aloc file.txt

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Anonymous
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392
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aloc file.txt
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2009-10-20 02:15:15
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aloc
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  1. Stroke (CVA)
    • -ALOC/confusion
    • -Headache
    • -Dysphasia/aphasia
    • -Facial droop
    • -Arm drift
    • -Hemiparesis/hemiplegia
    • -Lateralizing
    • -Difficulty thinking
    • -Hx of HTN (possible)
    • -Hx of A. fib (possible)
    • -Ataxia
    • -Incontinence
    • -Posturing (decorticate, decerebrate)

    • -Must get exact start time of signs & symptoms
    • -3 hour windown for tPA (TNK)
    • -Transport 30 degrees semi-fowler's POC
    • -Nitrates to reduce; BP must not drop more than 20 points
    • -No aspirin!
    • -Can give morphine or lasix
    • -TLC
    • -Anti-convulsant
  2. Stroke (TIA)
    • -Same as CVA
    • -Signs & symptoms fully resolve within 24 hours
    • -Signs & symptoms often resolve in 1 hour
    • -No permanent damage
    • -No damage 2nd to collateral blood flow
    • -No damage 2nd to naturally occurring clot busters


    • -Must get exact start time of signs & symptoms
    • -3 hour windown for tPA (TNK)
    • -Transport 30 degrees semi-fowler's POC
    • -Nitrates to reduce; BP must not drop more than 20 points
    • -No aspirin!
    • -Can give morphine or lasix
    • -TLC
    • -Anti-convulsant
    • -Mention suspicions
  3. Thrombolytic Stroke (53%)
    • -Same as CVA
    • -Relatively slower onset of signs & symptoms, but can be fast


    • -Must get exact start time of signs & symptoms
    • -3 hour windown for tPA (TNK)
    • -Transport 30 degrees semi-fowler's POC
    • -Nitrates to reduce; BP must not drop more than 20 points
    • -No aspirin!
    • -Can give morphine or lasix
    • -TLC
    • -Anti-convulsant
    • -Mention suspicions
  4. Embolytic Stroke (31%)
    • -Same as CVA
    • -Emboli often originate from carotid bodies; in patients with a. fib, recent surgeries, long bone fractures, prolonged bed rest, or coagulopathies
    • -Relatively faster onset of signs & symptoms


    • -Must get exact start time of signs & symptoms
    • -3 hour windown for tPA (TNK)
    • -Transport 30 degrees semi-fowler's POC
    • -Nitrates to reduce; BP must not drop more than 20 points
    • -No aspirin!
    • -Can give morphine or lasix
    • -TLC
    • -Anti-convulsant
    • -Mention suspicions
  5. Hemorrhagic Stroke (16%)
    • -Same as CVA
    • -Relatively faster onset of signs & symptoms
    • -If unresponsive, often with cushing's triad (increased ICP): HTN, bradycardia, irregular RR


    • -Must get exact start time of signs & symptoms
    • -3 hour windown for tPA (TNK)
    • -Transport 30 degrees semi-fowler's POC
    • -Nitrates to reduce; BP must not drop more than 20 points
    • -No aspirin!
    • -Can give morphine or lasix
    • -TLC
    • -Anti-convulsant
    • -Mention suspicions
  6. Subarachnoid Bleed
    • -Same as CVA
    • -Often presenting with worst headache of patient's life
    • -N/V
    • -Nuchal rigidity


    • -Must get exact start time of signs & symptoms
    • -3 hour windown for tPA (TNK)
    • -Transport 30 degrees semi-fowler's POC
    • -Nitrates to reduce; BP must not drop more than 20 points
    • -No aspirin!
    • -Can give morphine or lasix
    • -TLC
    • -Anti-convulsant
    • -Mention suspicions
  7. Generalized Seizure: Grand Mal
    • -Aura (short premonition)
    • -Tonic (short rigidity)
    • -Clonic (2-5 minutes of shaking)
    • -Post ictal (5-30 minutes of reawakening)

    • -Prevent further injury
    • -ABC's
    • -C-spine PRN
    • -NPA/OPA; O2 NRM
    • -NPO
    • -Pharm: Narcan if OD; D50 if hypoglycemic; Valium or Ativan
  8. Generalized Seizure: Petit Mal
    • -Sudden/abrupt LOC without shaking
    • -No post ictal state
    • -No loss of postural control

    • -Prevent further injury
    • -ABC's
    • -C-spine PRN
    • -NPA/OPA; O2 NRM
    • -NPO
    • -Pharm: Narcan if OD; D50 if hypoglycemic; Valium or Ativan
  9. Partial (focal) Seizure
    • -No ALOC
    • -Motor twitching/shaking in localized areas
    • -Hx of seizures

    • -Prevent further injury
    • -ABC's
    • -C-spine PRN
    • -NPA/OPA; O2 NRM
    • -NPO
    • -Pharm: Narcan if OD; D50 if hypoglycemic; Valium or Ativan
  10. Status Epilepticus
    -Seizure that is unbroken after 30 minutes

    • -Control airway
    • -O2
    • -Start an IV
    • -IV Valium if possible
    • -Rectal Valium for infants (diazepam)
  11. Breakthrough Seizure
    -Normal dosing of antiseizure medications does not prevent seizures anymore

    -Need to reassess pharmaceutical therapy
  12. Seizures - Causes
    • -Causes that create an untable group of neurons in the brain include:
    • -Epilepsy
    • -Hypoxia
    • -With spike in fever (febrile)
    • -Rx compliance issues
    • -DT
    • -CVA
    • -Eclampsia
    • -Idiopathic
    • -Infections
    • -OD
    • -Trauma
    • -Tumors
    • -Others
  13. Diabetes Type I
    • -AKA: Juvenile Onset
    • -AKA: IDDM (Insulin Dependent Diabetes Mellitus
    • -Hx of Diabetes Type I
    • -Virus or some other issue injured pancreas
    • -Little or no insulin is produced

    • -See hypoglycemia
    • -See hyperglycemia
  14. Diabetes Type II
    • -AKA: Adult Onset
    • -AKA: NIDDM (Non Insulin Dependent Diabetes Mellitus)
    • -AKA: Diet Dependent DM
    • -Often due to insulin resistance or obesity
    • -Often results in hyperglycemia

    • -See hypoglycemia
    • -See hyperglycemia
  15. Hypoglycemia (Insulin Shock)
    • -BS often less than 60 mg/dL (normal is 70-120 mg/dL)
    • -Often due to a mal-balance between insulin use, food consumption, exercise, illness
    • -Preceded by headache
    • -May complain of headache prior to ALOC
    • -ALOC/confusion
    • -Hx of quick ALOC
    • -Full rapid pulses
    • -Normal BP

    • -O2 PRN
    • -25g glucose IV (D50)
    • -Glucagon 1 mg IM if no IV available
  16. Hyperglycemia (Diabetic Coma, DKA)
    • -ALOC/confusion (often due to metabolites from fat breakdown)
    • -Onset often over many hours or days
    • -Often with BS levels chronically above 180 mg/dl (when high, BS levels will read 500+)
    • -Headache/ALOC/unresponsive
    • -Triad: Polyuria (pee of glucose in blood); polydipsia (thirsty 2nd to polyuria); polyphagia (hungry 2nd to cellular hypoglycemia)
    • -Ketones on breath (severe DKA)
    • -Kussmaul respirations (deep & rapid to blow off acids)
    • -Tachycardia/tachypnea
    • -Hypotension
    • -Dehydration

    • -O2 PRN
    • -IV wide open fluid if hypotensive
    • -Transport (need insulin therapy at hospital)
  17. HHNS (Hyperglycemic Hyperosmolar Nonketotic Syndrome)
    • -Often seen in Type II DM
    • -Insulin is produced, however, not enough for all sugars in blood stream, thus, sugar levels progressively increase, yet cells are adequately supplied with sugar
    • -BS levels exceed 500 mg/dL
    • -ALOC (possible)
    • -No indication of ketones
    • -Seem "drunk" or with seizures
    • -Weakness

    • -O2 PRN
    • -IV wide open fluid if hypotensive
    • -Transport (need insulin therapy at hospital)
  18. Syncope
    • -Sudden & brief LOC 2nd to decreased cerebral blood flow or pressure
    • -Hypotension
    • -Vaso-vagal
    • -Dysrhythmias
    • -Tumors

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