AMS PART 2

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Temple College EMS Professions

Neurological EmergenciesComa, Seizures, Syncope, Stroke

Coma

State of unconsciousness fromwhich patient cannot be aroused

Coma

Unconsciousness =

Immediate Life ThreatLoss of airwayAspiration

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Coma

Management of ABCs must comebefore investigation of cause

Airway

Open, clear, maintain

If trauma present or no historyavailable, immediately controlC-spine

Breathing

Assess presence, adequacy

High concentration O2 immediately onall patients with decreased LOC

Assist if respiratory rate, tidalvolume inadequate

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Circulation

Pulses?

Perfusion?

After ABCs stabilized. . .

Quickly investigate cause

DERM

D = Depth of coma

What does patient respond to?

How does he respond?

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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?

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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)

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Possible Causes

Alcohol Epilepsy

Insulin

Overdose

Uremia (andother metaboliccauses)

Trauma Infection

Psychiatric

Stroke, syncope,seizures

Management

Secure airway

Protective reflexes may be lost

Immobilize spine unless absolutelycertain injury not present

Spinal injury not suspected - patienton left side

Management

High concentration O2

Assist ventilation as needed Monitor neurological/vital signs

every 5 minutes

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Management

Protect patients eyes on longtransports (tape shut, moist pads)

Patient may hear, understand eventhough unable to respond

Treat, reassure accordingly

Neurologic Emergencies

Seizure

Key Term

Sudden change in sensation,

behavior, or movement caused by

irregular electrical activity of the

brain

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Seizures

Episodes of uncoordinatedelectrical activity in brain

Signs/symptoms depend on areainvolved

Seizure

Key Term

Sudden change in sensation,

behavior, or movement caused by

irregular electrical activity of the

brain

Causes of Seizures

Toxin (including drugs & alcohol)

Brain tumor

Congenital brain defects

Trauma

Infection/Fever (#1 cause in

pediatric patients 6 months to 3

years old)

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Causes of Seizures

Epilepsy

Stroke

Hypoglycemia

Eclampsia (complication of

pregnancy)

Hypoxia

Unknown

Epilepsy

Tendency to have repeatedepisodes of seizure activity

Seizure Types

Grand mal (major motor)

Petit mal (absence) Focal motor (simple partial)

Psychomotor (complex partial)

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Grand Mal Seizure

Aura Sensation coming before convulsion

Patient may recognize as sign ofimpending seizure

May help locate origin of seizure in brain

Grand Mal Seizure

ConvulsionLoss of consciousness

Tonic phase - rigidity

Clonic phase - rhythmic jerking,incontinence, ineffective breathing

Grand Mal Seizure

Post-ictal Phase

Exhaustion Drowsiness

Headache

Possible hemiparesis (Todds paralysis)

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Petit Mal Seizure

Loss of consciousness No loss of postural tone

More common in children

Focal Motor Seizure

Rhythmic jerking of limb, oneside of body

No loss of consciousness

Psychomotor Seizure

Loss of consciousness

Sterotyped movements (automatisms)May look purposeful, but arent Lip smacking, movements of hands

May be called in as drunk, O.D.,psych patient

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Generalized Seizure Management

During seizureRemove from potential harm

Do not forcibly restrain

Roll on side

Avoid putting anything in mouth


After seizure endsAssess ABCs

Clear airway

Most common cause of

seizure deaths is post-ictal

airway loss


High concentration O2 - immediately!!

Assist breathing if ventilationinadequate

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Obtain history/physicalTrauma 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 cancause seizures (AEIOU/TIPS)

Do not assume seizures are dueto idiopathic epilepsy until provenotherwise

Status Epilepticus

Key Term

A life-threatening condit ion in which

the patient has two or more

convulsive seizures without regaining

consciousness

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Status Epilepticus

> 2 seizures without interveningconscious period

Immediate Life Threat

Management Secure airway

Assist breathing with O2 Transport

Request ALS intercept

Syncope

Fainting

Sudden, temporary loss ofconsciousness

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

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Management

ABCsKeep patient supine, elevate

lower extremities

Oxygen

Assess underlying cause

CVA

Cerebrovascular accident

Stroke

CVA

Damage of portion of brain due to

interruption of blood supply MechanismsThrombosis

Hemorrhage

Embolism

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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 travelthrough vessel; lodge, block flow

Often associated with: Atherosclerosis of carotids

Chronic atrial fibrillation

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Signs/Symptoms

Alterations in consciousnessAltered affect

Confusion

Dizziness

Coma

Signs/Symptoms

Localizing signs Paralysis Loss of sensation Difficult or loss of speech

Left Hemispheric strokes Aphasia: Inability to speak or understand speech Receptive aphasia: Ability to speak, but unable to

understand speech Expressive aphasia: Inability to speak correctly,

but able to understand speech* Right Hemispheric strokes

Dysarthria: Able to understand, but hard to beunderstood

Signs/Symptoms

Unilateral blindnessLoss of vision in half of visual field

of both eyes

Unequal pupils Seizures Headache Stiff neck

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Transient Ischemic Attacks

TIAs Little strokes

Produce deficits that resolvecompletely in

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Cincinnati PrehospitalStroke Scale

Have patientattempt to

smile.

Have patient

attempt to hold

arms straight in

front of them

for 10 seconds.


Evaluate

patients

speech.


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Management

CVAs caused by thrombus, embolusmay be reversible with thrombolytics(clot busters)

Early recognition, rapid transport toappropriate facility is critical

Transport to a Stroke Center

AMS PART 2

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Transcript of AMS PART 2