Chapter 11

1. Chapter 11 Neurologic Emergencies

2. Lesson Objectives • List the components of the nervous system. • Assess and manage an unresponsive victim. • Assess and manage a responsive victim. • Assess and manage head injuries, including concussions; severe, diffuse brain injuries; and skull fractures. • Assess and manage other neurologic problems, including strokes, seizures, fainting, headaches, migraines, and diabetes.

3. Anatomy and Physiology

4. The Unresponsive Victim (1 of 4) • Causes and treatment for unresponsive conditions • What to look for: • Assess with AVPU scale. • With head injury, look for other injuries and assume spinal cord injury. • Look for signs of illness if there are no apparent injuries. • Signs of seizures. • Paralysis. • Medical ID tags.

5. The Unresponsive Victim (2 of 4) • Causes and treatment for unresponsive conditions • What to do: Evidence of head injury • Protect the spine. • Roll victim onto back for examination. • Check breathing and maintain open airway. • Stop bleeding. • Monitor vital signs. • Move victim to safety, comfort, and shelter.

6. The Unresponsive Victim (3 of 4) • Causes and treatment for unresponsive conditions • What to do: No evidence of head injury • Roll victim onto back. • Check breathing and maintain an open airway. • Place in recovery position when stable. • Ensure victim is taking medications properly if there is a history of seizures.

7. The Unresponsive Victim (4 of 4) • Causes and treatment for unresponsive conditions • Long-term care • Do not give pain medications. • Do not give food or fluids to an unresponsive victim. • Lubricate eyes with eye ointment and tape eyelids shut. • Keep victim clean. • Turn victim every 2 hours.

8. The Responsive Victim (1 of 3) • What to look for: • Obtain details of the incident. • Determine duration of unresponsiveness, if any. • Watch for alterations in behavior or level of responsiveness. • Monitor for seizures. • Obtain history of known diseases.

9. The Responsive Victim (2 of 3) • What to look for: • Look for medical ID tags. • Assess for odor of alcohol or sweet smelling breath. • Assess level of responsiveness. • Check for unequal pupil size. • Assess for spinal injury.

10. The Responsive Victim (3 of 3) • What to look for: • Look for blood or clear fluid coming from the nose or ears. • Assess for paralysis.

11. Head Injury (1 of 15) • Concussion • Brief disruption of brain function due to a blow to the head • Anyone who has been unresponsive from a head injury should not walk or be left unattended.

12. Head Injury (2 of 15) • Concussion • What to look for: • No loss or brief loss of consciousness • Visual changes • Nausea, dizziness, headache

13. Head Injury (3 of 15) • Concussion • What to do: • Allow victim to sleep but waken every 2 to 3 hours to check responsiveness. • If no symptoms appear 8 hours after injury, wake victim once during the first night.

14. Head Injury (4 of 15) • Concussion • What to do (continued): • Seek medical care if victim experiences vomiting, ringing in the ears, impaired balance, loss of taste or smell, or loss of responsiveness after regaining responsiveness.

15. Head Injury (5 of 15) • Head injury with delayed deterioration • Severe injury can bruise the brain or rupture blood vessels. • Resulting swelling or bleeding causes increased pressure within the skull. • Victim can die unless pressure is released by surgery.

16. Head Injury (6 of 15) • Head injury with delayed deterioration • What to look for: • Decreased level of responsiveness • Severe, progressive headache not relieved by medication • Repeated vomiting • Altered behavior

17. Head Injury (7 of 15) • Head injury with delayed deterioration • What to do: • Protect the main airway. • Maintain a stable body temperature. • Treat the victim as though he or she were unresponsive. • Evacuate the victim immediately.

18. Head Injury (8 of 15) • Severe, diffuse brain injury • Caused by initial head injury and subsequent swelling or by hypoxia secondary to inadequate breathing. • Generally causes complete unresponsiveness immediately.

19. Head Injury (9 of 15) • Severe, diffuse brain injury • What to look for: • Deeply unresponsive from time of injury • Obstructed airway and impaired breathing • Changes in responsiveness

20. Head Injury (10 of 15) • Severe, diffuse brain injury • What to look for: Good signs • Responsive victim • Normal body movement • Normal blink reactions

21. Severe, diffuse brain injury What to look for: Bad signs Enlarged pupils that do not react to light Unequal pupils Slowed pulse rate Irregular breathing Rising body temperature Loss of feeling One-sided weakness Paralysis Head Injury (11 of 15)

22. Head Injury (12 of 15) • Severe, diffuse brain injury • What to do: • Clear and maintain airway; start CPR if necessary. • Assume spinal cord injuries. • Repeat exam to determine progress. • Record your observations. • Evacuate immediately.

23. Head Injury (13 of 15) • Skull fractures • Closed: No break in the scalp • Open: Scalp over fracture is lacerated and brain or its coverings are exposed

24. Head Injury (14 of 15) • Skull fractures • What to look for: • Broken bone edges in the wound • Clear or blood-tinged fluid from the nose or ear without apparent injury

25. Head Injury (15 of 15) • Skull fractures • What to do: • Protect depressed area with a doughnut dressing. • Cover open wounds with a sterile dressing. • Control bleeding by applying a sterile dressing and applying pressure around edges of the wound. • Evacuate.

26. Other Neurologic Problems (1 of 19) • Stroke • Caused by blockage of a blood vessel or bleeding in the brain • Transient ischemic attack (TIA) • Common in older people and those with hardening of the arteries. • May occur in young, healthy people due to decompression sickness, head injury, cerebral edema or thickening of the blood due to altitude.

27. Other Neurologic Problems (2 of 19) • Stroke • What to look for: • Altered responsiveness • Numbness, weakness, paralysis of face, arm, or leg (usually on one side) • Turning of the head and eyes to one side • Noisy breathing or drooling • Visual changes

28. Other Neurologic Problems (3 of 19) • Stroke • What to look for: • Loss of balance or coordination • Difficulty speaking • Sudden, severe, unexplained, long-lasting headache • Convulsions • History of diabetes, hypertension, heart disease, or previous strokes

29. Other Neurologic Problems (4 of 19) • Stroke • What to do: • Place victim in recovery position. • Allow responsive victims to assume a position of comfort. • Offer clear liquids with caution. • Evacuate.

30. Other Neurologic Problems (5 of 19) • Seizures • Caused by sudden, temporary, abnormal electrical discharges in the brain. • A victim will be unresponsive following a seizure for minutes to an hour or longer and awakens gradually. • Epileptic seizures are rarely medical emergencies. • New onset of seizures requires evacuation and immediate medical care.

31. Other Neurologic Problems (6 of 19) • Seizures • Partial seizures • Momentary lack of awareness • Involuntary movement of a body part • Sensation of numbness or tingling • Abnormal vision or smell

32. Other Neurologic Problems (7 of 19) • Seizures • Generalized seizures • Frequently preceded by an aura • Start with a sudden spasm of body muscles • Causes victim to cry out and fall to the ground

33. Other Neurologic Problems (8 of 19) • Seizures • What to do: • Protect victim from injury, but do not restrain. • Maintain airway when seizure is over. • Arrange for privacy. • Assess as an unresponsive victim. • Keep victim in recovery position until awake and alert. • Check history.

34. Other Neurologic Problems (9 of 19) • Simple fainting • Common, benign, usually brief form of rapid drop in blood pressure • Result of inadequate blood flow to brain and loss of normal responsiveness • Can have a physical or emotional cause

35. Other Neurologic Problems (10 of 19) • Simple fainting • What to look for: • Visual disturbances (seeing spots), dizziness, feeling too hot or too cold, nausea • Paleness with cold, clammy skin • Passing out, slumping, or falling down

36. Other Neurologic Problems (11 of 19) • Simple fainting • What to do: Person who is about to faint • Prevent a hard fall. • Lay victim flat. • Raise the legs 6 to 12 inches. • Loosen tight clothing. • Place a cool, wet cloth on victim’s forehead.

37. Other Neurologic Problems (12 of 19) • Simple fainting • What to do: Person who has fainted • Check breathing. • Lay flat and raise legs 6 to 12 inches. • Loosen tight clothing. • Check for injuries. • Place a cool, wet cloth on victim’s forehead. • Provide care for unresponsiveness. • Do not mistake serious illness for simple fainting.

38. Other Neurologic Problems (13 of 19) • Headache • Most are harmless. • Usually relieved by rest, avoiding eye strain, and nonprescription medications. • Can be caused by altitude, glare, traction on muscles. • Can be caused by more serious conditions, such as high altitude cerebral edema.

39. Other Neurologic Problems (14 of 19) • Headache • What to look for: • Head trauma • Tenderness over scalp, neck, and shoulders • Unequal pupil size • Double vision • Impaired sensation/movement of extremities

40. Other Neurologic Problems (15 of 19) • Headache • What to look for: • Fever • Severe neck stiffness • Impaired balance • Suspect serious injury or illness if victim has vomiting, inability to sleep or eat, headache lasts more than a day, is not relieved by medication, or is sudden and severe

41. Other Neurologic Problems (16 of 19) • Headache • What to do: • Give nonprescription medication. • Descend to an appropriate altitude. • If cause appears serious, evacuate.

42. Other Neurologic Problems (17 of 19) • Migraine • Periodic, one-sided, throbbing headache accompanied by nausea and vomiting. • Frequently preceded by a warning aura. • Sufferers often carry medication. • Allow victim to rest in a dark area.

43. Other Neurologic Problems (18 of 19) • Diabetes • Low blood sugar (hypoglycemia): Caused by taking too much insulin or by taking insulin and not eating enough food. • Exercise lowers blood sugar. • Give sugar immediately.

44. Other Neurologic Problems (19 of 19) • Diabetes • High blood sugar (hyperglycemia): Caused by too much insulin • Excessive thirst • Large urine output • Exhaustion • Fruity smell to breath • Very dangerous condition • Evacuate immediately.