Coma, Seizure, Stroke
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Transcript Coma, Seizure, Stroke
Neurological Emergencies
Coma, Seizures, Syncope, Stroke
Temple College
EMS Professions
Coma
State of unconsciousness from
which patient cannot be aroused
Coma
Unconsciousness =
Immediate Life Threat
Loss of airway
Aspiration
Coma
Management of ABC’s must come
before investigation of cause
Airway
Open, clear, maintain
If trauma present or no history
available, immediately control
C-spine
Breathing
Assess presence, adequacy
High concentration O2 immediately on
all patients with decreased LOC
Assist if respiratory rate, tidal
volume inadequate
Circulation
Pulses?
Perfusion?
After ABC’s stabilized. . .
Quickly investigate cause
DERM
D = Depth of coma
What does patient respond to?
How does he respond?
E = Eyes
Pupils equal, dilated, constricted,
Responsive to light?
How?
R = Respiratory pattern
Rate?
Unusually deep or shallow?
Altered pattern?
M = Motor Function
Evidence of paralysis?
Movement on stimulation?
How?
Vital Signs
Shock?
Increased ICP?
Arrhythmias?
Head to Toe Survey
Injuries causing coma?
Injuries caused by fall?
What do the scene, bystanders tell you?
Possible Causes
Not enough oxygen
Not enough sugar
Not enough blood flow to deliver O2, sugar
Direct brain injury
Structural (trauma)
Metabolic (toxins, infections, temperature)
Possible Causes
Alcohol
Epilepsy
Insulin
Overdose
Uremia (and
other metabolic
causes)
Trauma
Infection
Psychiatric
Stroke, syncope
Management
Secure airway
Protective reflexes may be lost
Immobilize spine unless absolutely
certain injury not present
Spinal injury not suspected - patient
on left side
Management
High concentration O2
Assist ventilation as needed
Monitor neurological/vital signs
every 5 minutes
Management
Protect patient’s eyes on long
transports (tape shut, moist pads)
Patient may hear, understand even
though unable to respond
Treat, reassure accordingly
Seizures
Episodes of uncoordinated
electrical activity in brain
Signs/symptoms depend on area
involved
Epilepsy
Tendency to have repeated
episodes of seizure activity
Seizure Types
Grand mal (major motor)
Petit mal (absence)
Focal motor (simple partial)
Psychomotor (complex partial)
Grand Mal Seizure
Aura
Sensation coming before convulsion
Patient may recognize as sign of
impending seizure
May help locate origin of seizure in brain
Grand Mal Seizure
Convulsion
Loss of consciousness
Tonic phase - rigidity
Clonic phase - rhythmic jerking,
incontinence, ineffective breathing
Grand Mal Seizure
Post-ictal Phase
Exhaustion
Drowsiness
Headache
Possible hemiparesis (Todd’s paralysis)
Petit Mal Seizure
Loss of consciousness
No loss of postural tone
More common in children
Focal Motor Seizure
Rhythmic jerking of limb, one
side of body
No loss of consciousness
Psychomotor Seizure
Loss of consciousness
Sterotyped movements (automatisms)
May look purposeful, but aren’t
Lip smacking, movements of hands
May be called in as “drunk”, “O.D.”,
“psych patient”
Generalized Seizure Management
During seizure
Remove from potential harm
Do not forcibly restrain
Roll on side
Avoid putting anything in mouth
Generalized Seizure Management
After seizure ends
Assess ABC’s
Clear airway
Most common cause of
seizure deaths is post-ictal
airway loss
Generalized Seizure Management
High concentration O2 - immediately!!
Assist breathing if ventilation
inadequate
Generalized Seizure Management
Obtain history/physical
Trauma that could have caused, been
caused by seizure
Anti-seizure medications
Neuro/vital signs every 5 minutes
If patient ventilating adequately,
transport on left side
Seizures
Anything that injures brain can
cause seizures (AEIOU/TIPS)
Do not assume seizures are due
to idiopathic epilepsy until proven
otherwise
Status Epilepticus
> 2 seizures without intervening
conscious period
Immediate Life Threat
Management
Secure airway
Assist breathing with O2
Transport
Request ALS intercept
Syncope
Fainting
Sudden, temporary loss of
consciousness
Caused by lack of blood flow to brain
Causes
Stress, fright, pain (vasovagal syncope)
Orthostatic hypotension (BP fall on standing)
Decreased blood volume
Increased size of vascular space
Decreased cardiac output
Prolonged forceful coughing
Management
ABCs
Keep
patient supine, elevate
lower extremities
Oxygen
Assess underlying cause
CVA
Cerebrovascular
Stroke
accident
CVA
Damage of portion of brain due to
interruption of blood supply
Mechanisms
Thrombosis
Hemorrhage
Embolism
Thrombosis
Blockage of vessel by thrombus
Usually forms at area narrowed by
atherosclerosis
Typically in older persons
Frequently occurs during sleep
Hemorrhage
Vessel ruptures
Associated with hypertension,
aneurysms of cerebral blood vessels
Usually characterized by
Sudden onset
Severe signs, symptoms
Embolism
Blood clots, plaque fragments travel
through vessel; lodge, block flow
Often associated with:
Atherosclerosis of carotids
Chronic atrial fibrillation
Signs/Symptoms
Alterations in consciousness
Altered affect
Confusion
Dizziness
Coma
Signs/Symptoms
Localizing signs
Paralysis
Loss of sensation
Loss of speech
Unilateral blindness
Loss of vision in half of visual field of
both eyes
Unequal pupils
Signs/Symptoms
Seizures
Headache
Stiff neck
Transient Ischemic Attacks
TIAs
“Little strokes”
Produce deficits that resolve
completely in <24 hours
Frequently precede CVA
Management
Assess ABC’s
Protect airway
High concentration O2
Vital signs every 5-10 minutes
Note increased BP, irregular pulse
Management
Nothing by mouth
Avoid rough handling
Transport paralyzed side down
Guard your conversation
Patients who cannot speak may still
understand!
Management
CVAs caused by thrombus, embolus
may be reversible with thrombolytics
(clot busters)
Early recognition, rapid transport to
appropriate facility is critical