Neurological Emergencies. 4 Dr. Maha Al Sedik 2015 Medical Emergency I.

Neurological Emergencies. 4

Dr. Maha Al Sedik2015Medical Emergency I

Neurological Emergencies

Headache

Stroke

ComaStatus epileptics

seizure

is a state of unconsciousness in which a person: cannot be

awakened; fails to respond normally to painful stimuli, light, or

sound; and, does not initiate voluntary actions.

Coma

Coma

Pathophysiology:

History of present illness is vital to determine the underlying

cause.

Determine when the patient was last seen normal.

Evaluate the speed of onset.

is a neurological scale that aims to give a reliable recording about

the conscious state of a person.

A patient is assessed against the criteria of the scale, and the

resulting points give a patient score between 3 (indicating deep

unconsciousness) and15.

Glasgow Coma Scale (GCS)

Best eye response (E)

Best verbal response (V)

Best motor response (M)

4 Eyes opening spontaneously

5 Oriented 6 Obeys commands

3 Eye opening to speech

4 Confused 5 Localizes to pain

2 Eye opening in response to pain

3 Inappropriate words 4 Withdraws from pain

1 No eye opening 2 Incomprehensible sounds 3 Abnormal Flexion

1 None 2 Abnormal Extension

1 No motor response

Glasgow Coma Scale (GCS)

brain injury is classified as:

Severe, with GCS < 8-9.

Moderate, GCS 8 –12 .

Minor, GCS ≥ 13.

Normal : 14 - 15

Management

Support vital functions ( ABC ).

Special attention to the history about the cause.

Administer naloxone if you suspect narcotic overdose.

Patients may need:

Urine and blood analysis.

Radiography.

Computed tomography.

Magnetic resonance imaging.

Neurological Emergencies

Headache

Stroke

Coma

Status epileptics

seizure

Seizures

Incidence:

Account for up to 30% of EMS calls.

In the United States, it is estimated that 4 million people

have epilepsy.

Pathophysiology

Sudden firing of neurons.

Signs and symptoms include:

Muscle spasms.

Increased secretions.

Cyanosis.

• If a seizure continues for a long time:

Cerebral glucose and oxygen supplies can be depleted.

There can be serious, long term effects, including death.

Try to determine the cause of the seizure.

Medication compliance.

Fever.

Congenital.

Tumor.

Seizures

Absence seizures (petit mal seizures)

Pseudoseizures

partial seizures

generalized seizures ( grand mal seizures )

Absence seizures (petit mal seizures) Typical patient: child.

Patient stops and freezes mid action.

Usually no longer than several seconds.

Pseudo seizures: Cause is of psychiatric origin.

Triggered by emotional event, stress, lights, or pain.

partial seizures:

Only a limited part of the brain is involved.

Simple partial seizures involve one part of the body.

generalized seizures ( grand mal seizures ):

• Full body continuous strong jerking movements.

• It may be caused by psychological trauma.

• The patient is not pretending.

Other problems associated with the seizure:

Patients who have fallen during a seizure may have a head injury.

Patients having a generalized seizure may also experience

incontinence.

Decrease in the oxygen and glucose demand of the brain.

Management:

Remain calm.

Prevent the patient from becoming injured.

Do not place anything in the patient’s mouth.

Loosen the tie.

Let the patient to lie in a recovery position.

Correct hypoglycemia as needed.

Ventilatory assistance may be necessary.

All patients should be transported.

Be prepared to administer diazepam or lorazepam.

Neurological EmergenciesHeadache

Stroke

Coma

Status epileptics

seizure

Pathophysiology:

Seizure that lasts longer than 4 to 5 minutes or consecutive

seizures without a return to consciousness between seizures.

Refer to local guidelines regarding intervention.

Nearly 20% of patients die.

May result in neurons being damaged or killed.

Goal: stop seizure and ensure adequate ABCs.

Status epileptics

Management

Administer a benzodiazepine.

Be prepared to control airway and ventilation.

Reference:

AAOS Emergency Care in the Streets 7th Edition, Caroline

Jones & Bartlett, 2012; ISBN 13: 978-1-469-0922-1

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