Chapter 18: Neurologic Emergencies

Key Topics

• Anatomy and physiology of the nervous system
• Common neurologic disease processes: strokes, seizures, headaches, altered mental status
• Assessment and management of neurologic emergencies
• Stroke: significance, causes, signs, symptoms, and types
• Seizures: causes, types, and emergency care
• Altered mental status: causes and emergency care

Anatomy and Physiology of the Nervous System

• Brain as the body's computer
  • Controls breathing, speech, and other body functions
  • Three major parts: brain stem, cerebellum, cerebrum
• Cerebrum: largest part, divided into right and left hemispheres
  • Controls activities on opposite sides of the body
  • Front: emotion and thought
  • Middle: sensation and movement
  • Back: sight
  • Speech: controlled on the left side
• Brain stem: controls basic functions such as blood pressure, breathing, swallowing
• Cerebellum: controls muscle and body coordination

Pathophysiology

• Disorders can affect consciousness, speech, voluntary muscle control
• Sensitive to: oxygen, glucose, temperature

Common Neurologic Conditions

Headaches

• Tension headaches: muscle contractions in the head/neck, stress-related
• Migraine headaches: changes in blood vessel size, associated with nausea, vomiting
• Sinus headaches: pressure from fluid in sinus cavities

Stroke

• Ischemic stroke: most common, due to thrombus/emboli
• Hemorrhagic stroke: bleeding inside the brain, high-risk with high blood pressure
• TIA (Transient Ischemic Attack): stroke-like symptoms resolve within 24 hours

Signs and Symptoms of Stroke

• Facial drooping, sudden weakness, decreased sensation, lack of coordination, vision loss
• Left hemisphere stroke: aphasia, paralysis of right side
• Right hemisphere stroke: paralysis of left side, slurred speech

Seizures

• Generalized seizures: tonic-clonic, unconsciousness, severe muscle twitching
• Absence seizures: brief lapse of consciousness
• Focal seizures: affect specific part of the brain, may involve altered awareness
• Status epilepticus: prolonged seizures, life-threatening

Altered Mental Status

• Causes: hypoglycemia, hypoxia, intoxication, head injury, metabolic disturbances

Patient Assessment for Neurologic Emergencies

• Scene size-up: determine medical/trauma, ensure safety
• Primary assessment: rapid exam, establish priorities
• History taking: gather from family/bystanders, look for signs of altered mental status
• Vital signs: check for slow pulse, high blood pressure, unequal pupil size

Stroke Assessment Tools

• BE FAST mnemonic: Balance, Eyes, Facial droop, Arm drift, Speech, Time
• Cincinnati Pre-hospital Stroke Scale: facial droop, arm drift, speech
• Glasgow Coma Scale: assess consciousness

Emergency Medical Care

Stroke

• Support ABCs, rapid transport to stroke center
• Notify hospital about last normal status

Seizures

• Protect from harm, maintain airway, provide oxygen
• Status epilepticus: suction airway, provide ventilations, transport quickly

Headaches

• Assess for serious conditions, provide O2 if tolerated, transport without lights/sirens

Altered Mental Status

• Determine cause, provide spinal immobilization, support ABCs

Review Questions

• Understanding of neurologic emergencies, including signs, symptoms, and treatments
• Tests and scales to assess stroke and level of consciousness

Conclusion

• Neurologic emergencies require careful assessment and rapid intervention
• Effective use of stroke scales and patient history can aid in quicker diagnosis and treatment

Note: This summary covers the key points from the lecture on Chapter 18, providing a comprehensive overview of neurologic emergencies and their management.