chapter 18: neurologic emergencies

tension headache

most common, muscular contractions

tension headache quality

squeezing, dull ache

migraine

visual disturbance, sensitivity to stimuli

migraine quality

pounding, throbbing, pulsating for SEVERAL HOURS

migraine side effects

nausea/vomiting

sinus headache

pressure in sinuses

stroke

cerebral vascular accident; caused by issue in cerebral vessels; ischemic + hemorrhagic

ischemic stroke

blockage of cerebral artery (87% of strokes)

what is ischemic stroke from

thrombosis, embolus

ischemic stroke risk factor

hyptertension, smoking, a-fib, uncontrolled diabetes

atherosclerosis

plaque cracks —> blood clot forms over crack; can cause ischemia

atherosclerosis RF

HTN, smoking, high cholesterol

atrial fibrillation (afib)

atria fibrillate/cant pump blood properly

atrial fibrillation is a RF for?

RF for pulmonary embolism, heart attack, ischemic stroke

hemorrhagic stroke

rupture of cerebral artery (HTN emergency); 13% of all strokes

hemorrhagic stroke quality

“worst headache of my life”

hemorrhagic stroke RF

HTN (180+), berry aneurysm, trauma, age

if a young person has a stroke what type of stroke is it and what caused it?

hemorrhagic stroke by berry aneurysm (genetics)

stroke S/S (mnemonic)

BEFAST

balance (can you walk to the gurney? do you normally need help?)

eyes (fixed gaze, PERRL pupils, blurry vision)

facial droop (can you smile for me?)
arm drift (one arm droops down)

speech (dysarthria, dysphasia)

time (how long as this been going on?)

stroke S/S (not BEFAST)

sudden weakness/numbness in one side of body; dysphagia (difficulty swallowing), ALOC, sudden/severe headache; dizziness; tongue deviation

main: dysphagia, tongue deviation

left hemisphere

language/speech; aware of deficits (knows when something is wrong)

dysarthria

slurred speech

dysphasia

wrong words

dysphagia

difficulty swallowing

right hemisphere

spatial awareness; unaware of deficits (neglect)

transient ischemic attack (TIA)

stroke-like symptoms that resolve on its own in <24 hrs (can result in stroke in future)

conditions that mimic stroke

hypoglycemia, postictal state, sub/epidural bleeding, bell’s palsy

epidural bleeding

from direct blow to temporal lobe (sudden onset)

epidural bleeding s/s

unconscious —> conscious (lucid inferval) —> unconcious s

ubdural bleeding

gradual onset

bell’s palsy

paralysis/droop in upper face as well (stroke only in lower face)

cerebral hemorrhage caused by

high BP

cerebral hemorrhage causes

high BP

what meds can you NOT give for stroke

aspirin (could be hemorrhagic)

treatment for stroke

lay on paralyzed side in recumbant pos; support ABCs (OXYGEN ONLY GIVEN IF EXPERIENCING RESP DISTRESS/HYPOXIA); rapid transport to stroke center

seizures (3 types)

generalized, partial/focal, status epilepticus

generalized (tonic-clonic) seizure

involves both hemispheres

generalized (tonic-clonic) seizure S/S

unconsciousness + generalized, severe twitching of all muscles for <5 mins,

important: incontinence (loss of bladder control), tongue trauma

absence seizure

no motor changes, breif lapse of consciousness where patient stares, in children (~15 sec)

simple partial/focal on set aware seizure

no change in LOC, numbness, weakness, dizziness, visual changes, unusual smell/taste, twitching/brief paralysis

complex partial/focal on set, impaired awareness seizure

AMS, lip smacking, eye blinking, isolated jerking, experience unpleasant smells/visual hallucinations (fear)

aura

warning sign of impending seizure (esp focal seizures); visual auditory, olfactory

postical state S/S

tachypnea, hemiparesis (muscle weakness), lethargy, confusion/altered

what should you do when someone is in postical state

check blood glucose levels + buccal glucose if needed

status epilepticus

seizures that continue every few min w/o regaining consciousness OR last 30+ mins

febrile seizures

sudden high fevers in children; usually benign (no permanent/serious damage)

seizure treatment

protect from harm, maintain airway, PROVIDE OXYGEN

altered mental status S/S

A&Ox<3; confusion/lethargy, agitation/combativeness, delirium, anxiety/restlessness

delirium S/S

confusion/disorientation, disorganized thoughts, inattention, memory loss, changes in personality, hallucinations, delusions, declining LOC

AEIOU TIPS (why AMS?)

alcohol

epilepsy/electrolytes

insulin

opiates/drugs: bradytachea/pnea, pinpoint pupils

uremia (kidney failure): jaundice, dialysis

trauma, temperature: head trauma

infection: infected wound/fever —> sepsis

poisoning, psychogenic (shock)

shock, stroke, seizuer, syncope