Prehospital Disease Processes

The Nervous System.

what is another name for a stroke?

Cerebrovascular accident

CVA

cerebrovascular accident

what is the occurence of a stroke

blood supply to a part of the brain is interrupted or significantly reduced

what can a stroke lead to?

damage or death of the brain tissue leading to imparted or loss of function

what is in constant supply or need for in the brain?

oxygenated and glycose-carrying blood

with interruption of blood flow what are the two primary causes?

ischemic and hemorrhagic stroke.

whats an ischemic stroke?

blood vessel supplying the brain becomes blocked or narrowed

what is the most common type of stroke?

ischemic stroke

whats a thrombus

blood clot

what is a thrombotic stroke

where a blood clot forms inside the brains blood vessesl

what is a embolic stroke

where a blood clot is formed in the body and travels to the brain

what is a haemorrhagic stroke

when a blood vessel in the brain ruptures leading to bleeding within or around brain tissue

what is the percentage of ischemic stokes

80%

what is the percetage of haemorrhagic strokes

20%

what is the more sever stroke out of ischemic and haemorrhagic strokes?

haemorrhagic stroke

Transient ischemic attack (TIA)

temporary disruption of blood flow to the brain

TIA

Transient ischemic attack

what is the recovery time of a TIA stroke

minuites to a few hours

what are some risk factors that can increase the likelihood of experiencing a stroke

hypertension, diabetes, high cholesterol, smoking, obesity, heart conditions.

what are the common sings and symptoms of a stroke?

Sudden weakness or numbness in the body, slurred speech, facial drooping, severe headache, dizziness, balance and coordination loss, changes in vision

F A S T (stroke)

Face drooped, Arms cant be raised, Speech slurred or confused, Time is critical.

is it appropritae to refer a patient to a GP if they are showing signs or a stroke

no, refer to ED

what is the medication used to dissolve a blood clot? for an ischemic stroke

Thrombolytics

what is a hospital treatment when for an ischemic stroke

clot retrieval via surgery or medications to dissolve blood clot

what interventions need to be done when experiencing a haemorrhagic stroke

surgery to repair bleeding blood vessel

what is a seizure

sudden excessive and uncontrolled electrical activity in the brain that disrupts normal function

what is characteristi symptoms of a siezure?

convulsions, altered consciousness, sensory disturbances

what are some symptoms a aptient can feel just after a seizure has subsided

tired, confused, possible postictal phase

whats ictal in a medical term?

seizure

what is the most severe seizures? and why?

generalized seizures, is covers both hemispheres of the brain

absent seizure

brief loss of awarness, staring and subtle movements, lip smaking or blinking

what age bracket in absent seizures are most common

children

tonic seizure

muscle stiffness in arms, legs, back.

clonic siezures

rhythmic jerking movements of muscles in typical face, neck arms

myoclonic seizure

sudden breif muscles twitches or jerks

atonic seizures

sudden loss of muscle tone, causing collapse or falls (drop attack)

tonic-clonic seizure

combination of the two, muscle stiffness and jerking, loss of consiousness, convulsions, breathing difficulty

epilepsy

neurological disorder charicteristed by recurrent seizures

what factors can cause a seizure

brain injury, infections, genetic conditions, tumors, drugs and alcohol withdrawal, high fever in kids, metabolic imbalances

febrile seizures

high fever induced seizure in kids often due to viral or bacterial illness

epilepsy triggers

high temp, drug or alcohol, head injury, hypoglycemia, electrolyte disturbance (illness, dehydration, vomiting, diarrhoea)

result of a seizures with conditions like….

epilepsy, traumatic brain injury or stroke, tumours in brain, infection

what are the antiepileptic medications

carbamazepine (tegretol), phenytoin (dilantin), sodium valpoate (epilim) levetiracetam (keppra)

what is the prehospital treatment to reduce a febrile seizure

reduce patient temp

whats the pre-hospital treatment for a hypoxic seizure

oxygen therapy

Pre-hospital care for a hypoglycaemic seizure

increase blood sugar

What medications can we use in an out of hospital environment for tonic clonic seizures?

medazolam

what type of medication is medazolam

benzodiazepine, CNS depressant

What does medazelam do?

muscles go limp

TBI

traumatic brain injury

closed head injury

no penetration of the skull

open head injuries

penetration or fracture of the skull

brain truama is a consiquence of what

sudden acceleration or deceleration within the cranium

focal brain injuries

involve a specific area or localized damage within the brain

hematoma

collection of blood

laceration of the brain

tearing of brain tissue

focal axonal injuries

damage to nerve fibres

examples of focal brain injuries

contusions, hematomas, lacerations, focal axonal injuries

contusions of brain

brusies

diffuse brain injuries

widespread damage to the brain affecting multiple areas

diffuse axonal injury

damage to the brains connecting nerve fibres

concussion

temp disruption of brain function interfering with concentration, memory, balance, coordinations and causing headaches

oedema

excess watery fluids in cavities or tissues in the body

what can cause a concussions

violent shakes of the head, blows to head, hitting surfaces in fall

what is the name for a syndrom related to of concussion in babies

shaken baby syndrome

chronic traumatic encephalopathy

a progressive degenerative brain disease linked to repetitive head impacts

what conditions can appear after repeated exposure to head injuries/ concussions

anger, depression or anxiety, increased risk of neurodegenerative conditions such as alzeimers and parkinsons disease

physical symptoms of a mild TBI

headaches, diziness, nausea and fatigue

physical symptoms of moderate TBI

worsening/persistent headaches, repeat vomiting or nausea, seizures, confusion, lasting fatigue

physical symptoms of a severe TBI

cognitive and behavioral function, loss of consiousness, profound confusion or disorentation, severe headache with no subside, repeated vomiting or nausea, seizure, loss of coordination, slurred speech, persistent agitation, cognitive imparement

what is the initial managment of a TBI

airway, breathing and circulation to prevent secondary brain injury, then pain management, stabalization of potential fractures.

spinal cord injury SCI

damage or trauma to the spinal cord

what are some non traumatic SCI

spinal cord compression from herniated discs, tumors, infection, inflammation

what % is incomplete SCI

60-70%

whats an incomplete SCI

not a total loss of neural function past lesion

paraplegia

damage to the thorasic, lumbar or scral are of spine. loss of movement and sensation in both legs and sometimes torso

tetraplegia (quadripleagia)

damage in the cervical area and refers to the loss of movement and sensation in all four limbs

flexion injury

the head or neck are forced forward staining the spinal cord

compression injury

spinal cord compressed or squeezed due to external forces

hyperextension injury

neck is excessively extended

flexion rotation injury

twisting or excessive rotation of spinal cord

penetration injury

foreign object penetrates the spinal cord

distraction injury

excessive force is applied, stretcing or pulling spine apart

autonomic dysreflexia

spinal cord indury at T6 or above with an abnormal exaggerated response of the ANS

what process happens with the ANS in autonomic dysreflexia

sensory impulse is transmitted from organ to the spinal cord but cannot pass the point of injury to the brain, sympatheitc neurons trigger a response rising blood pressure and heart slows down to normalie pressure

what are some risks with autonomic dysreflexia

seizures and internal haemorrhages

what drug can help lower blood pressure with autonomic dysreflexia

GTN glycerol trinitrate

how to identify a SCI

1. mechanism of injury

2. neck or back pain

3. loss of sensations or movement

4. difficulty breathing

5. abnormal position of neck or head

6. loss of bowel or bladder control

initial managment of SCI

supportive care: stabilize spine, breathing and circulation

what can cause meningititis

fungal or parasitic infection

what can cause bacterial meningitis

meningococcus. pneumococcus haemophilus influenzae type b, E.coli and group b strep and tuberculosis

meningococcal septicaemia

multiplies in the blood, damaging the walls of blood vessels and causing bleeding into the skin and organs leading to skin and tissue damage, limb loss and organ failure

key characteristic of meningococcal septicaemia

non blanching rash- blood is outside the cardiovascular system

identification of meningitis or meningococcal disease

sudden high fever, severe headache, stiff neck, photophobia, altered mental status, nausea and vomiting, skin rash, tiredness, muscle and joint pain, rapid breathing, cold extremities

what is the managment of meningitis or meningococcal disease

antibiotic treatment intravenously, pain management, hydration IV fluids, and use of antipyretic medications such as paracetamol

what are the classes of drugs that act to inhibit the CNS

benzodiazepines and opiates

opiates

binds to opiate receptors throughout CNS inducing modulation of pain transmittion (block pain signs getting to brain)

what are the dose dependent side effects of opiates

euphoria, hallucinations, decreased consious state, CNS depression

what are some drugs classed as opiates

heroin, morphine, codeine, oxycontin (after surgery strong pain relief)

benzodiazepine

CNS depressant drug common to treat anxiety