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Nervous system

Nervous system. & Emergencies. Nervous System. Look up in text Central Nervous System Brain & Spinal cord Peripheral nervous system All the rest of the nerves. Central Nervous System. Look up anatomy in TEXT! Chapter 4. CNS Parts. Cerebrum - Center of intellect

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Nervous system

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  1. Nervous system & Emergencies

  2. Nervous System • Look up in text • Central Nervous System • Brain & Spinal cord • Peripheral nervous system • All the rest of the nerves

  3. Central Nervous System • Look up anatomy in TEXT! • Chapter 4

  4. CNS Parts • Cerebrum - Center of intellect • Cerebellum - Balance, muscle coordination • Brainstem - Controls vital functions • CSF (cerebral spinal fluid) - Protection • Spinal cord - Transmits impulses

  5. Lobes of cerebrum & function • Frontal - Cognition and motor • Parietal - Touch and orientation • Temporal - Speech & Hearing • Occipital - Sight

  6. Brainstem is Location of • Cardiac center • Respiratory center • Vasomotor center • RAS - reticular activating system

  7. and... • Blood supply = carotids • Meninges - tissue layers(3) that cover brain & spinal cord. Dura mater Pia mater arachnoid

  8. Peripheral Nervous System • Links the organs of the body to the central nervous system. • Sensory nerves carry information from the body to the central nervous system. • Motor nerves carry information from the central nervous system to the muscles of the body.

  9. The Nervous System • The nervous system controls the body’s voluntary and involuntary actions. • Somatic nervous system • Autonomic nervous system

  10. Sympathetic • Fight or flight • pupils dilate • increased CNS stimulation • increased heart rate & BP • bronchioles dilate • decreased GI activity

  11. Parasympathetic • Passive mode • After eating a big meal • increased GI activity • constricted pupils • sleepy

  12. Neurologic Emergencies

  13. Neurologic Trauma

  14. Concussion • Temporary loss or alteration in brain function • Brief loss of consciousness • Brain can sustain bruise • Not a problem unless there is bleeding

  15. Intracranial bleeding • Subdural • Intracranial • Epidural • All bleeds causes increased intracranial pressure & brain damage

  16. EPIDURAL BLEED

  17. Intracranial Bleed

  18. signs of increasing intracranial pressure • ALOC • vomiting • unequal pupils • hypertension & decreasing heart rate • expanding pulse pressure • Seizure • Abnormal respiratory patterns • Posturing

  19. Posturing • Severe sign of increased intracranial pressure • Decerebate • Decorticate • will be unconscious !!

  20. ALOC • Single most important observation • Use AVPU or GCS • Repetitive questioning • Level of consciousness Decreasing? = worry

  21. Change in Pupil Size • Unequal pupil size may indicate increased pressure on one side of the brain.

  22. Shock • If patient has signs/symptoms of shock, look elsewhere for cause!! • Abdomen or chest!

  23. Basilar skull fracture • Indicates SIGNIFICANT force • CSF fluid in ears & nose • “battle” sign • “raccoon” eyes

  24. Signs and Symptoms of Spinal Injury • Pain, swelling, deformity • Tingling in the extremities • Paralysis or paresis • Incontinence • Injuries to the head

  25. Spinal cord injury • Paraplegia = paralysis of lower extremities • Quadriplegia = paralysis of all extremities

  26. Identifying C-spine candidates • Mechanism of injury • pain • numbness or tingling in extremities

  27. Significant Mechanisms of Injury (MOI) • MVA’s • Auto vs. Peds/bicycle/motorcycle • Falls • Blunt or penetrating trauma • Hangings • Recreational accidents

  28. Rx for Head & Spine Injury • Maintain airway (jaw thrust) • Oxygen • Hyperventilate • Stabilize C-spine

  29. Stabilization of the Cervical Spine • Do not force the head into a neutral, in-line position if: • Muscles spasm • Pain increases, resistance, crepitus • Numbness, tingling, or weakness develop • There is a compromised airway or breathing

  30. notes • PMSC before and after AND DOCUMENT! • Manual head stabilization

  31. Non-traumatic Brain Injuries • Not always caused by trauma. • Medical conditions may cause spontaneous bleeding in the brain. • S/S are the same • There is no mechanism of injury.

  32. More Neurologic Emergencies • Seizure • Stroke • Altered Mental Status (AMS)

  33. Seizures – Nervous system disorder • Generalized (grand mal) seizure • Unconsciousness and generalized severe twitching • Petit mal seizure • a brief lapse of attention • Focal or Jacksonian • One area

  34. Congenital High fevers Structural problems in the brain Metabolic disorders Chemical disorders Causes of Seizures

  35. Stages of seizure • Aura - prior sensory warning • Tonic - contraction phase • Clonic - alternating movements • Postictal - after seizure a period of ALOC with deep and labored respirations

  36. Status Epilepticus • 1 seizure over 10 minutes • 2 seizures without regaining consciousness • 3 seizures within 1 hour

  37. Complications • Hypoxia • Trauma • Hyperthermia • Hypoglycemia • Aspiration • Dehydration

  38. Common medications • Dilantin • Tegretol • Pheno-Barbitol • and ...

  39. Treatment • ABC’s • Protect patient from injuring self • Oxygen • Supine or left lateral • Transport

  40. Stroke • CVA • TIA • Hemorrhagic stroke • Ischemic stroke

  41. Signs and Symptoms of Stroke • Left Hemisphere • Aphasia • Receptive aphasia • Expressive aphasia • Right Hemisphere • Dysarthria

  42. Stroke Mimics • Hypoglycemia • Postictal state • Subdural or epidural bleeding

  43. Assessing the Stroke Patient • Initial assessment • ABCs. • Obtain history if possible. • High flow O2 • Focused history and physical exam • GCS • Perform neurologic exam. • Cincinnati Stroke Scale

  44. Cincinnati Stroke Scale • Facial droop • Arm drift • Speech

  45. Hypoglycemia Hypoxemia Intoxication Drug overdose Unrecognized head injury Brain infection Body temperature abnormalities Brain tumors Glandular abnormalities Poisoning Altered Mental Status (AMS)

  46. END Questions?

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