EMS Care
Name a very common and easily testable mimic of a stroke?
Hypoglycemia
Define status epilepticus
Continous or multiple seizures lasting 5 minutes or more without a return to consciousness
List three key risk factors for stroke
1) Hypertension
2) High cholesterol
3) Smoking
Define febrile seizure
A seizure caused by fever (usually 102 degrees or more); common in peds
How to perform a CPSS
Facial Droop
-big smile; 1 sided weakness, no toothy grin
Arm drift
-is unable to keep arms up, has 1 arm drop
Slurred speech
-repeat back a common phrase
What does TIA stand for?
Transient Ischemic Attack; ischemia to an area of the brain caused by a clot, clot is absorbed and thus restores blood flow to area w/o intervention
Describe the location, mechanism, history, and presentation of epidural hematoma
Above the dura of the brain. Usually arterial bleed = rapid bleeding. Usually from trauma; possible "lucid" interval or LOC followed by regaining consciousness, then becoming unresponsive.
List two clues that may be present in some seizure patients that can be identified in a field exam.
1) Oral trauma
2) Incontinence
What is the purpose of a Stroke Alert?
To prep the ER to have the CT ready; strokes are considered a TCD (Time Critical Diagnosis) and have to be treated ASAP
Define petit mal / Absence seizure
Define grand mal/ tonic-clonic seizure
1) absent stare, brief lapse in consciousness, period of rapid eye blinking; no loss of muscle tone
2) alternating stiffing and jerking of a patient's body
Describe the location, mechanism, history, and presentation of subdural hematoma
Below the dura of the brain. Typically venous bleed = slower onset, causing gradual onset of symptoms including nausea, vomiting, vision issues, and possibly unresponsiveness.
Describe what is meant by "aura"
When a patient hears, sees, smells, or feels sensations that aren't actually there; precursor to a seizure; some patients will know about an oncoming seizure based on this
Describe your management of a patient during a seizure
Protect them from injuring themselves, oxygen as needed, if seizures continue, medicate to stop the seizure
-Valium: IV slow push 5mg/minute
-Ativan: caution w/ pregnancy, allergy, severe hypotension. 2-4mg IM, IV, IO, IN
-Versed: caution w/ severe hypotension. 2-4mg IM, IV, IO, IN
Explain the two major types of stroke and state which is more common.
Ischemic: clot obstructing blood flow to an area of the brain
Hemorrhagic: bleeding in an area of the brain causing obstruction, pressure, and lack of circulation
Ischemic is most common
Describe the location, mechanism, history, and presentation of subarachnoid hematoma.
Located in subarachnoid space. Sudden, severe headache, changes in mental status or LOC, etc.
Describe the "postictal" phase.
Varying period of time where the patient is regaining consciousness after a seizure; periods of confusion during this time
Why is the "last known well" time so important to the Stroke Team/ ER?
Certain treatments and medications must be given within a time frame, so knowing the patient's last known well time is important to the treatment plan
Define thunderclap headache
Sudden, severe headache
Describe the location, mechanism, history, and presentation of intracerebral bleeding
Within brain tissue, usually w/ trauma and associated with other bleeds.
What is potentially a life-threatening cause of a febrile seizure and describe how you might assess for this.
Meningitis. History and assessment - nuchal (neck) rigidity, HA, unknown cause of fever, etc.