Neurologic and Behavioral Emergencies Lecture Notes

Introduction

• Focus on neurologic emergencies and behavioral emergencies.
• Interactive teaching approach; expects student discussion.
• Importance of pre-reading chapters for effective discussion.

Neurologic Emergencies Overview

• Key Conditions: Strokes, seizures, syncope.
• Assessment of Consciousness:
  • Use AVPU (Alert, Verbal, Pain, Unresponsive) scale before GCS.

Neurologic Anatomy Review

• Brain Parts:
  • Brainstem: Controls breathing, located at lower brain.
  • Cerebrum: Largest part, not deeply focused here.
  • Foramen Magnum: Pathway for spinal cord.

Conditions and Symptoms

Decreased Level of Responsiveness

• Use AVPU to assess.

Headaches

• When to worry: Sudden, severe, associated with other symptoms.
• Types:
  • Tension: Stress-related.
  • Migraine: Pounding, often with nausea.
  • Sinus: Pressure-related.

Strokes

• Importance: 5th leading cause of death, leading cause of adult disability.
• Types:
  • Ischemic (87%): Caused by thrombosis or embolus.
  • Hemorrhagic (13%): High mortality, often results in altered consciousness.
• Risk Factors: High BP, stress, aneurysms, TIAs as warning signs.
• Signs: Facial droop, weakness on one side, speech difficulties.
• Assessment: FAST exam (Face, Arms, Speech, Time).

Seizures

• Types:
  • Generalized (Tonic-Clonic): Loss of consciousness, severe twitching.
  • Absence: Brief lapse in consciousness.
  • Partial: Localized symptoms, consciousness may be retained.
• Common Causes: Epileptic, stroke-related, head trauma, metabolic issues.
• Postictal State: Confusion/lethargy following a seizure.
• Status Epilepticus: Continuous or repeated seizures without recovery.

Assessment and Response

Key Initial Assessments

• Neurologic Patients:
  • Oxygen, blood glucose, temperature.
  • Blood sugar range: 80-120, important for detecting hypoglycemia.

Handling Seizures

• Protect patient during seizure, maintain airway, provide oxygen.
• Consider status epilepticus if seizures continue.

Syncope (Fainting)

• Usually occurs when standing; no postictal phase.
• Differentiate from seizures based on recovery.

Altered Mental Status

• Assessment Tool: AEIOU TIPS (Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psych, Stroke, Seizure).
  • Important to assess scene, medications, and potential causes.

Scene Management

• Assess Environment:
  • Be observant for clues about patient’s condition (e.g., alcohol, medications).
  • Scene safety is critical, especially with altered mental status or potential violence.

Reassessment and Documentation

• Regularly reassess ABCs and vital signs.
• Document findings and trends for effective communication to receiving facilities.

Transport Considerations

• Strokes: Transport to stroke-capable centers if available.
• Seizures: Manage safety, monitor if postictal, transport if necessary.

Conclusion

• The focus is on supporting ABCs, knowing the signs and symptoms, and proper assessment and documentation.
• Continuous learning and adaptation to field experience is crucial for handling neurologic emergencies.