Download Paramedic Care: Principles & Practice Volume 3 Medical Emergencies

Paramedic Care:
Principles & Practice
Volume 3
Medical Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 3
Neurology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Anatomy and Physiology
Pathophysiology
General Assessment Findings
Management of Specific Nervous System
Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
The nervous
system consists of
two main divisions:
– Central Nervous
System
Brain and spinal
cord
– The peripheral
nervous system
Somatic
Autonomic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
The Central Nervous System
–
–
–
–
The Neuron
Protective Structures
The Brain
The Spinal Cord
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
The Neuron
–
–
–
–
Dendrites
Axons
Synapse
Neurotransmitters
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
Protective
Structures
– The Skull
Cranium
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
Protective Structures
– The Spine
33 vertebrae
Spinal canal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
Protective Structures
– The Meninges
3 layers
Cerebrospinal fluid
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
The Brain
– Divisions of
the Brain
– Areas of
Specialization
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Brain
Click here to view an animation on the brain.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
The Brain
– Vascular
Supply
Carotid
system
Vertebrobasilar
Circle of
Willis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
The Spinal Cord
– Responsible for
Conducting
impulses to and
from the peripheral
nervous system
Reflexes
31 pair of nerves
exit spinal cord
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Central Nervous System
The Spinal
Cord
– Dorsal Roots
Afferent
fibers
– Ventral Roots
Efferent
fibers
– Dermatome
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
The Peripheral Nervous System
– Consists of cranial nerves and peripheral nerves
– Automatic and voluntary functions
– Categories of peripheral nerves
Somatic sensory
Somatic motor
Visceral (autonomic) sensory
Visceral (autonomic) motor
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cranial Nerves
Click here to view the Cranial Nerves illustration.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Autonomic Nervous System
The Sympathetic Nervous System
– “Fight-or-flight”
– Neurotransmitters epinephrine and
norepinephrine
The Parasympathetic Nervous System
– “Feed-or-breed” or “rest-and-repair”
– Mediated by the neurotransmitter acetylcholine
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Autonomic Nervous System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology
Alteration in Cognitive Systems
– Altered forms of consciousness result from
dysfunction or interruption of the CNS
– Alterations may vary
Minor thought disturbances
Coma
– Two mechanisms capable of producing
alterations in mental status
Structural lesions
Toxic-metabolic states
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology
Structural Lesions
–
–
–
–
–
Brain tumor (neoplasm)
Degenerative disease
Intracranial hemorrhage
Parasites
Trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology
Toxic-Metabolic States
–
–
–
–
–
–
–
Anoxia (lack of oxygen)
Diabetic ketoacidosis
Hepatic failure
Hypoglycemia
Renal failure
Thiamine deficiency
Toxic exposure (e.g., cyanide,
organophosphates)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Causes of Altered Mental
Status
Drugs
Respiratory
– Depressants
(including alcohol)
– Hallucinogens
– Narcotics
Cardiovascular
–
–
–
–
–
Anaphylaxis
Cardiac arrest
Stroke
Dysrhythmias
Hypertensive
encephalopathy
– Shock
– COPD
– Inhalation of toxic
gas
– Hypoxia
Infectious
– AIDS
– Encephalitis
– Meningitis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology
Peripheral Nervous System Disorders
– Mononeuropathy
Caused by localized conditions such as trauma,
compression, or infections
Carpal tunnel syndrome
– Polyneuropathy
Demyelination or degeneration of peripheral nerves
Leads to sensory, motor, or mixed sensorimotor
deficits
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology
Autonomic System Disorders
– Frequently a result of another condition
– Conditions that affect the integrity of an
individual are accompanied by some changes in
autonomic nervous system functioning
Body’s internal maintenance dependent on the ANS
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Scene Size-up and Initial Assessment
–
–
–
–
–
AVPU
General Appearance
Speech
Skin and Facial Drooping
Mood, Thought, Perception, Judgment, Memory,
and Attention
Attempt to correct life threats
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Focused History and Physical Exam
– History-Taking
Trauma-related or medical problem
Underlying medical problems
Environmental clues
– Physical Exam
Face, eyes, nose, and mouth
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Respiratory Patterns
– Any of five abnormal
respiratory patterns
may be observed
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Cardiovascular Assessment
–
–
–
–
Heart rate
ECG
Bruits
Jugular venous distention
Nervous System Status
– Sensorimotor Evaluation
– Motor System and Cranial Nerve Status
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nervous System Status
Sensorimotor Evaluation
– To document loss of sensation and/or motor
function
– Decorticate and decerebrate posturing are
ominous signs of deep cerebral or upper
brainstem injury
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Posturing
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nervous System Status
Motor System Status
–
–
–
–
–
Muscle tone
Muscle strength
Flexion/extension
Coordination
Balance
Cranial Nerve Status
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nervous System Status
Further Mental Status Assessment
– Glasgow Coma Scale
Three components
Eye opening
Verbal response
Motor response
May be used on adult or pediatric patient
Simple tool for evaluating and monitoring
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Glasgow Coma Scale
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Glasgow Coma Scale
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Glasgow Coma Scale
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Vital Signs
– Cushing’s Reflex
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment Findings
Other Assessment Tools
–
–
–
–
Capnography
Pulse Oximeter
Blood Glucometer
CO Oximetry
Geriatric Considerations in Neurological
Assessment
Ongoing Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management of Specific
Nervous System Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management of Specific
Nervous System Emergencies
General Principles
– Airway and Breathing
– Circulatory Support
– Pharmacological Intervention
Dextrose, thiamine, naloxone, and diazepam
– Psychological Support
– Transport Considerations
Computerized tomography (CT) or magnetic
resonance imaging (MRI)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Altered Mental Status
AEIOU-TIPS
Assessment
Management
– Initial Assessment
– IV Access
– Treatable Causes
Hypoglycemia, narcotic overdose, suspected alcoholic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
AEIOU TIPS
A = acidosis or
alcohol
E = epilepsy
I = infection
O = overdose
U = uremia
T = trauma
I = insulin
P = psychosis
S = stroke
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Altered Mental Status
Chronic Alcoholism
– Wernicke’s Syndrome
– Korsakoff’s Psychosis
Increased Intracranial Pressure
– Hyperventilation
20 breaths per minute
Overventilation will lead to alkalosis
– Mannitol
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stroke and
Intracranial Hemorrhage
General term that describes injury or death
of brain tissue
– Usually due to interrupted blood flow
– “Brain attack”
Transport considerations
–
–
–
–
CT
Neurological services
Fibrinolytics available
Warrants rapid recognition and prompt transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stroke and
Intracranial Hemorrhage
Occlusive
Strokes
– Embolic and
Thrombotic
Strokes
Hemorrhagic
Strokes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stroke and
Intracranial Hemorrhage
Signs
–
–
–
–
–
–
–
–
Symptoms
Facial Drooping
Headache
Aphasia/Dysphasia
Hemiparesis
Hemiplegia
Paresthesia
Gait Disturbances
Incontinence
–
–
–
–
Confusion
Agitation
Dizziness
Vision Problems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Prehospital Stroke Screens
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Prehospital Stroke Screens
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stroke and
Intracranial Hemorrhage
Transient Ischemic Attacks
– Indicative of carotid artery disease
– Symptoms of neurological deficit:
Symptoms resolve in less than 24 hours
No long-term effects
– Evaluate through history taking:
History of hypertension, prior stroke, or TIA
Symptoms and their progression
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stroke and Intracranial
Hemorrhage
Management
–
–
–
–
–
–
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–
–
Scene safety and standard precautions
Maintain the airway
Support breathing
Obtain a detailed history
Position the patient
Determine the blood glucose level
Establish IV access
Monitor the cardiac rhythm
Protect paralyzed extremities
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Suspected Stroke Algorithm
Click here to view the Suspected Stroke Algorithm illustration.
Reproduced with permission from “2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation
and Emergency Care,” Circulation 2005, Volume 112, IV-112 © 2005 American Heart Association.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Generalized Seizures
– Tonic-Clonic
Aura
Loss of consciousness
Tonic phase
Hypertonic phase
Clonic phase
Postseizure
Postictal
– Absence
Petit-mal
10- to 30-second loss of consciousness or awareness
Eye or muscle twitching
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Generalized Seizures (cont.)
– Pseudoseizures
Hysterical seizures
Stems from psychological disorders
Can often be interrupted with a terse command
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Partial Seizures
– Simple Partial Seizures
Involve one body area
Can progress to generalized seizure
– Complex Partial Seizures
Characterized by auras
Typically 1–2 minutes in length
Loss of contact with surroundings
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Assessment
– Ascertain exactly what the patient may recall or
what bystanders witnessed
Other problems mimic seizure
– Differentiating Between Syncope and Seizure
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Patient History
–
–
–
–
–
–
History of Seizures
History of Head Trauma
Any Alcohol or Drug Abuse
Recent History of Fever, Headache, or Stiff Neck
History of Heart Disease, Diabetes, or Stroke
Current Medications
Phenytoin (Dilantin), phenobarbitol, valproic acid
(Depakote), or carbamazepine (Tegretol)
– Physical Exam
Signs of head trauma or injury to tongue
Alcohol or drug abuse
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Management
–
–
–
–
–
–
Scene safety and standard precautions
Maintain the airway
Administer high-flow, high-concentration oxygen
Establish IV access
Treat hypoglycemia if present
Do not restrain the patient
Protect the patient from the environment
– Maintain body temperature
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Management
(cont.)
– Position the patient
– Suction if required
– Monitor cardiac
rhythm
– Treat prolonged
seizures
Anticonvulsant
medication
– Provide a quiet
atmosphere
– Transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Seizures
Status Epilepticus
– Two or More Generalized Seizures
Seizures occur without a return of consciousness
– Management
Management of airway and breathing is critical
Establish IV access and cardiac monitoring
Administer 25 g 50% dextrose if hypoglycemia is
present
Administer 5–10 mg diazepam IV
Monitor the airway closely
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Syncope
A sudden, temporary loss of consciousness
Assessment
– Cardiovascular:
Dysrhythmias or mechanical problems
– Noncardiovascular:
Metabolic, neurological, or psychiatric condition
– Idiopathic:
The cause remains unknown even after careful
assessment
– Extended unconsciousness is NOT syncope
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Syncope
Management
–
–
–
–
–
–
–
–
–
Scene safety and standard precautions
Maintain the airway
Support breathing
Check circulatory status
Monitor mental status
Establish IV access
Determine blood glucose level
Monitor the cardiac rhythm
Reassure the patient and transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Headache
Types
– Vascular
Migraines
Throbbing pain, photosensitivity, nausea, vomiting, and
sweats; more frequent in women
May last for extended periods of time
Cluster
One-sided with nasal congestion, drooping eyelid, and
irritated or watery eye; more frequent in men
Typically last 1–4 hours
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Headache
Types
– Tension
– Organic
Occur due to tumors, infection, or other diseases of the
brain, eye, or other body system
Headaches associated with fever, confusion, nausea,
vomiting, or rash can be indicative of an infectious
disease
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Headache
Assessment
–
–
–
–
What was the patient doing at the onset of pain?
Does anything provoke or relieve the pain?
What is the quality of the pain?
Does the pain radiate to the neck, arm, back, or
jaw?
– What is the severity of the pain?
– How long has the headache been present?
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Headache
Management
–
–
–
–
–
–
–
Scene safety and standard precautions
Maintain the airway
Position the patient
Establish IV access
Determine blood glucose level
Monitor the cardiac rhythm
Consider medication
Antiemetics or analgesics
– Reassure the patient and transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
“Weak and Dizzy”
Assessment
– Symptomatic of Many Illnesses
– Focused Assessment
Include a detailed neurological exam
Specific signs and symptoms:
Nystagmus
Nausea and vomiting
Dizziness
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
“Weak and Dizzy”
Management
– Scene safety and standard precautions
– Maintain airway and administer high-flow,
high-concentration oxygen
– Position of comfort
– Establish IV access and monitor cardiac rhythm
– Determine blood glucose level
– Consider medication:
Antiemetic
– Transport and reassure patient
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Neoplasms
Tumors
– Benign
– Malignant
Assessment
– Signs and Symptoms
Recurring or severe headaches
Nausea and vomiting
Weakness or paralysis
Lack of coordination or unsteady gait
Dizziness, double vision
Seizures without a prior history of seizures
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Neoplasms
Assessment (cont.)
– History
Surgery, chemotherapy, radiation therapy, or holistic
therapy
Experimental treatments
Management
– Scene size-up and BSI
– Maintain airway and administer high-flow,
high-concentration oxygen
– Position of comfort
– Establish IV access and monitor cardiac rhythm
– Consider medication administration:
Analgesics, antiseizure meds, anti-inflammatory meds
– Transport and reassure patient
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Brain Abscess
Abscess
– Collection of Pus
Assessment
– Signs and Symptoms
Lethargy, hemiparesis, nuchal rigidity
Headache, nausea, vomiting, seizures
Management
– Similar to Neoplasm
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Degenerative Neurological
Disorders
Types of Disorders
– Alzheimer’s Disease
Most frequent cause of dementia in the elderly
Results in atrophy of the brain due to nerve cell death
in the cerebral cortex
– Muscular Dystrophy
Characterized by progressive muscle weakness
– Multiple Sclerosis
Unpredictable disease resulting from deterioration of
the myelin sheath
– Dystonias
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Degenerative Neurological
Disorders
Types of Disorders (cont.)
– Parkinson’s Disease
Tremor, rigidity, bradykinesia, postural instability
–
–
–
–
–
–
Central Pain Syndrome
Bell’s Palsy
Amytrophic Lateral Sclerosis
Myoclonus
Spina Bifida
Poliomyelitis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Degenerative Neurological
Disorders
Assessment
– Obtain history
– Exacerbation of chronic illness or new problem?
Management
– Special Considerations
Mobility, communication, respiratory compromise, and
anxiety
– Interventions
Determine blood glucose level
Establish IV access
Monitor cardiac rhythm
Transport and reassure the patient
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Back Pain and
Non-Traumatic Spinal Disorders
Low Back Pain
Causes
–
–
–
–
Disk Injury
Vertebral Injury
Cysts and Tumors
Other Causes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Back Pain and
Non-Traumatic Spinal Disorders
Assessment
– Evaluate history
Speed of onset
Risk factors such as vibration or repeated lifting
Determine if pain is related to a life-threatening
problem
Management
– Consider c-spine
Immobilize if in doubt
– Consider analgesics
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Anatomy and Physiology
Pathophysiology
General Assessment Findings
Management of Specific Nervous System
Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ