs of seizures

generalized and partial unknown or known

form of seizure

convulsion

what can seizure be associated with

temporary alteration in consciousness

common cause of seizures

epilepsy

generalized seizure

results from abnormal electrical discharges from large areas of the brain

what is generalized seizure characterized by

- unconsciousnessness and twitching and jerking of all muscles lasting several minutes or longer -> muscles are contracting at same time - apnea

absence seizure

- does not involve any changes in motor activity - last for seconds - patient fully recovers with brief lapse of memory

absence seizure characterized by

brief lapse of consciousness in which patient seems to stare and not respond

focal-onset aware seizure

- no change in patient's LOC - not dramatic compared to generalized

signs and symptoms of focal-onset aware seizure

- numbness, weakness, dizziness, visual changes, unusual smells/tastes - twitching or brief paralysis, muscle tremor, body shaking

focal-onset impaired awareness seizure

- altered mental status - does not remember events occurring during seizures

what does focal-onset impaired awareness seizure result from

abnormal discharges from temporal lobe of brain

signs and symptoms of focal-onset, impaired awareness seizure

lip smacking, eye blinking, isolated jerking, unpleasant smells, visual hallucinations, uncontrollable fear, repetitive physical behavior

aura

- visual changes or hallucinations prior to seizure, not all the time - people with history of seizures take steps to minimize injury

what might people with generalized seizure exhibit

bilateral muscle movement characterized by a cycle of muscle rigidity and relaxation

how long does generalized seizure last

less than 5 minutes -> brief lapse of memory of event

what follows generalized seizure

postictal state

phases in generalized seizure

tonic then clonic

tonic phase

short period of extreme muscular rigidity