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NEUROGENIC CONDITIONS, (ASESSMENT FINDINGS …

- - - - DEMOGRAPHICS Most common in:
        -Older adults 55+ but can happen to anyone
        -Elderly patients
        Can also occur in younger adults caused by:
        -Drug use
        -Clotting disorders
        -Trauma
      - TREATMENT (ON UNIT):
        EMT SCOPE
        Maintain airway
        Suction if needed
        Oxygen
        Glucose Check
        Rule out hypoglycemia
        Stroke Scale
        Use:
        FAST
        BE-FAST
        Determine Last Known Normal
        
        DEFINITIVE TREATMENT (HOSPITAL) Thrombolytics (Clot-Busting Drugs)
        (alteplase)
        Must usually be given within:
        4.5-5 hours from symptom onset
        Mechanical Thrombectomy
        (Clot physically removed from vessel.)
        Used for:
        Large vessel blockages
        Long-Term Management
        Anticoagulants
        Blood pressure control
        Rehabilitation
        
        TREATMENT (ON UNIT): PARAMEDIC SCOPE
        Advanced Airway Management
        If decreased LOC:
        Supraglottic airway
        Intubation if necessary
        IV
        Usually normal saline at keep-vein-open rate
        Advanced Cardiac Monitoring
        12-lead ECG
        Monitor for atrial fibrillation or dysrhythmias
    - - DEMOGRAPHICS
        55+ years old
        -Elderly patients
        Can Occur in Pts with:
        Hypertension
        Diabetes
        Smoking
        High cholesterol
      - TREATMENT
        EMT SCOPE
        Airway Management
        Position patient appropriately
        Oxygen
        Only if:
        Hypoxic
        Respiratory distress present
        Stroke Assessment
        Neurologic exam
        Neuro status
        Rapid Transport
        
        TREATMENT PARAMEDIC SCOPE
        IV Access
        (Usually saline lock/KVO) fluidsContinuous ECG Monitoring
        Look for:
        Atrial fibrillation
        Dysrhythmias
        Cardiac ischemia
        Neuro Exams
        Monitor for:
        Deficits
        Worsening symptoms
        New weakness/speech problems
        
        DEFINITIVE TREATMENT (HOSPITAL)
        Diagnostic Testing
        CT Scan
        (Rules out hemorrhage)
        MRI
        Carotid Ultrasound
        Check carotid stenosis
        Cardiac Evaluation
        Medications
        Antiplatelet Therapy
        Anticoagulants
        -Eliquis
        -Warfarin
      - ASSESMENT FINDINGS
        Sudden one sided weakness
        Facial droop
        Arm drift
        Temporary paralysis
        Temporary blindness in one eye
        Blurred vision
        Double vision
        Dizziness
        Loss of balance
    - - TREATMENT
        EMT SCOPE
        -Airway Management
        Very important due to decreased LOC.
        May require:
        BVM
        Oxygen
        Monitor ICP Signs
        Watch for:
        Bradycardia
        Hypertension
        Irregular respirations
        Seizure Precautions
        Hemorrhagic strokes commonly cause seizures.
        
        DEFINITIVE TREATMENT (HOSPITAL)
        Careful BP reduction.
        Surgery
        Can include:
        Craniotomy
        Aneurysm clipping
        Hematoma evacuation
        Osmotic medications
        Ventricular drains
        
        TREATMENT PARAMEDIC SCOPE Advanced Airway
        Intubation
        Prevent hypoxia
        Prevent aspiration
        Maintain ventilation
        Medication (especially blood thinners)
        Warfarin
        Eliquis
        Xarelto
      - ASSESMENT FINDINGSMental Status
        -LOC
        -Confusion
        -Agitation
        -Coma in some cases
        -Nausea/Vomiting
        (Very common due to increased ICP)
        -Unequal pupils
        -Sluggish pupils
        -Seizures
        Cushing’s Triad
        (Hypertension with widening pulse pressure)
        -Bradycardia
        -Irregular respirations
      - DEMOGRAPHICS -Middle-aged adults
        -Elderly
        Adults with:
        -Hypertension
        -Aneurysms
        Can occur younger with:
        -Trauma
        -Cocaine use
- - - - What are they? A sudden uncontrolled burst of abnormal electrical activity in the brain
        This abnormal activity disrupts normal brain function and can affect
        -Movement
        -Consciousness
        -Sensation
        -Behavior
        
        PATHOPHYSIOLOGY
        Brain neurons become overexcited
        Excess electrical discharge occurs
        Normal communication is interrupted
        Abnormal motor/sensory/mental activity
        Symptoms differ
        
        GENERALIZED SEZIURE (TONIC CLONIC) Generalized Seizures
        Affect both sides of the brain
        Absence
        Usually involve impaired consciousness
        
        TREATMENT
        EMT SCOPE
        Airway
        Vomiting
        Secretions
        Breathing
        Respiratory effort
        Watch out for
        Cyanosis
        Oxygen saturation
        Circulation
        Pulse
        BP
        Skin signs
        Neurologic Assessment:
        LOC
        Pupil response
        Postictal state
        Glucose level
        Duration of seizure?
        First seizure?
        Trauma?
        History of epilepsy?
        Medications?
        Drug/alcohol?
        
        TREATMENT PARAMEDIC SCOPE
        Oxygen
        Give oxygen if:
        Hypoxic
        Cyanotic
        Respiratory distress present
        Monitor Pulse/BP/ECG rhythm Benzodiazepines
        Midazolam
        Lorezapam
        
        *TREATMENT HOSPITAL EEG/advanced diagnostics
        CT/MRI
        Long-term anticonvulsants
        Glucose correction Treat underlying cause ICU care if severe
        Cardiac monitoring Neurospecialty care
        
        ASSESMENT FINDINGS
        Before the Seizure (Aura)
        Strange smell/taste
        Déjà vu
        Anxiety
        Visual disturbance
        During the seizure
        Jerking movements
        Full body convulsions
        Drooling/foaming
        Tongue biting
        
        DEMOGRAPHICS can happen to anyone but usually occurs in older adults or trauma
        
        FOCAL/ PARTIAL SEZIURES
        Begin in one area of the brain
        Might
        Stay localized
        OR
        Spread to generalized seizure
        
        Demographics Usually occurs in children and young adults but can happen to ANYONE
        
        TREATMENT Protect airway
        Prevent injury
        Monitor neurologic status
        Identify reversible causes
        Ensure patient/environment safety.
        Airway Management
        Look out for:
        Vomiting
        Secretions
        Airway compromise
        Check blood glucose
        
        DEFINITIVE TREATMENT (HOSPITAL) Blood Tests
        Checking:
        Electrolytes
        Glucose
        Infection
        Toxicology
        Imaging
        CT Scan
        Checks for:
        Stroke
        Bleeding
        Tumor
        Trauma
        MRI
        Medications
        Anticonvulsants
        Keppra
        Carbamazepine
        Lamotrigine
        
        TREATMENT PARAMEDIC SCOPE
        Cardiac Monitoring
        Continuous ECG monitoring.
        Looking out for:
        Dysrhythmias
        Cardiac causes of AMS
        IV/IO Access
        Establish access if:
        Recurrent seizures
        Potential medication needed
        Benzodiazepines
        
        ASSESMENT FINDINGS
        Conscious and aware
        Able to speak/respond
        Twitching of one arm/leg
        Facial twitching
        Jerking movements on one side
        Tingling/numbness
        Visual disturbances
        Auditory hallucinations
        Strange smells/tastes
- - - - PATHOPHYSIOLOGY
        Two abnormal proteins build up in the brain:
        Beta-Amyloid Plaques
        -Protein clumps that accumulate between neurons.
        -interfere with communication between brain cells.
        Neurofibrillary Tangles
        -Twisted tau proteins inside neurons.
        -Damage the cell’s transport system and cause cell death.
        
        What Happens to the Brain?
        Neurons die
        Brain tissue shrinks
        Connections between brain cells are lost
        
        DEMOGRAPHICS
        Most Common
        Adults 65+ years old
        Risk increases with age.
        Early-Onset Alzheimer’s
        Can occur:
        30s–60s
        Usually has to do with genetics.
        
        ASSESMENT FINDINGS
        Mental Status Changes
        Disorientation
        Poor short-term memory
        Confusion about time/place
        Communication Changes
        Aphasia
        Difficulty following commands
        Repetitive speech
        
        TREATMENT (ON UNIT) Calm Approach
        Speak slowly
        Use simple language
        Reduce Anxiety
        Quiet environment
        Gentle reassurance
        Explain actions clearly
        Assess ABCs
        Airway
        Breathing
        Circulation
        Blood Glucose Check
        Check for any other illness/Injury
        
        DEFINITIVE TREATMENT (HOSPITAL/ NURSING HOME)
        Treat acute illness/injury
        Sudden mental-status changes
        Treat medical complications
        Determine baseline mental status
        Maintaining function
        Managing symptoms
        Preventing complications
        Supporting quality of life