EMT-Chapter 18-Altered Mental Status, Stroke, and Headache
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Reticular Activation System (RAS)
- Nerve cells within the brain stem that control consciousness
- If damaged, patient will lose consciousness.
Altered Mental Status
A variation from normal function of the mind.
An unconscious state in which a person doesn't respond to any stimulus, including pain.
Physical examination on patient with ALS
- Pupils-head injury
- Mouth and oral mucosa-hypoxia or poor perfusion
- Breath sounds
- Abdomen-intra-abdominal bleeding
- Lower and upper extremities
- Lower extremities-for peripheral edema
- Posterior body
ALS signs and symptoms related to trauma
- Obvious trauma signs
- Abnormal respiratory problems
- Tachycardia or bradycardia
- Unequal pupils
- Pale cool moist skin
ALS signs and symptoms related to nontraumatic conditions
- Abnormal respiratory pattern
- Dry or moist skin
- Cool or hot skin
- Pinpoint, midsize, or dilated, or unequal pupils
- Stiff neck
- Lacerations to the tongue indicating seizure activity
- High systolic b.p. and bradycardia
- Loss of bowel or bladder control
- Altered BGL
Any deficiency in the nervous system's functioning.
Nontraumatic Brain Injury
A medical injury to the brain, such as a stroke, that is nor caused by external trauma.
A sudden disruption in the blood flow to the brain that results in brain cell damage.
A stroke cause by obstruction to a vessel in the brain, called a thrombotic stroke if caused by a clot, or embolic stroke if cause by plaque or other material carried to the brain.
A stroke caused by rupture of a blood vessel in the brain.
Transient Ischemic Attack (TIA)
Brief, intermittent episode with strokelike symptoms that disappear within 24 hrs. TIAs are caused by an O2 deficit in the brain tissue(ischemia) and are often a precursor to a stroke.
Cincinnati Prehospital Stroke Scale
- Facial droop-have a patient look at you and smile.
- Arm drift-have patient lift arms up and hold them out with eyes closed for 10 seconds.
- Abnormal speech-have the patient say "You can't teach an old dog new tricks."
Los Angeles Prehospital Stroke Screen (LAPSS)
- Age greater than 45yrs
- No history of seizures or epilepsy
- Not wheelchair bound or beddridden
- BGL between 60-400mg/dL
- 1. Have patient look up and smile and show teeth
- 2. Compare grip strength of upper extremities
- 3. Assess arm strength for drift or weakness
Things to ask for history
- When did it begin
- Is there any recent history of trauma or injury to the head
- History of previous stroke
- Were there any seizure activity prior to arriving
- What was the patient doing at the onset
- Does the patient have a history of diabetes
- Has the patient complained of a stiff neck or a headache
- Slurred speech
- Result of dilation or distension of vessels or inflammation within the cranium.
- Cluster headaches are similar
Caused by contraction of the muscles of the neck and scalp.
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