Chapter 18 Neurological Emergencies Assessment in Action

You are dispatched to a residence for a patient with a headache. You arrive to find a 68-year-old man sitting up in a recliner in the living room, but he is leaning slightly to the left. His wife reports he had a sudden headache about 1 hour ago. As you assess the patient, you notice that his speech is slurred and he is not moving his left side. You ask the patient to lift his left arm; he lifts his right instead. You also note a left-sided facial droop. A check of his vital signs shows a pulse of 100 beats/min, a blood pressure of 188/110 mm Hg, and respirations of 22 breaths/min. His past medical history includes poorly controlled diabetes and hypertension. He reports a blood glucose level of 70 mg/dL. As you prepare for transport, the patient experiences a generalized seizure.

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1. On the basis of the patient's condition, what should you be most concerned with?

A. Maintaining the ABCs

B. Determining the type of stroke C. Administering oral glucose

D. Performing further assessment

Maintaining the ABCs

2. The patient was exhibiting slurred speech, facial droop, and an inability to move his left arm. Which neurologic examination emphasizes these possible stroke signs?

A. Chicago Prehospital Stroke Scale

B. Philadelphia Stroke Scale

C. Cincinnati Prehospital Stroke Scale

D. Camden Stroke Scale

Cincinnati Prehospital Stroke Scale

3. Which of the following occurs when blood flow to a particular part of the brain is cut off by a blockage resulting in tissue damage?

A. Ischemic stroke

B. Hemorrhagic stroke

C. Seizure

D. Status epilepticus

Ischemic stroke

4. What is the name of the condition when the patient forgets about the injured side after a stroke?

A. Hemiparesis

B. Neglect

C. Aphasia

D. Ataxia

Neglect

5. The patient in this scenario experienced a seizure. What criteria must be met for this patient to have status epilepticus?

A. A seizure lasting greater than 30 minutes

B. A seizure that was preceded by an aura

C. The presence of incontinence during the seizure

D. Multiple seizures with normal consciousness between each event

A seizure lasting greater than 30 minutes

6. Which of the following is a metabolic cause for a seizure?

A. Brain tumor

B. Head trauma

C. Hypoglycemia

D. Brain abscess

Hypoglycemia

This patient appears to be suffering from a stroke and a seizure. What condition mimics a stroke and also causes a seizure?

A. Meningitis

B. Postictal state

C. Hypoglycemia

D. Migraine headache

Hypoglycemia

8. Describe how to use the Cincinnati Prehospital Stroke Scale.

Have the patient smile and frown; have the patient hold his arms out with palms up and eyes closed; have the patient repeat the sentence, "The sky is blue in Cincinnati."

9. What is the difference between a stroke and a transient ischemic attack?

Stroke is a loss of brain function in certain brain cells that do not get enough oxygen resulting in permanent damage. A TIA is a disorder of the brain in which brain cells temporarily stop functioning because of insufficient oxygen, causing stroke-like symptoms that resolve within 24 hours of onset. 1

10. Explain why it is important to determine the time when the patient was last seen normal.

Stroke patients who receive treatment within the first few hours of the onset of stroke symptoms have a much greater chance of surviving and avoiding long-term brain damage. Patients with ischemic strokes, the most common type of stroke, may be candidates for treatment with tissue plasminogen activator (tPA), but this drug must be given within the first few hours after a stroke; ideally within the first hour of arrival in the ED to have the best chance of reversing the symptoms. Therefore noting the time of symptom onset and transporting to a stroke center are crucial steps because the time helps determine whether the treatment can be administered, and transport to a stroke center ensures the patient is delivered to a facility that can deliver the specific treatment.