Altered mental status

Seizure

A sudden episode of abnormal, irregular electrical activity in the brain that temporarily disrupts normal brain function

Absence (Petit mal) seizure (generalized)

A brief (~10 seconds) loss of awareness with a blank stare

• No convulsions

• May occur hundreds of times per day

Simple partial seizure

One body part jerks / tingles; consciousness intact

Can progress into tonic clonic

Complex partial seizure

Staring, lip smacking, aimless movements, no memory afterward

often mistaken for intoxication

Tonic clonic seizure

Loss of consciousness + whole body convulsions

3 phases of tonic clonic seizures

Tonic: Body rigid, up to 30 seconds

Clonic: Violent jerking, 1-2 minutes

Postical: Seizure stops, patient regains consciousness but may be confused, drowsy, or combative

Generalized tonic clonic seizure

Seizure involving the entire brain, causing loss of consciousness and major whole body motor activity

Most common cause of seizures in infants and young children

High fever

Status epilepticus

Two or more convulsive seizures in a row OR one seizure lasting >10 minutes

HIGH PRIORITY EMERGENCY

What do you do during convulsive seizures

Protect patient from injury, remove dangerous objects, loosen restrict clothing, DO NOT RESTRAIN THEM

What should you never put in a seizing patients mouth, what is your priority immediately after a seizure ends

NEVER PUT ANYTHING IN A SEIZING PATIENTS MOUTH

first priority after seizure ends is AIRWAY

Aura

A sensation that may precede a seizure such as an unusual smell, sound, or feeling

Two types of generalized seizures

Absence & tonic clonic

Two types of partial (focal) seizures

Simple partial & complex partial

Difference between simple partial and complex partial seizures

Simple partial: Consciousness is preserved, one part of the body may tingle, stiffen, or jerk

Complex partial: Altered awareness / behavior, staring, lip smacking, fidgeting, aimless movement, usually no memory afterward

Stroke

Death or injury of brain tissue caused by oxygen deprivation

Ischemic vs Hemorrhagic stroke

Ischemic - Blood vessel is blocked by a thrombus or embolus

Hemorrhagic - Blood vessel ruptures and bleeds into the brain

BEFAST

Balance

Eyes

Face

Arms / Legs

Speech

Time

Aphasia

Difficulty communicating due to brain damage

Expressive vs receptive aphasia

Expressive: Patient knows what they want to say but cannot produce the correct words

Receptive: Patient cannot understand what you’re saying

TIA

Transient Ischemic Attack - Temporary stroke like symptoms, caused by temporary blockage, symptoms resolve traditionally within 24 hours

Syncope

A brief loss of consciousness with spontaneous recovery

Orthostatic hypotension

A significant drop in blood pressure when changing position

Laying down different than sitting / standing = inadeuqate circulating volume