Module 6 Exam Review Part 3

Overview

• Focus on altered mental status, strokes, seizures, syncopal episodes, and diabetic emergencies.
• Quick review due to less in-depth topics.

Altered Mental Status (AMS)

• Recognize AMS as a potential life-threatening situation.
• Symptoms: confusion, unresponsiveness, responsive only to stimuli.
• Management:
  • Take C-spine precautions if necessary.
  • Manage ABCs: Airway, Breathing, Circulation.
  • Reassess every 5 minutes, check for changes in mental status.

Stroke

• Deficiency in nervous system function; neurological deficit.
• FAST Mnemonic:
  • F: Facial droop
  • A: Arm drift
  • S: Slurred speech
  • T: Time (last seen normal, time to hospital)
• Types of Stroke:
  • Ischemic (blockage/clot)
  • Hemorrhagic (rupture/bleed)
• Management:
  • Get to a hospital with a cath lab.
  • Do not give aspirin.
  • Differentiate from Transient Ischemic Attack (TIA); symptoms resolve in <5 minutes.
  • Use Cincinnati Prehospital Stroke Scale.

Headaches

• Types: cluster, tension, migraine.
• Not heavily tested but review for National Registry.

Seizures

• Sudden alteration in brain function due to electrical discharges.
• Types: Primary (genetic/unknown) and Secondary (underlying cause).
• Status Epilepticus: Life-threatening, continuous seizures >5 minutes.
• Management:
  • Protect from injury, do not restrain.
  • Check blood glucose levels.
• Tonic-Clonic Seizures:
  • Tonic (muscle tone) and Clonic (convulsion).
  • Postictal state: recovery phase, altered mental status.

Syncope (Syncopal Episode)

• Temporary loss of consciousness (fainting).
• Differentiate from seizures via patient history and witness accounts.
• Management: similar to AMS, ensure supine position.

Diabetic Emergencies

• Importance of glucose for cell function.
• Types of Diabetes:
  • Type 1: Insulin-dependent, prone to Diabetic Ketoacidosis (DKA).
  • Type 2: Insulin-resistant, managed through diet/exercise.
• Hypoglycemia:
  • Low blood sugar, leads to AMS, pale/cool/clammy skin.
  • Check blood glucose and administer oral glucose if conscious.
• Hyperglycemia/DKA:
  • High blood sugar, lack of insulin usage.
  • DKA involves production of acidic ketones.
  • Symptoms: dehydration, Kusmaul respirations.

Key Points

• Thoroughly assess and manage ABCs in all cases.
• Reassess patients frequently to monitor changes.
• Review additional material for National Registry exam.