Paramedic Ch 18 Neurological Emergencies

What is the most sensitive organ within the body to variable temperature and fluctuating oxygen and glucose levels

The Brain

A persons talking and explaining to you what hearts gives you what kind of understanding in regards to their nervous system

Provides evidence of a functioning nervous system

If a person has an messy or dirty house this can be a sign of

Nervous system condition

What are 4 nerves responsible for airway control

trigeminal, glossopharyngeal, vagus and hypoglossal

(Swallowing, tongue control, muscles in hypopharynx are slightly contracted)

Stridor is a classic sign of

Partial airway obstruction

What can cause Trismus or clenching of the teeth

Seizure, severe head injury or cerebral hypoxia

What do you want your sp02 to be around

greater than 94 percent

When do we hyperventilate patients

Signs of increased intracranial pressure

What part of the brain controls breathing depth and rate or breathing

Pons and Medulla

Define:

Eupnea

Tachpnea

Bradypnea

Apnea

Hyperpnea

Cheyne-Stokes

Biot/ataxic

Kussmaul

Apneustic

Regular rate and pattern

Incresed rate regular pattern

decreased rate and regular pattern

Absence of breathing

Rapid rgular deep respirations

Gradual increases and decreased in respirations with periods of apnea

Irregular respirations with periods of apnea

Extreme Tachynpnea and hypernea

Prolonged inspiratory phase with shortened expiratory phaae and bradypnea

What condition can cause Kussmaul respirations

Diabetic Ketoacidosis and Acidosis

What can cause Cheyne- Stokes, Apneustic, Biot/Ataxic

brain stem injury

What are the symptoms of Cushing Reflex

Bradycardia

Bradypnea

Widened Pulse pressure with increased Systolic Pressure

Other than Cushings Reflex what are other signs and symptoms of ICP

Anisocoria, Biots, Chene-Stokes, Decorticate and decerebrate posturing

Define Aniscoria

Unequal Pupils

Define Decorticate and what part of brain is damaged

Flexing of arms and legs just inferior of cerebral hemispheres

Define Decerebrate and what part of brain is injured

Extension of the arms and legs and damage near brainstem

What is the optimal Blood Pressure for ICP

systolic 110-120mmhg

What Happens during ICP

As ICP rises blood to brain diminishes as this happens the medulla sends signals to heart to increase force of contraction. This in turn increases Systolic Pressure as the pressure rises the downward forces puts pressure on the brainstem which decrease the ability of the medulla to send signals and the diastolic falls and the which results in widening pulse pressure and finally the pressure damages the ability to control the respiratory and pulse rates

When should a rapid trauma or medical exam be done

On any anyone with a significant MOI, decreased LOC or needing an abdominal assessment

What is critical in a stroke patients history

Time of onset of Symptoms

What are some common seizure medications

Phenobarbital (Solfoton) and Dilantin (Phenytoin)

If a Patient is a diabetic and has had a seizure what can happen to their glucose stores

The seizure can use up their glucose

If a patient has a first time seizure what should the Paramedic assume that the cause is

Brain tumor, Intercranial bleeding or a serious infection

During Secondary assessment what is the part of the body you will spend the most time on for a neurologic exam

The head

How to cardiac dysrhythmias cause neurologic disorders

by decreasing the amount of blood supplied to the brain

Normal SP02 readings is

95-100 percent

what are common GI symptoms with a headache

Nausea and Vomiting

Urinary or fecal incontinence can be a sign of

Fainting and Seizure

During a neuro assessment what do you do for extremity assessment

Pulse Motor Sensation

Define Ptosis

Drooping sagging or prolapse of a part of the body for example Eyelid ptosis is eyelid drooping

Other than a CVA what can Eyelid Ptosis be sign of

Bell Palsy

Define Coma

Is a state in which a person does not respond to verbal or painful stimuli

For a patient to respond to pain the patient needs what 3 things to be functioning and intact

brain, spinal cord and peripheral nervous system

Define Supraoribital foramen

is a part of the frontal bone and feels like a notch near the bridge of the nose. Will cause pain if pressed

Define Hallucinations

Sensory Stimulation the patient experiences that are not based in a common reality

Patients can see things that others can not and they believe they are real

Should a paramedic reinforce hallucinations

NO but make sure you tell the patient they are safe

Define Delusion

thoughts perceived by the patient of their abilities or that people may be out to get them.

When a patient can no longer determine what is real and what is inside his or her mind what state are they in

Psychosis

How should we deal with psychosis

Give clear commands, 1 person talk only, keep lights on because shawdow can be interpreted as harmful always have an exit and be safe

If a patients mood or tempo has changed this an be a sign of

decreased 02 or BP or increased Temp or decreased BGL

Define Corneal reglex

A patient who is unresponsive or pretending to be unresponse if you tap between the eyes the patient will blink. If the patient does not blink the patient will probably not be able to control their airway and have an intact gag reflex

What can cause unequal pupils

Trauma, Glaucoma, Increased ICP

Stimulants cause Pupils to

Dilate

Narcotics and cholinergic agonists cause pupils to

Go pin point

Define Agnosia

Unable to tell you names of common objects

Define Apraxia

inability to know how to use a common object

Name the 3 different Aphasia

Receptive Aphasia

Expressive Aphasia

Global Aphasia

Define Receptive Aphasia

Unable to understand or receive speech but is able to speak clearly

In receptive aphasia what part of the brain is damaged

Temporal lobe

Define Expressive aphasia

Patient is unable to speak or express themselves

In Expressive aphasia what part of the brain is damaged

Frontal lobe which controls motor function of speech

Define Global Aphasia

features both expressive and receptive aphasia

Define Hemiparesis

Weakness of one side of the body

Define Hemiplegia

Paralysis on one side of the body

What is Decussation

The crossing of nerves as they leave the cerebral cortex so the patient might drooping face on left and weakness on right

When doing the drift test what part of the brain are you assessing

The cerebellum Posture, balance, equilibrium

How many Cranial Nerves are there

12

What is the saying to memorize cranial nerves

On, Old, Olympus, Towering, Top, A, Friendly, Viking, Grew, Vines, And, Hops

What are the first 3 cranial Nerves and what are there function

1) Olfactory Smell

2) Optic Sight

3) Oculomotor Movement of eye pupil and eyelid

What are the 4 and 5 cranial nerves and Function

Towering, Top

4) Throchlear (Movement of eye)

5) Trigeminal (Chewing, Pain, Temperature touh of mouth and face)

What are 6,7,8 cranial nerves and what are there functions

A, Friendly, Viking

6) Abducens Movement of the Eye

7) Facail (movement of the face, tears, salvation and taste)

8) Vestibulochlear or auditory ( Hearing and balance)

What are 9,10,11,12 cranial nerves and their functions

Grew Vines And Hops

9) Glossopharyngeal (swallowing, taste, sensations in mouth and pharynx)

10)Vagus (Sensatoin and movement of the pharynx, larynx throat and GI system)

11) Accessory (movement of the head and shoulders)

12) Hypoglossal (movement of the tongue)

Define Ataxia

describe alteration of persons ability to perform coordinated motions such as walking

Define Gait

A Walking Pattern

Assessing Gain is assessing what part of the Brain

Cerebellum because it is fine motor skill you don't have to think about

Define Myoclonus

Rapid Jerky muscles contractions

What is a Rest Tremor

pateitn at rest and not moving

Intention Tremor

Patient is asked to reach out and grab an object

Postural tremor

When you have to maintain a body position for a long period of time.

Define Tonic Activity

Rigid contracted body posture so tight body shakes

Define Clonic

Rhythmic contraction and relaxation of muscle groups

Define Paresthesia

numbness or tingling

Define anesthesia

No feeling at all

What part of the body used glucose faster than any other part

Brain

What is the happens When D50 extravasation into the interstitial space

Can casue severe damage or death to muscle nerves and skin

When do we use Thiamine

For malnourished Hypoglycemic Patients

Other than D50 what is secondary Treatment to Hypoglycemia

Glucagon

What do we administer for Seizures

Diazepam or Valium Can give it rectally

Narcotic Overdose treatment

ABC and Naloxone