Chapter 18: Neurologic Emergencies - Emergency Care and Transportation

Key Objectives

• Understand the significance of anatomy and physiology of the nervous system.
• Recognize common diseases like strokes, seizures, headaches, and altered mental status.
• Learn assessment and care management for neurologic emergencies.
• Understand stroke as a leading cause of death and disability.

Anatomy and Physiology of the Nervous System

• Brain Parts:
  • Cerebrum: Largest part, divided into hemispheres, controls opposite body sides.
    • Controls emotion, thought, sensation, movement, and vision.
  • Cerebellum: Controls muscle and body coordination.
  • Brain Stem: Controls basic functions like blood pressure, breathing, and pupil constriction.
• Nerves and Spinal Cord:
  • 12 cranial nerves from brain to head.
  • Spinal cord exits through foramen magnum, nerves branch out from vertebrae.

Pathophysiology

• Brain dysfunction affects consciousness, speech, and muscle control.
• Sensitive to changes in oxygen, glucose, and temperature.

Common Neurologic Conditions

• Headaches:
  • Tension, migraine, and sinus headaches are common.
  • Serious conditions include hemorrhagic stroke, brain tumor, meningitis.

Stroke (Cerebrovascular Accident - CVA)

• Types of Stroke:

  • Ischemic Stroke: Most common (87%).
    • Caused by thrombus or emboli, often due to atherosclerosis.
  • Hemorrhagic Stroke: Accounts for 13%, involves brain bleeding.
    • High risk in stress, exertion, and high blood pressure.
  • Transient Ischemic Attack (TIA): Warning sign for potential stroke.

• Signs & Symptoms:

  • Facial drooping, sudden weakness, numbness, balance loss, vision issues.
  • Aphasia, slurred speech, confusion, headache.
  • Left hemisphere stroke: Aphasia, right-side paralysis.
  • Right hemisphere stroke: Slurred speech, left-side paralysis, neglect.

Seizures

• Types of Seizures:

  • Generalized Seizures: Tonic-clonic, involves unconsciousness and severe twitching.
  • Absence Seizures: Brief lapse of consciousness.
  • Focal Seizures (Partial): Awareness changes, may affect senses, emotions, or movement.

• Postictal State:

  • After seizure, characterized by flaccidity, labored breathing, confusion.

Altered Mental Status

• Causes include hypoglycemia, hypoxia, intoxication, infections, trauma.

Patient Assessment

• Scene Size-up: Determine medical vs. trauma, ensure safety.
• Primary Assessment: Rapid exam, focus on life-threatening issues.
• History Taking: Gather information from bystanders or family.
• Vital Signs: Monitor pulse, blood pressure, respirations, glucose levels.

Stroke Assessment Tools

• Scales: BE FAST, Cincinnati Pre-Hospital Stroke Scale, LAMS.
• Glasgow Coma Scale: Measures eye, verbal, motor responses.

Treatment and Management

• General Care: Support ABCs, rapid transport, monitor vitals.
• For Stroke: Determine and communicate last normal signs, consider fibrolytic therapy.
• For Seizures: Protect the patient, airway suction, oxygen.
• For Headaches: Assess for serious conditions, provide comfort measures.

Review Questions

• Assessment questions testing knowledge on diagnosing and managing stroke, seizures, and altered mental status.