Be fix-it-felix
You respond to a 45-year-old male found acting confused and slurring his words at a bus stop. He is sweaty and trembling.
What is the first diagnostic assessment you should perform?
What is blood glucose test (to rule out hypoglycemia, the great neurologic mimicker).
This type of generalized seizure is characterized by a sudden loss of consciousness followed by alternating phases of rigid muscle tensing and rhythmic, violent jerking of the extremities.
What is a Tonic-Clonic seizure? (Grand Mal is also acceptable, though "Tonic-Clonic" is preferred
This dual-injury mechanism occurs when the brain strikes the front of the skull, then bounces back to hit the opposite side, common in high-speed rear-end collisions.
What is a coup-contrecoup injury?
This phenomenon occurs when a patient experiences a brief "lucid interval" of normal behavior before a rapidly expanding arterial blood clot severely compresses brain tissue.
What is an epidural hematoma?
A 62-year-old female suddenly experiences left-sided facial droop and right arm weakness while eating dinner. Her symptoms completely disappear 15 minutes later before your arrival.
What neurological event did this patient most likely experience?
What is Transient Ischemic Attack (TIA).
Common in children, this seizure type involves a sudden, brief lapse of consciousness where the patient appears to be "blankly staring" or day-dreaming, typically lasting only a few seconds with no postictal confusion.
What is an Absence seizure? (Petit Mal is also acceptable).
During a motor vehicle accident, this sudden, temporary loss of spinal reflex activity occurs immediately following a severe spinal cord injury, causing flaccid paralysis and a loss of sensation below the level of the injury.
What is neurogenic shock?
This life-threatening condition occurs within 24 to 48 hours of trauma when fluid buildup increases pressure inside the rigid, unyielding human skull.
What is cerebral edema (or increased intracranial pressure)?
You arrive to find a 22-year-old male lying on the floor. Witnesses say he just finished a 2-minute episode of full-body muscle jerking. He is currently unresponsive to verbal commands and breathing deeply.
What is the medical term for this patient’s current altered neurological state?
What is postictal state (or postictal phase).
During this specific type of seizure, the abnormal electrical activity is localized to one hemisphere of the brain, causing isolated symptoms like localized twitching or sensory changes, while the patient remains fully alert and oriented.
What is a Focal Aware seizure? (Simple Partial seizure is also acceptable).
A linear fracture to the temporal bone frequently disrupts the middle meningeal artery, leading to this rapidly expanding, life-threatening intracranial bleed.
What is an epidural hematoma?
Accompanied by systemic issues like broken ribs or a collapsed lung, this secondary insult occurs when the brain is starved of oxygen despite surviving the initial impact.
What is hypoxia (or ischemic brain injury)?
A 50-year-old male reports a sudden, excruciating headache that he rates a "10 out of 10," You note he has a stiff neck and is suddenly vomiting.
What specific life-threatening presentation does this suggest?
What is subarachnoid hemorrhage (SAH).
This life-threatening neurological emergency is defined as a continuous seizure lasting longer than 5 minutes, or consecutive seizures occurring without the patient regaining full consciousness in between.
What is Status Epilepticus?
This type of traumatic brain injury is caused by a mechanism of rapid acceleration or deceleration that disrupts neurologic function, sometimes losing consciousness, often presenting with temporary confusion, amnesia, or dizziness without showing physical damage on standard imaging.
What is a concussion?
To rapidly identify a stroke in the field, EMTs assess for abnormal speech, an asymmetrical smile, and this motor sign where one arm involuntarily drifts downward.
What is arm drift?
A 70-year-old trauma patient opens their eyes only when you pinch their trapezius muscle. They moan incomprehensibly when asked questions, and they actively pull their arm away when you apply a painful stimulus.
What is this patient’s exact Glasgow Coma Scale (GCS) score?
What is GCS 8 (Eyes = 2 for pain, Verbal = 2 for incomprehensible sounds, Motor = 4 for withdrawing from pain).
This physiological response—characterized by bradycardia, bradypnea, and hypertension—occurs when severe head trauma causes a drastic spike in intracranial pressure.
What is Cushing’s triad?
Unlike standard hemorrhagic shock, an EMT can suspect neurogenic shock from a high spinal injury if the hypotensive patient presents with this unusually low vital sign.
What is bradycardia (or a slow heart rate)?