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Neurologic EMT

NREMT Preparation

TermDefinition
STROKE Death to brain tissue due to an interruption in blood flow. Also called cerebrovascular accident (CVA) or "brain attack."
Ischemic Strokes Blood flow to the brain is compromised due to a blockage. Ischemic strokes are often due to atherosclerosis.
Hemorrhagic Strokes Caused by bleeding within the brain.
Signs and Symptoms of Stroke Severe headache, slurred speech Facial droop, drooling Unilateral (one-sided) numbness, weakness, or paralysis Altered level of consciousness, difficulty moving or walking Vision problems
Cincinnati Prehospital Stroke Scale- Elements ~ Facial droop Ask the patient to smile. Abnormal: facial droop is present.
Cincinnati Prehospital Stroke Scale- Elements ~ Arm drift Ask the patient to close eyes while holding arms out front, palms up. Abnormal: one arm drifts unintentionally.
Cincinnati Prehospital Stroke Scale- Elements ~ Speech Ask the patient to repeat a given sentence. Abnormal: speech is slurred, word choice is incorrect, or patient is unable to speak.
Assessment and Management of the Stroke Patient 1. Any patient with signs and symptoms of a stroke should be considered a high transport priority and taken to an approved stroke center per local protocol. 2. Protect patient from further harm during movement and transport.
TRANSIENT ISCHEMIC ATTACK (TIA) A. TIAs have the same presentation as a CVA. However, the signs and symptoms self-correct within about 24 hours with no permanent brain damage. B. TIAs are also called mini strokes. C. TIAs are a warning sign of an impending stroke.
SEIZURES Seizures are caused by disorganized electrical activity within the brain.
Types of Seizures Generalized seizures Also called grand mal seizures. Patient is unresponsive and experiences full-body convulsions.
Types of Seizures Absence seizures Also called petit mal seizures. Patient does not interact with environment, but there is no convulsive activity.
Types of Seizures Partial seizures Simple partial seizure: no change in level of consciousness (LOC); possible twitching or sensory changes, but no full-body convulsions
Types of Seizures Complex partial seizures: altered LOC; isolated twitching and sensory changes possible
Status epilepticus Prolonged seizure (about 30 minutes) or recurring seizures without the patient regaining consciousness in between Highly dangerous, possibly leading to permanent brain damage and death
Phases of a Seizure Not every stage is present for every type of seizure or every patient.
Aura phase This is the warning stage. The patient may sense onset of seizure.
Tonic phase Muscle rigidity Possible incontinence
Tonic-clonic phase Patient experiences uncontrolled muscle contraction and relaxation. Patient may be apneic during the tonic or tonic-clonic phase.
Postictal phase This is the "recovery" phase. Patient's LOC progressively improves over about 30 minutes.
Causes of Seizures Seizures can be caused by congenital problems, traumatic injuries, or medical conditions, including alcohol, brain injury, tumor, diabetic emergency, epilepsy, fever, infection, insulin or other medications, poisoning or toxic exposure, stroke, or biological or chemical weapons.
Febrile seizures are a common cause of seizures in pediatric patients. Caused by high fevers that develop rapidly, they do not typically present significant risk to the patient. The child should, however, be transported and evaluated by a physician.
Recognizing seizures Often, EMS providers will not arrive until the patient is in the postictal phase.
Question bystanders. Assess for incontinence, tongue biting. Obtain thorough history, medications, etc., when able.
Management of seizure patients If possible, position postictal patient in the lateral recumbent position to protect airway. If vomiting occurs while in cervical-spine precautions, tilt the long board.
SYNCOPE Syncope is fainting.
Syncope causes It is typically caused by a temporary loss of blood flow to the brain. Causes include cardiac emergency, hypotension, neurological problem, stress, diabetes, pregnancy, anemia, medications, and toxic exposure. Patients typically regain consciousness as soon as they are supine and blood flow returns to the brain.
Syncope- It is typically caused by a temporary loss of blood flow to the brain. Causes include cardiac emergency, hypotension, neurological problem, stress, diabetes, pregnancy, anemia, medications, and toxic exposure. Patients typically regain consciousness as soon as they are supine and blood flow returns to the brain.
Syncope Assessment and Management When in doubt, err on the side of caution and encourage treatment and transport for a patient experiencing a syncopal episode. Consider assistance from ALS providers or contact medical direction.
HEADACHE Headaches have many causes, some of them neurological.
Headache causes A few causes of headache include stroke, aneurysm, tumor, hypertension, migraines, trauma, and meningitis.
Signs and symptoms of possible medical emergency Headache include severe headache, hypertension, fever, stiff neck, neurological impairment, or recent trauma.
Assessment and Management Headache When in doubt, err on the side of caution and encourage treatment and transport for a patient with a headache. Consider assistance from ALS providers or contact medical direction.
How long of a window do you have in treating a stoke patient They should receive treatment within 3 hours
What is an important question to ask the family of a stroke patient When did the patient last appear normal.
Created by: ditchdoctech