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Coma
Coma
Coma
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?
D = Depth of coma
E = Eyes
R = Respiratory pattern
M = Motor Function
Vital Signs
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)
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 patients eyes on long transports (tape shut, moist pads) Patient may hear, understand even though unable to respond Treat, reassure accordingly
Neurologic Emergencies
Key Term
Seizure
Sudden change in sensation, behavior, or movement caused by irregular electrical activity of the brain
Seizures
Key Term
Seizure
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)
Causes of Seizures
Epilepsy Stroke Hypoglycemia Eclampsia (complication of pregnancy) Hypoxia Unknown
Epilepsy
Seizure Types
Grand mal (major motor) Petit mal (absence) Focal motor (simple partial) Psychomotor (complex partial)
Aura
Sensation coming before convulsion Patient may recognize as sign of impending seizure May help locate origin of seizure in brain
Convulsion
Loss of consciousness Tonic phase - rigidity Clonic phase - rhythmic jerking, incontinence, ineffective breathing
Post-ictal Phase
Psychomotor Seizure
During seizure
Remove from potential harm Do not forcibly restrain Roll on side Avoid putting anything in mouth
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
Key Term
Status Epilepticus
A life-threatening condition in which the patient has two or more convulsive seizures without regaining consciousness
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)
Management
ABCs Keep
CVA
Cerebrovascular Stroke
accident
CVA
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
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
Signs/Symptoms
TIAs Little strokes Produce deficits that resolve completely in <24 hours Frequently precede CVA
Management
Assess ABCs 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 Transport to a Stroke Center