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47 Cards in this Set
- Front
- Back
Seizures may occur as the result of:
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Recent or old head injury
Brain tumor Metabolic problem Genetic disposition |
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Three major parts of brain and what they control:
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Brain stem - Controls most basic functions
Cerebellum - Controls muscle and body coordination Cerebrum, Largest part Divided into right and left hemispheres Each controls activities on opposite side of body. Front controls emotion and thought. Middle controls touch and movement. Back processes sight. |
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________ (#) cranial nerves run directly from the brain to parts of the head. The rest of the nerves join in the spinal cord and exit the brain through the ___________
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Twelve
foramen magnum |
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S&S Migraine headaches
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Thought to be caused by changes in the blood vessel size in the base of the brain.
Patient may experience aura and unilateral, focused pain that spreads over time. Pain is usually described as pounding, throbbing, and pulsating. Nausea, vomiting, photophobia also occur. Can last for several days |
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Dead brain cells are called
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infarcted cells
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Interruption of cerebral blood flow may result from:
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Thrombus
Arterial rupture Cerebral embolism |
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There are two main types of stroke:
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Ischemic - From embolism or thrombus
Hemorrhagic - From arterial rupture |
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S&S Ischemic Stroke
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Loss of movement on opposite side of body, confusion, and inability to speak
Patient may experience anything from a few symptoms to complete paralysis. |
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Preventing Hemorrhagic Stroke
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People at high risk include those with chronic, poorly controlled hypertension.
Cerebral hemorrhages are often fatal. Proper treatment of hypertension can prevent long-term damage to blood vessels |
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When a hemorrhagic stroke occurs in an otherwise healthy young person, it is likely caused by
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a berry aneurysm= Subarachnoid hemorrhage
Surgical repair possible if care is immediate Can result in bizarre vital signs, other findings Continued bleeding will lead to death |
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With increased ICP, the brain may:
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Become ischemic due to lack of blood
Herniate |
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Prehospital treatment to decrease ICP
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is not effective. Also, do not treat high blood pressure in stroke patients in field.
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Signs and Symptoms of Stroke - Left hemisphere problems
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Aphasia - Inability to produce or understand speech, Speech problems can vary widely.
Paralysis on right side of body Right hemisphere problems Paralysis on left side of body Dysarthria - Understand language and are able to speak; Their words are slurred and hard to understand. |
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"Neglect" in stroke Pt=
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Neglect= Patient is oblivious to problem.
Patients with problem affecting occiput may neglect certain parts of vision. Try to sit or stand on patient’s unaffected side. Patient may delay seeking help. |
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Conditions That May Mimic Stroke
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Hypoglycemia - Not enough blood glucose, Check blood glucose level. Find out if patient is diabetic.
Postictal state - Reset period of brain after a seizure Nonstroke patients will recover spontaneously. Subdural or epidural bleeding - Blood within the skull compresses the brain. Usually result of trauma Symptoms may be subtle, patient may not remember injury. |
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Steps of a Tonic-Clonic Seizure
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Aura - Sensation before seizure occurs
Loss of consciousness Tonic phase - Body-wide rigidity Hypertonic phase - Arched back and rigidity Clonic phase - Rhythmic contraction of major muscle groups Postseizure - Major muscles relax Postictal - Rest period of the brain |
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Characteristics of "Absence Seizures"
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Present with little or no movement
Child is typical patient- Child will stop moving, but will rarely fall. Last for no more than several seconds No postictal period and no confusion May be brought on by flashing lights or hyperventilation |
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characteristics of Partial Seizures
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Simple partial seizure - Movement or sensations of one part of the body when originating in the frontal lobe. Altered sensations in one part of the body when originating in the parietal lobe. May spread from one part to another in a wave
Complex partial seizure - Subtle changes in LOC Patient may become confused, lose alertness, have hallucinations, or be unable to speak. Eyes or head may make small movements. Patient usually does not become unresponsive. |
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Characteristics of Status Epilepticus
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Seizures lasting more than 4 or 5 minutes
Time frame is arbitrary. Refer to local protocols for guidelines on how long a seizure can continue before you intervene. During seizure, neurons are in a hypermetabolic state. For a short period, seizure does not produce long-term damage. If seizure continues, neurons will be damaged or killed. Goals of prehospital care - Stop the seizure. Ensure adequate ABCs. |
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Epileptic seizures usually can be controlled by
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Most seizures are the result of medication noncompliance.
Phenytoin (Dilantin) is used to control seizures, but can cause them if patient takes too much. |
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Characteristics of Febrile Seizures
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Result from sudden high fevers, usually in infants and small children. Transport child for evaluation in the hospital. Not how high the fever goes, but how quickly it gets there
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Describe the Postictal State
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-After a seizure, the muscles relax, becoming almost flaccid, and breathing becomes labored.
-Breathing pattern helps body balance acidity. -With normal circulation and liver function, the patient will begin to breathe more normally within minutes. In some situations, postictal state may be characterized by hemiparesis. -Lethargy. AMS and confusion are common. -Be prepared; the patient may be combative. -If the patient’s condition does not improve, consider other conditions, such as:Hypoglycemia, Infection |
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Causes of Altered Mental Status
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Hypoglycemia
Hypoxemia Intoxication Drug overdose Unrecognized head injury Brain infection Body temperature abnormalities Psychological problems Infections Drug overdose and poisonings Uncommon conditions, such as: Brain tumors, Glandular abnormalities |
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Syncope can be caused by a ___ second loss in blood flow and can result from:
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3- to 5-second
Problems with cardiac rhythm, conduction, or muscle Myocardial infarction Dehydration Hypoglycemia Vasovagal episode |
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The ______ is the organ that is most sensitive to fluctuating levels of oxygen, glucose, and temperature.
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Brain
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Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score?
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The Glasgow Coma Scale gives a score of 3 to a patient who opens his or her eyes in response to speech. “Incomprehensible sounds” has a score of 2, and “withdraws to pain” has a score of 4. When added together, this patient’s GCS score is 9.
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The name for a seizure that lasts for longer than 4 to 5 minutes or consecutive seizures that occur without the return of consciousness between seizure episodes is
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status epilepticus
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A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as
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Dysarthria - defined as slurred, poorly articulated speech; it is common in stroke patients.
Dysphasia is defined as difficulty speaking; the patient’s speech may or may not be slurred. Aphasia is the inability to speak. Dysphagia is defined as difficulty swallowing. |
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A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is
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hemorrhagic stroke
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A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the
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brain stem
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Be alert for the Cushing reflex, as it indicates
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increased ICP
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decorticate posturing
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curls arms towards chest, points toes
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decerebrate posturing
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points toes, extends arms out & rotates palm palms down (severe finding)
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trimus
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clenching teeth
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ICP in infant is characterized by
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cat eyes and cat cries
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Tx stroke
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Administer 100% supplemental oxygen.
Obtain IV access. Transport patient. Most treatments must be started as soon as possible. Do not give aspirin. |
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Tx seizures
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Administer 100% supplemental oxygen.
Gain IV access. Note medications, seizure history. Depending on protocols and the situation: -Assess for trauma. -Treat for hypoglycemia. -Manage the airway. Be professional, compassionate. |
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Tx Syncope
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Begin with standard care.
Determine whether patient experienced trauma during fall. Take cervical spine precautions as needed. Focus on blood glucose level, likely cardiac causes. Obtain orthostatic vital signs. Provide supplemental oxygen; gain IV access. Provide emotional support. Syncope can be a sign of life-threatening medical conditions. Call for paramedic backup if needed. |
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aphasia
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inability to produce or understand speech (sign of left hemisphere stroke)
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clonic phase
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rhythmic contraction of major muscle groups, lip smacking, biting
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tonic phase
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body-wide rigidity
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hypertonic phase
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arched back and rigidity
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A Pt who answers "What day is today?" with "Green" is likely having s stroke in which hemisphere?
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Left
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S&S of a right hemisphere stroke
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can't move muscles on Left side of body. Can understand language and speak but words are slurred. May be oblivious to the problem.
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dysarthria
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slurred speech
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Characteristics of absence seizures
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starring episodes or "absence spells";
most common in children 4-12 lip smacking; |
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Grand Mal seizure
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now called - Tonic-Clonic
loss of consciousness, can occur at any age. |