Altered Mental Status // Neurological Emergencies

Aneurysm

Ballooning of a weakened portion of an arterial wall

-Note: An aneurysm is NOT mean a leaking vessel.

-Prone to bursting

CVA Meaning

Cerebrovascular accident; stroke

Ischemic Stroke

A type of stroke that occurs when the flow of blood to a certain part(s) of the brain.

~75-85% of strokes are these

Hemorrhagic Stroke

Occurs when a blood vessel in the brain leaks, can be caused by an aneurism. Massive blood loss.

-May see Cushings Triad as pressure builds (ICP)

Ischemic Stroke Risk Factors

Embolism/thrombosis, high cholesterol.

Cushing's Triad

Sign of ICP

-High blood pressure

-widening pulse pressure

-projectile vomiting

-Erratic respirations (cheyne-stokes)

-Bradycardia/lowering pulse rate

Hemorrhagic Stroke Risk Factors

Hypertension, diabetes, smoking

How can you tell the difference between an ischemic and hemorrhagic stroke?

Hard to in field, needs heat CT for definitive diagnosis.

Is TPA given for hemorrhagic strokes? If so, within how many hours?

It is not given

Is TPA given for ischemic strokes? If so, within how many hours?

It is given for ischemic, within 3 hours of symptom onset.

S/S of stroke

Asymmetry, facial droop, BP different on arms, unequal pupils, may appear drunk, headache

Note: A patient may have one of these symptoms, or maybe none.

Stoke Care

Mainly supportive

-Elevate head 8 to 10 inches if BP is good. Place on side to protect airway. Some stroke patients may have dysphagia, and may have lost some or all ability to swallow.

Cincinnati Stroke Scale

Facial droop, arm drift, slurred speech

TIA stands for:

Transient ischemic attack

What is a TIA?

A mini stroke

-Similar S/S of a stroke but person returns "normal" within about 24 hours (no long lasting effects)

-Can be a partial blockage that resulted in ischemia, or the blockage broke away

-TIA's are often precursors to CVA's

What is a seizure?

Temporary abnormal electrical activity of the brain

-Seizure is generally not considered a non-life threatening event as long as airway remains patent.

Seizure causes

low/high sugar, low/high temperature, trauma to the brain, cancer in brain, vision into the brain, smells, swelling of brain, drugs, lack of O2, acids in brain, high BP, infections of brain, or congenital abnormalities.

-Anything that can get into the brain can cause a seizure

Grand Mal Seizure (tonic-clonic)

Full body contractions, may urinate and defecate on self, lasts about 45 seconds to 2 minutes

-Major problem is patient is not breathing during that time

Focal Seizure (partial seizure)

Isolated area only, not the entire body

Petit Mal Seizure

Also called absence attack. A seizure that is characterized a loss of awareness and inability to recall events surrounding the seizure. The seizure does not include convulsing

Postictal State

A period following a seizure that lasts between 5 and 30 minutes; a state of decreased/altered mental status following a seizure

Seizure Care

Protect the patient from injury, maintain an open airway (recovery position as needed), do NOT put anything in the mouth

Most common reason adults have seizures

Not taking medications

Most common reason children have seizures

Febrile seizure

When are seizures concerning?

Typically not medical emergency especially if patient has a history of seizures. Things you should ask after someone has a seizure:

-Have you had seizures before?

-If you have a history of seizures, was there anything different about this seizure? (typically would have to ask a family member who knows their seizures)

-Has your prescription changed? Have you been taking your medicine?

Causes of AMS

Anything that can cause a seizure, can also cause AMS

-Typical first cause is hypoxia so give O2, other common causes could be hypoglycemia

AMS Care

Always protect airway, place in recovery to prevent aspiration