Chapter 18 AMS, Strokes, & Headaches1.pptx

EMT

1. Chapter 18 Altered Mental Status, Stroke, and Headache Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care , Ninth Edition Joseph J. Mistovich • Keith J. Karren

2. Altered Mental Status

3. Reticular activating system (RAS) Altered mental status Coma

4. Causes Structural Brain Tumor Hemorrhage Direct brain tissue trauma Degen. disease Toxic-metabolic Hypoxia Abnormal BGL Liver Failure Kidney Failure Poisoning Other Shock CNS drugs Post-seizure Stroke

5. Assessment-Based Approach: Altered Mental Status Scene Size-Up and Primary Assessment

6. Scene Size-Up and Primary Assessment Scene clues to figure out what’s going on? Scan the scene Stabilize spine if necessary ABCs

7. Assessment-Based Approach: Altered Mental Status Secondary Assessment

8. Secondary Assessment History Physical exam Vital signs

9. Signs and Symptoms Trauma Nontraumatic or medical condition

10. Assessment-Based Approach: Altered Mental Status Emergency Medical Care

11. Emergency Medical Care Spine stabilization Patent airway Suction Provide O 2 Assist ventilation if necessary Position the patient Transport

12. Assessment-Based Approach: Altered Mental Status Reassessment

13. Reassess every five minutes Mental status ABCs Vital signs

14. Stroke

15. Neurologic Deficit Resulting from Stroke

16. Neurologic deficit Nontraumatic brain injury Stroke

17. Acute Stroke

18. Drugs Time AHA – F.A.S.T. (© Michal Heron)

19. Pathophysiology of Stroke

20. Similar to a heart attack “ Brain attack ”

21. Types of Stroke

22. Ischemic Stroke Hemorrhagic Stroke

23. Anterior Circulation Stroke vs Posterior Circulation Stroke Anterior -   typically causes unilateral symptoms Posterior -   can cause unilateral or bilateral deficits and is more likely to affect consciousness

24. Stroke vs Transient Ischemic Attack

25. Stroke or Transient Ischemic Attack Transient Ischemic Attack

26. Transient Ischemic Attack TIA symptoms gone within 24 hours No permanent neurologic damage Higher chance of permanent stroke

27. Assessment-Based Approach: Stroke and Transient Ischemic Attack Scene Size-Up

28. Scene Size-Up Look for signs of trauma Look for CNS-altering substances Note patient location and appearance

29. Assessment-Based Approach: Stroke and Transient Ischemic Attack Primary Assessment

30. Primary Assessment ABCs Positioning

31. Assessment-Based Approach: Stroke and Transient Ischemic Attack Secondary Assessment

32. Secondary Assessment Rapid head-to-toe assessment Cincinnati Prehospital Stroke Scale Los Angeles Prehospital Stroke Screen (LAPSS) (© Michal Heron)

33. Cincinnati Prehospital Stroke Scale Facial droop Arm drift Slurred speech

34. Los Angeles Prehospital Stroke Screen Age greater than 45 years old History of seizures or epilepsy Duration of symptoms Wheelchair or bedridden status of patient Blood glucose level Smile, grip, and arm strength

35. History Signs Symptoms

36. Assessment-Based Approach: Stroke and Transient Ischemic Attack Emergency Medical Care

37. Emergency Medical Care Patent airway Suction Assist ventilation if necessary Provide O2 Position the patient Check the blood glucose level Protect any paralyzed extremities Rapid transport

38. Assessment-Based Approach: Stroke and Transient Ischemic Attack Reassessment

39. Reassess every five minutes ABCs Mental status Vital signs

40. Headache

41. Vascular - dilation or distention of vessels or inflammation w/in the cranium Cluster - usually excruciating and found on only one side of the head or face Tension - caused by contraction of the muscles of the neck and scalp Organic - result of tumors, infection, stroke, or inflammatory disorders within the cranium such as meningitis, hemorrhagic stroke, and tumor

42. Assessment

43. Assessment ABCs Serious signs Altered mental status Motor or sensory deficit Behavior change Seizure Headache unlike anything the patient has experienced with an abrupt onset Worsening pain with coughing, sneezing, or bending over Fever or stiff neck Change in the quality of a chronic headache

44. Emergency Medical Care

45. Emergency Medical Care ABCs Suction Assist ventilation if necessary Administer O 2 Place in position of comfort Transport