Chapter 18 West Coast EMT

What is the 5th leading cause of death in the United States?

Stroke

Which ethnicities have a higher rise of stroke?

African Americans, Hispanics, and Asians

What are the 3 major parts of the brain? (fig 18-1)

1. Cerebrum

2. Cerebellum

3. Brain stem

Out of the three major parts of the brain, which is the larges?

Cerebrum

What are the 4 basic functions that the brain stem control?

1. Breathing

2. blood pressure

3. swallowing

4. pupil constriction

What does the cerebellum control?

Muscle and body coordination (including balance)

Each hemisphere of the cerebrum control ______ ______ of the body

opposite sides (ex: right side controls left)

What does the front part of the cerebrum control?

Emotion and thought

What does the middle part of the cerebrum control?

Sensation and movement

What does the back side of the cerebrum process?

Sight

Does the right or left side of the brain control speech?

Left

How many pairs of cranial nerves run directly from the brain to various parts of the body?

12 pairs

What is the large opening in the base of the skull where the spinal cord exits?

Foramen magnum

What are the three things that the brain is most sensitive to?

1. oxygen

2. glucose

3. temperature

What is a state of profound unconsciousness that may result in permanent brain damage?

Coma

What is the term for low glucose levels?

hypoglycemia

As an EMT, what is one of the most common complaints of pain you will hear?

Headache

What are meninges?

Membranes that cover the brain and spinal cord

What are tension headaches?

Caused by muscle contractions in the head and neck

What can attribute to tension headaches?

Stress

How do patients describe the pain of tension headaches?

squeezing, dull or an ache

True or False: Tension headaches do not require medical attention

True

How are migraine headaches caused?

Changes in blood vessel size in the base of the brain

Women are _____ times as likely as men to experience migrains

three

How do patients describe the pain of a migraine headache?

Pounding, throbbing, or pulsating

What are migraines typically associated with?

nausea/vomiting

Why type of "warning signs" can be a tell for migrains?

Flashing lights or partial vision loss

How long can migraines last?

hours to days

What are sinus headaches caused by?

pressure that is the result of fluid accumulation in the sinus cavities

Which headache will have patients reporting of "increased pain when they bend over or when their heads are moving forward"

Sinus headaches

What should you highly suspect if a patient says "This is the worst headache of my life"

Hemorrhagic stroke

What may indicate carbon monoxide poisoning?

An incident with multiple patients reporting a headache

Why is there severe headache with hemorrhagic stroke?

Blood from a ruptured blood vessel irritates the tissues of the brain causing increased intracranial pressure (ICP)

What three things should make you suspect hemorrhagic stroke?

1. Severe headache

2. seizures

3. altered mental status

What is bacterial meningitis?

A highly contagious bacterial infection causing inflammation of the meninges

What is the best definition of cerebrovascular accident (stroke)

An interruption of blood flow to an area within the brain that results in the loss of brain function

What is ischemia?

A reduction in blood supply that results in inadequate oxygen supplied to the brain cells

What is the difference between ischemic and hemorrhagic stroke?

- Ischemic is when blood flow through the cerebral arteris is blocked

- Hemorrhagic is when a blood vessel ruptures and the accumulated blood causes ICP in the brain

What is the single most common stroke accounting for 87% of all strokes?

Ischemic stroke

What is a broad definition of ischemic stroke?

When blood flow to a specific part of the brain is stopped by a blockage (blood clot) inside the blood vessel

What is the difference between a thrombus and embolus?

A thrombus is a clot that stays in place while an embolus is a clot that is dislodged and circulates in the bloodstream.

What is the term that describes a disorder in which calcium and cholesterol build up, forming plaque inside the walls of the blood vessels?

Atherosclerosis

How can atherosclerosis cause ischemic stroke?

It causes narrowing of an artery potentially causing a blood clot that can block oxygen from reaching the brain

Hemorrhagic stroke accounts for ___% of all strokes

13%

Which stroke is when a blood vessel ruptures and the accumulated blood then forms a blood clot which compresses the brain tissue next to it?

Hemorrhagic stroke

What type of symptoms put people at high risk for hemorrhagic stroke?

1. High blood pressure

2. long term untreated elevated blood pressure

Why is high blood pressure a risk for hemorrhagic stroke?

It weakens the blood vessels in the brain

What is an aneurysm?

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

What is a berry aneurysm?

weakness in an artery resembling a tiny balloon and often causes hemorrhagic stroke in young healthy patients

What is the space between the two coverings of the brain?

Subarachnoid space

Stroke like symptoms that are resolved on their own in less than 24 hours?

Transient ischemic attack (TIA)

What are common S/S of stroke?

1. Facial drooping

2. Lack of muscle coordination (ataxia)

3. slurred speech

4. Aphasia

What is aphasia?

Difficulty expressing/understanding thoughts or ability to use right words

What is dysarthria?

Slurred speech

What occurs when stroke affects the LEFT cerebral hemisphere?

1. Speech disorders (Aphasia)

2. Paralysis of the right side of the body

What occurs when stroke affects the RIGHT cerebral hemisphere?

Loss of muscle coordination on left side of the body

With bleeding in the brain, why does blood pressure increase?

An attempt to force more oxygen to the damaged area

What is a postictal state?

Period following a seizure that lasts between 5 and 30 minutes

What characterizes the posticatal state?

Labored respirations and some degree of altered mental status

What is a leathery covering of the brain that lies next to the skull?

Dura

What type of bleeding is slower, epidural or subdural bleeding?

Subdural

What defines the lucid interval with epidural hemorrhage?

Normal mental status that deteriorates within minutes to hours

What is the term for an unknown seizure?

Idiopathic

What is a generalized seizure?

abnormal neuronal (electrical) activity on both sides of the brain

What is a generalized seizure characterized by?

Unconsciousness and generalized severe twitching of the body's muscles

What is a generalized-onset absence seizure?

When a patient has periods of staring and not responding to anyone

What is the term that describes a "warning signs" before a seizure? (flashes or hallucinations)

Aura

What is the difference between a tonic and clonic period of a seizure?

1. Tonic - sudden muscle stiffening, loss of consciousness, and falling, typically lasting 10-20 seconds

2. Clonic - rhythmic, jerking muscle contractions, usually lasting 1-2 minutes

What is status epilepticus?

Seizures that continue every few minutes without the person regaining consciousness or that last longer than 30 minutes

What are the 4 common causes of seizure?

1. Epileptic (congenital)

2. Structural (tumor)

3. Metabolic (hypoxia)

4. Febrile (high fever)

What are the medications for seizures?

1. Levetiracetam (Keppra)

2. Phenytoin (Dilantin)

3. Phenobarbital

4. Carbamazepine (Tegretol)

5. Valproate (Depakote)

6. Topiramate (Topamax)

7. Clonazepam (Klonopin)

What is a febrile seizure?

Seizure caused my high fever that is primarily found in children

What is incontinence?

Loss of bowel or bladder control

What is hemiparesis?

Weakness on one side of the body, resembling stroke

True or False: Syncope (fainting) is associated with seizures

False

True or False: Patients with decreased level of consciousness should NOT be given anything by mouth

True

What should you always consider in a patient with an altered or decreased level of consciousness?

Hypoglycemia

What is the mnemonic AEIOU TIPS?

A Alcohol

E Epilepsy, Endocrine, Electrolytes

I Insulin

O Opiates and other drugs

U Uremia (kidney failure)

T Trauma, Temperature

I Infection

P Poisoning, Psychogenic causes

S Shock, stroke, seizure, syncope

Is delirium a symptom or a disease

Symptom

Children having what disorder puts them at higher risk for ischemic stroke?

Sickle cell anemia

What signs will you see in a postictal state?

1. Rapid/deep respirations

2. fast hearth rate

Which part of patient assessment would you apply the SAMPLE mnemonic?

History taking

Which part of patient assessment would you gather a complete set of vital signs?

Secondary assessment

What is the BE FAST mnemonic for stroke assessment?

B Balance

E Eyes

F Facial droop (ask patient to show teeth or smile)

A Arm drift (ask patient to close eyes and hold both arms out)

S Speech

T Time

What does a cincinnati prehosptial stroke scale test?

1. Facial droop

2. Arm drift

3. Speech

What does the LAG scale test?

Level of consciousness

Arm drift

Gaze

What is the only reliable way to tell if there is bleeding in the brain?

A CT scan of the head

What is treatment for patients with status epilepticus?

1. suction airway

2. Apply bag mask ventilations

3. rapid transport

4. If possible rendezvous with ALS

True or False: It is okay to use lights and sirens for a patient with a migraine

False

What is fibrinolytic therapy?

Blood clot dissolving drugs that may reverse stroke symptoms

True or False: NEVER attempt to tightly restrain a patient experiencing a seizure

True

Is any type of altered mental status an emergency?

Yes, and always needs immediate attention

True or False: The brain and skull sense pain

False; it's the nerves and meninges etc

Where is CSF in the meninges?

In the subarachnoid space

Describe the dura mater

Thick membrane (outermost layer)

Describe arachnoid matter

middle layer, thin web-like

Describe pia matter

Delicate layer and innermost layer

What is cushings triad?

1. Irregular respirations

2. Bradycardia

3. Hyper tension

What is Bell's palsy?

A condition that causes sudden, temporary weakness in the facial muscles on one side of your face

What is another term for petit mal?

Absence seizure