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NEUROLOGIC OBJECTIVES

NEUROLOGIC OBJECTIVES. Upon completion of this lecture, you will be better able to: Describe assessment considerations for a student who exhibits an altered level of consciousness List assessment findings that indicate a neurologic problem requiring urgent or emergent care

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NEUROLOGIC OBJECTIVES

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  1. NEUROLOGIC OBJECTIVES Upon completion of this lecture, you will be better able to: • Describe assessment considerations for a student who exhibits an altered level of consciousness • List assessment findings that indicate a neurologic problem requiring urgent or emergent care • Describe appropriate interventions for a student with abnormal neurologic findings Illinois EMSC

  2. NEUROLOGIC EMERGENCIES Illinois EMSC

  3. Causes of Altered Level of Consciousness • Trauma • Cerebral thrombosis • Infection • Tumor • Shock • Hypoglycemia or Diabetic ketoacidosis • Alcohol/substance abuse • Anoxia • Seizures/postictal states • Ingestion/poisoning Illinois EMSC

  4. ASSESSMENT • Initial Assessment • ABCD’s • Detailed Assessment • Head-to-toe survey • Detailed neurologic exam • LOC • Motor function • Sensory function • History Illinois EMSC

  5. Level of ConsciousnessAssessment • Orientation • AVPU • Glasgow Coma Scale Illinois EMSC

  6. INITIAL APPROACH • ABC’s • Activate EMS • Manual C-spine stabilization • Oxygen assisted ventilations if AVPU is less than verbal level Illinois EMSC

  7. GENERAL APPROACH • Standing orders, if appropriate • Protect from further injury • Provide psychosocial support Illinois EMSC

  8. TRIAGE AND TRANSPORTEMERGENT • Altered LOC • Acute neurologic deficit • Generalized seizure or first time seizure • Seizure > 15 minutes or multiple seizures • Head injury with altered LOC • Head injury in child with bleeding disorder Illinois EMSC

  9. TRIAGE AND TRANSPORTURGENT • Student with VP shunt exhibiting early signs of shunt malfunction • Syncopal episode • Severe headache without neurologic deficit Illinois EMSC

  10. TRIAGE AND TRANSPORTNON-URGENT • Mild to moderate headache • Minor closed head injury, no LOC and asymptomatic Illinois EMSC

  11. HEAD AND SPINAL CORD TRAUMA • Most common type of injury in children • Causes: • Falls • Motor vehicle crashes (MVCs) • Pedestrian vs. motor vehicle • Inflicted injury • Sports/recreational related injury Illinois EMSC

  12. INTERVENTIONS • Primary survey with C-spine stabilization • General approach • Transport by EMS and maintain C-spine immobilization Illinois EMSC

  13. SYNCOPE • TYPES • Intrapsychic • Vascular • CAUSES • Vasovagal • Cardiac problem • Hypoglycemia • Hyperventilation • Other causes Illinois EMSC

  14. SEIZURES • PARTIAL • GENERALIZED Illinois EMSC

  15. SEIZURE SYNDROMES • FEBRILE • Most common seizure disorder • Occurs most frequently in children 3 months to 5 years old • Can be simple or complex • STATUS EPILEPTICUS • Generalized tonic-clonic • Lasts more than 15-20 minutes or are repeated Illinois EMSC

  16. CAUSES OF SEIZURES • Fever • Infection • Trauma • Intracranial bleeding • Toxic disturbances • Metabolic disturbances • Anoxia • Tumors • Congenital or degenerative disorders Illinois EMSC

  17. INTERVENTIONS • Follow generalized approach • Do not put anything in the mouth • Protect student from injury • Maintain airway • Place student on side • Observe duration and characteristics Illinois EMSC

  18. TRIAGE AND TRANSPORT:EMERGENT • Seizure lasting longer than 15 minutes • Respiratory compromise • Seizure following head injury • Atypical seizure in child with known seizure disorder Illinois EMSC

  19. CSF/VP SHUNT DYSFUNCTION SIGNS AND SYMPTOMS - Secondaryto Increased Intracranial Pressure • Vomiting, nausea • Decreased activity • Change in gait • Headache • Irritability or lethargy • Vision changes • Seizures Illinois EMSC

  20. CSF/VP SHUNT DYSFUNCTION TREATMENT • General approach • Transport based on signs and symptoms • Contact parent/guardian and MD Illinois EMSC

  21. Hyperreflexia • Seen in students with quadriplegia or spinal cord damage at or above the sixth thoracic vertebra • Causes • Bladder distension • Fecal impaction • Signs include: • Upper body erythema • Acute hypertension • Bradycardia Illinois EMSC

  22. HEADACHE • TYPES • Inflammatory • Vascular • Traction • Muscle Contractions • HISTORY • Quality of pain • Location • Relief measures • What makes it worse • Duration/frequency Illinois EMSC

  23. SPECIAL NEEDS STUDENTS CHRONIC HEALTH CONDITIONS • Seizure disorder • Sickle cell disease • Hemophilia • VP shunts • Congenital Heart Disease • Diabetes • Cystic Fibrosis Illinois EMSC

  24. PREVENTION • Educate students and staff regarding safe practices to prevent/decrease head & spinal injury • Bicycle helmets and other protective sports gear • Personal floatation devices • Seat belts/shoulder harness • Invite a speaker who has suffered a spinal cord injury to recount their post-injury experiences Illinois EMSC

  25. SUMMARY Your assessment of students with acute injury or illness should always include a thorough evaluation to identify neurologic deficits or increased risk for neurologic deterioration. Except for mild headaches and minor asymptomatic head injury, any illness or injury with neurologic manifestations should be triaged as urgent or emergent. Illinois EMSC

  26. ANY QUESTIONS?? Illinois EMSC

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