Neurologic Disorders

1
22
Neurologic Disorders
2
Advanced EMT Education Standard

• Applies fundamental knowledge to provide basic
  and selected advanced emergency care and
  transportation based on assessment findings for
  an acutely ill patient.

3
Multimedia Directory

• Slide 65 Transient Ischemic Attack Video

4
Objectives

1. Define key terms introduced in this chapter.
2. Recognize complaints that may indicate a
   neurologic problem. 32-43
3. List possible underlying causes of altered mental
   status, neurologic deficit, headache, seizures,
   and syncope. 44-47

5
Objectives

1. Explain the importance of airway assessment and
   management in patients with altered mental status
   and neurologic deficit. 47-49
2. Obtain information in the patient history that is
   focused on the evaluation of altered mental
   status, neurologic deficit, headache, seizure, or
   syncope. 34-35

6
Objectives

1. Given a scenario with a patient with altered
   mental status, neurologic deficit, headache,
   seizure, or syncope, perform a physical
   examination that is focused on relevant findings
   and anticipated consequences. 39-43

7
Objectives

1. Integrate scene size-up information, the
   patients history, vital signs, and physical exam
   findings with knowledge of anatomy and physiology
   and pathophysiology to identify more likely
   causes of the patients condition. 44-47

8
Objectives

• Determine the need for the following
  interventions in patients with a neurologic
  emergency 47
• Interventions to open and maintain the airway
• Manual spinal stabilization
• Oxygenation
• Ventilation
• Identify the signs and symptoms of stroke. 60-62

9
Objectives

1. Describe the pathophysiology of stroke. 58-65
2. Explain the importance of early recognition of
   stroke signs and symptoms by patients, family or
   bystanders, and EMS personnel. 57-67
3. Describe the relationship between stroke and
   transient ischemic attack. 64

10
Objectives

• Assess the patient with possible stroke for
  neurologic deficits, including use of a stroke
  scale. 40-43
• Cincinnati Prehospital Stroke Scale
• Los Angeles Prehospital Stroke Scale
• Discuss the role of blood glucose determination
  in the assessment of patients with altered mental
  status, neurologic deficits, and seizures. 38,
  44, 47

11
Objectives

1. Describe ways of communicating with patients who
   have difficulty speaking. 36-40
2. Recognize indications that a headache may have a
   potentially life-threatening underlying cause,
   such as toxic exposure, hypertension, infectious
   disease, or hemorrhagic stroke. 62-63
3. Describe measures that you can take to improve
   the comfort level of the patient suffering from a
   headache. 89-97

12
Objectives

1. Explain the importance of reassessment of the
   patient with altered mental status, neurologic
   deficit, headache, seizure, or syncope. 48
2. Describe the various ways that seizures can
   present. 77-78
3. Discuss possible underlying causes of seizures.
   75-76
4. Explain the concerns associated with prolonged or
   successive seizures. 82-87

13
Objectives

1. Describe the assessment and emergency medical
   care of patients with tonicclonic, simple
   partial, complex partial, febrile, and absence
   seizures, and patients in a postictal state.
   81-86
2. Anticipate bystander reactions to patients having
   seizures and measures needed to stop any
   unnecessary or inappropriate interventions. 86

14
Objectives

1. Compare and contrast features of dementia and
   delirium. 99-107
2. Describe basic information about various
   neurologic disorders, such as Bells palsy,
   vertigo, Parkinsons disease, Wernicke-Korsakoff
   syndrome, multiple sclerosis, normal pressure
   hydrocephalus, and others that may affect the
   assessment and management of patients. 109-128

15
Introduction

• Neurologic disorders arise in either central or
  peripheral divisions of nervous system.
• Altered mental status, behavioral changes,
  neurologic deficits common manifestations of
  nervous system disorders.

16
Introduction

• Understanding pathophysiology of disease
  processes helps you understand importance of your
  actions.

17
Think About It

• What are some potential causes of the patients
  headache?
• What level of concern should Anna and Brian have
  for a chief complaint of severe headache?

18
Think About It

• What is the best way to approach the gathering of
  this patients history?
• What aspects of the examination will provide the
  most important information?

19
Anatomy andPhysiology Review

• Nervous and endocrine systems two major control
  systems of body.
• Nervous system divided anatomically into
• Central nervous system (CNS) brain, spinal cord.
• Peripheral nervous system all neural tissue
  outside brain and spinal cord.

20
Anatomy andPhysiology Review

• Nervous system divided into somatic (voluntary)
  and autonomic (involuntary) divisions.
• Autonomic divided into
• Parasympathetic vegetative functions and
  reproduction.
• Sympathetic response to stressors.

21
Table 221 Functions of the Sympathetic and
Parasympathetic Divisions of the Autonomic
Nervous System
22
Anatomy andPhysiology Review

• Function of nervous system is to
• Monitor input from bodys internal and external
  environments.
• Integrate sensory input from environment.
• Coordinate both voluntary and involuntary
  responses to input.

23
Anatomy andPhysiology Review

• Figure 22-3 Representative neuron.

24
Anatomy andPhysiology Review

• What is the basic unit of structure of the
  nervous system?
• What are the components of each neuron?

25
Anatomy andPhysiology Review

• Gap between axon and dendrites of adjacent neuron
  or effector tissue is a synapse.
• Molecules of neurotransmitter secreted into
  synapse and bind with receptors on dendrites.

26
Anatomy andPhysiology Review

• Figure 22-5 (B) Structure of brain Sagittal
  view.

27
Table 222 Selected Neurotransmitters
28
Anatomy andPhysiology Review

• Human brain consists of six major parts
• Cerebrum
• Diencephalon
• Midbrain
• Pons
• Medulla oblongata
• Cerebellum

29
Anatomy andPhysiology Review

• Cerebrum uppermost portion of brain responsible
  for higher brain functions.
• Divided into right and left hemispheres.
• Each hemisphere composed of frontal, temporal,
  parietal, occipital lobes.

30
Table 223 Functions of the Brain
31
Think About It

• If your scene size-up shows that there are
  multiple patients with altered mental status,
  suspect exposure to a toxin.
• Do not enter the area.
• Notify dispatch of a possible hazardous materials
  situation.

32
Assessment ofNeurologic Complaints

• Presentation, complaints, history help determine
  if problem due to neurologic causes.
• Knowledge of pathophysiology of common neurologic
  problems important.

33
Assessment ofNeurologic Complaints

• Scene Size-Up
• Standard operational and patient care.
• Ensure your safety and patients.
• Note indications that problem is neurologic.
• Note general appearance obtain chief complaint.

34
Assessment ofNeurologic Complaints

• Primary Assessment
• Unresponsive patient, check carotid pulse begin
  cardiac resuscitation.
• Determine level of responsiveness using AVPU.
• Patients with some neurologic problems can be
  deeply unresponsive, leading to airway
  obstruction and decreased ventilation.

35
Assessment ofNeurologic Complaints

• Primary Assessment
• Intervene as needed to establish and protect
  airway.
• Impaired brain oxygenation worsens outcome of
  neurologic problems.
• Limit secondary brain injury from poor perfusion,
  hypoxia, hypoglycemia.

36
Assessment ofNeurologic Complaints

• Secondary Assessment
• Obtain medical history use mnemonics SAMPLE and
  OPQRST.
• Obtain list of medications.

37
Table 224 Medications That May Indicate a
Neurologic Problem
38
Assessment ofNeurologic Complaints

• Secondary Assessment
• Obtain vital signs, pulse oximetry.
• If patient has altered mental status or history
  of diabetes, obtain blood glucose level (BGL).

39
Assessment ofNeurologic Complaints

• Secondary Assessment
• Consider possibility of increased intracranial
  pressure (ICP) and concept of cerebral perfusion
  pressure (CPP).
• Perform rapid physical examination for critical
  patients.
• Perform focused physical examination for
  noncritical patients.

40
Assessment ofNeurologic Complaints

• Secondary Assessment
• Exams of mental and neurologic status required in
  patients with potential neurologic problems.
• Examine pupil assess motor and sensory functions
  in all four extremities.
• Use stroke screening tools.

41
Table 225 Cincinnati Prehospital Stroke Scale
(CPSS)
42
Table 226 Los Angeles Prehospital Stroke
Screen (lAPSS)
43
Table 227 Glasgow Coma Scale
44
Assessment ofNeurologic Complaints

• Reasoning and Decision Making
• Understand basic functions of nervous system and
  causes of neurologic signs and symptoms.
• Altered mental status.
• Behavioral emergencies.
• Headache.
• Slurred speech.

45
Assessment ofNeurologic Complaints

• Reasoning and Decision Making
• Extracranial infection, metabolic problems,
  hypoxia, hypoperfusion, toxins, environmental
  conditions, overdoses.
• Intracranial traumatic brain injury, stroke,
  epilepsy.

46
Table 228 Mnemonic AEIOU-TIPS for Causes of
Altered Mental Status
47
Assessment ofNeurologic Complaints

• Reasoning and Decision Making
• Manage airway, ventilation, oxygenation.
• Control bleeding and maintain blood pressure.
• Transport stroke or traumatic brain injury
  patient to right facility for care.

48
Assessment ofNeurologic Complaints

• Reassessment
• Reassess critical patients every 5 minutes.
• Reassess noncritical patients every 15 minutes.

49
Think About It

• The patient may present with altered mental
  status, behavioral changes, sensory impairment,
  headache, weakness, paralysis, or other
  complaints.
• You must use knowledge of various causes of the
  presenting signs and symptoms to arrive at a
  field impression.

50
Altered Mental Status

• Altered mental status (AMS) is not disease in
  itself, but indication of underlying problem
  affecting brain function.
• Patients vulnerable due to decreased or lost
  reflexes.
• Manage airway, breathing, circulation.
• Search for correctable underlying causes.

51
Think About It

• AMS patients may have lost their gag and cough
  reflexes, muscle tone may be impaired, and
  respirations may be depressed.
• Patients with involvement of the hypothalamus and
  brainstem may lose the ability to control body
  temperature, blood pressure, heart rate, and
  respirations.

52
Syncope

• Syncope temporary loss of consciousness caused
  by inadequate brain perfusion.

53
Syncope

• Causes
• Transient cardiac dysrhythmia.
• Volume depletion.
• Medications that prevent increase in heart rate
  or vasoconstriction when patient changes from
  supine or sitting position to standing.
• Vasovagal response.

54
Syncope

• Underlying cause of syncope in most cases is
  cardiovascular, not neurologic.
• Syncope transient.
• Syncope can be benign potentially
  life-threatening causes.
• Patients thoroughly evaluated and encouraged to
  be transported to hospital.

55
Think About It

• Syncope can be benign there are also potentially
  life-threatening causes.
• It is possible for a patient to sustain injury if
  he falls during the syncopal episode.

56
Think About It

• All patients who have experienced syncope or a
  near-syncopal episode must be thoroughly
  evaluated and encouraged to be transported to the
  hospital.

57
Stroke

• Leading cause of death and disability.
• Area of brain deprived of circulation thus of
  oxygen and glucose.
• Ischemic stroke blood clot blocks arterial blood
  flow to portion of brain.
• Hemorrhagic stroke rupture of blood vessel
  within cranium.

58
Stroke

• Stroke Pathophysiology
• Ischemic stroke often result of atherosclerosis
  of cerebral arteries internal carotid arteries
  that supply blood to brain.
• Risk factors for atherosclerosis same as those
  for cardiovascular disease.

59
Table 229 Stroke Risk Factors
60
Stroke

• Stroke Pathophysiology
• Hemorrhagic strokes occur due to rupture of
  aneurysm in brain or from AVM.
• Hypertension and atherosclerosis risk factors.
• Neurologic damage and death begin to occur within
  4 minutes.

61
Table 2210 Stroke Terminology
62
Stroke

• What are the common warning signs of stroke?

63
Stroke

• Stroke Pathophysiology
• Hemorrhagic strokes begin with sudden, severe
  headache unlike other headaches patient has
  experienced followed by progressively worsening
  signs and symptoms.
• Ischemic stroke no headache signs and symptoms
  at worst at or near time of onset.

64
Stroke

• Stroke Pathophysiology
• Transient ischemic attack (TIA) temporary
  interruption in perfusion (from atherosclerotic
  disease or emboli).
• Patient who has experienced TIA at high risk for
  subsequent stroke.

65
Transient Ischemic Attack Video

• Click here to watch a video on the topic of
  transient ischemic attacks.

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66
Stroke

• Stroke Treatment
• Recognize signs, symptoms that indicate stroke.
• Use prehospital stroke screening tool.

67
Table 2211 The Ds of Stroke Care
68
Stroke

• Stroke Treatment
• Support patients airway, breathing, circulation.
• Administer oxygen to patients with SpO2 less than
  95
• Manage hypotension.

69
Stroke

• Stroke Treatment
• Establish time of onset.
• Select most appropriate receiving facility.
• Transport without delay.
• Be prepared to manage seizures.
• Notify receiving facility.
• Check patients blood glucose level.

70
Stroke

• Stroke Treatment
• Patients at risk for upper airway obstruction and
  aspiration.
• Treat hypoxia do not over administer oxygen.
• Patients may be hypertensive not recommended to
  treat high blood pressure in prehospital setting.

71
Stroke

• Stroke Treatment
• For fibrinolytic treatment to be effective, it
  must be initiated within 3 to 4½ hours from onset
  of signs and symptoms.

72
Table 2212 Fibrinolytic Treatment Inclusion
and Exclusion Criteria
73
Think About It

• Transport stroke patient without delay.
• Most appropriate facility to maximize the
  patients chances for improvement.
• Stroke centers regionally located.
• Air transport may be required if you are in a
  rural area.
• Follow protocols and policies for destination and
  mode of transport.

74
Seizures

• Figure 229 A generalized tonicclonic, or
  grand mal, seizure is a sign of abnormal release
  of electrical impulses in the brain (A) aura,
  (B) loss of consciousness followed by tonic
  phase, (C) clonic phase, and (D) postictal phase.

75
Seizures

• Seizure abnormal discharge and spread of
  neuronal activity through cerebral cortex, which
  interferes with neurologic functioning.
• Abnormal generalized motor activity.
• Motor activity localized.
• Behavioral change.

76
Seizures

• Underlying causes of seizures
• Epilepsy
• Toxins, drugs
• Metabolic disorders
• Trauma
• Stroke
• Tumor
• Fever

77
Seizures

• Key piece of information is whether or not
  patient has history of seizures.
• Generalized seizures tonic clonic and absence
  seizures.
• Tonic clonic seizures motor seizures involving
  entire body followed by postictal state.
• Absence seizure may appear as patient simply
  staring off into space or daydreaming.

78
Seizures

• Partial seizures focal or localized to one area
  of brain.
• Simple partial seizures motor, sensory, psychic,
  autonomic phenomena.
• Complex partial seizures accompanied by aura
  involve impairment of awareness associated with
  stereotyped movements and postictal period.

79
Seizures

• Patients may be injured during seizure, become
  hypoxic or acidotic, or suffer airway obstruction
  during postictal period.
• Patients may continue to be sleepy for several
  hours following seizure.

80
Seizures

• In immediate postictal period, patients have
  copious oral secretions often require
  positioning and suctioning to clear airway.

81
Seizures

• Administer oxygen in immediate postictal period.
• Control any major bleeding.
• Assess for injuries and other abnormalities.
• Obtain vital signs and blood glucose level.

82
Seizures

• Determine if patient has history of seizures,
  recent trauma, medical problems, medications
  patient is taking.
• Check for medical identification jewelry.

83
Seizures

• Postictal period can last up to 30 minutes.
• Most common cause of life-threatening condition
  status epilepticus is inadequate level of
  anticonvulsant medication.
• Follow your protocol for contacting medical
  direction and obtaining refusal of care.

84
Seizures

• Status Epilepticus
• Tonic clonic seizure lasting more than 5
  minutes, or consecutive seizures without
  intervening period of consciousness.
• Life-threatening emergency.

85
Seizures

• Status Epilepticus
• Request advanced life support, if available
  transport without delay.
• Manage patients airway and ventilation.
• Consult medical direction about fluid
  administration.

86
Seizures

• Status Epilepticus
• Do not use bite-block or insert anything between
  patients teeth to attempt to prevent him from
  biting his tongue.
• Move objects away from patient to prevent injury.
• Place padding beneath head to protect it from
  hard surfaces.

87
Seizures

• Sudden Unexpected Death in Epilepsy (SUDEP)
• Cause 8 to 17 of deaths in patients with
  epilepsy.
• Does not occur during seizure may occur shortly
  afterward.
• May be unwitnessed.
• Autopsy findings are varied.

88
Think About It

• What have the findings so far suggested about
  causes that should be higher on Brian and Annas
  list of possible differential diagnoses?
• What line of questioning should Brian pursue
  next?
• How should Brian and Anna approach treatment and
  transport decisions for this patient?

89
Headache

• Chief complaint determine change in pattern from
  patients other headaches.
• Primary headache syndromes migraines, cluster
  headaches, tension headaches.
• Secondary headache syndromes caused by other
  problems, some can be life threatening.

90
Headache

• Primary Headache Syndromes Migraine
• Abnormal nervous system pain transmission
  neurochemical in origin.
• Occur more frequently in females than males.
• Occur at younger age.

91
Headache

• Primary Headache Syndromes Migraine
• Last from minutes to hours.
• May experience aura prior to onset.
• Pain accompanied by photosensitivity, nausea,
  vomiting.

92
Headache

• Primary Headache Syndromes Cluster
• Uncommon occur more frequently in males.
• Sudden onset of series of severe headaches of
  short duration.
• Unilateral, temporal region or around eye.

93
Headache

• Primary Headache Syndromes Tension
• Dull, nagging pain may extend from shoulders and
  neck to scalp.
• Abnormal serotonin or neurotransmitter activity.

94
Headache

• Secondary Headache Syndromes
• Vascular problems
• CNS or non-CNS infections
• Glaucoma
• Hypoxia
• Toxins
• High altitude
• Tumors
• Hypertension

95
Headache

• Secondary Headache Syndromes
• Hypoglycemia
• Carbon monoxide exposure
• Fever
• Dental problems
• Pre-eclampsia
• Hypertension

96
Headache

• Secondary Headache Syndromes Subarachnoid
  Hemorrhage
• Bleeding accumulates between brain and arachnoid
  layer of meninges.
• Sudden onset of severe headache nausea,
  vomiting, altered mental status.

97
Headache

• Secondary Headache Syndromes Subarachnoid
  Hemorrhage
• 50 of patients have normal vital signs, normal
  level of responsiveness, no neck pain or
  stiffness.
• May result in death or disability.

98
Think About It

• It is difficult to understand how debilitating
  the pain of a migraine headache is, if you have
  not experienced one yourself.

99
Dementia and Delirium

• Dementia progressive condition in which
  intellectual function severely impaired may be
  accompanied by emotional and behavioral changes.
• Intellectual components impaired memory,
  reasoning, and problem-solving, language, other
  cognitive skills.

100
Dementia and Delirium

• Incidence increases with age not normal
  consequence of aging.
• Alzheimers disease presence of amyloid deposits
  in brain.

101
Dementia and Delirium

• Multi-infarct dementia result of multiple, small
  strokes.
• Frontotemporal dementia strong familial
  component manifests as either loss of
  inhibitions or severe language deficits.

102
Dementia and Delirium

• Be calm and tolerant.
• World can be frightening place to patient.
• Such patients can be agitated and combative
  behavior arises from confusion.

103
Dementia and Delirium

• Take care patient does not injure himself or
  others.
• Sudden change in baseline mental status.

104
Dementia and Delirium

• Delirium acute state of confusion that occurs
  from underlying problem (infection, metabolic
  disturbances, toxins, medications).
• More prevalent in elderly patients with renal
  failure, heart failure, chronic illness.
• Affect patient less in morning, worsening in
  evening.

105
Dementia and Delirium

• Delirium acute state of confusion that occurs
  from underlying problem (infection, metabolic
  disturbances, toxins, medications).
• May have delusions and hallucinations may be
  frightened.
• Protect patient from harm and reassure him.

106
Dementia and Delirium

• Excited delirium (ExDS) delirium accompanied by
  agitated, combative behavior, often prompting
  involvement of law enforcement.
• Associated with cocaine, methamphetamine use.
• Implicated in several deaths of persons in
  custody of law enforcement.

107
Dementia and Delirium

• Excited delirium (ExDS) delirium accompanied by
  agitated, combative behavior, often prompting
  involvement of law enforcement.
• May exhibit unusual pain tolerance, tachypnea,
  sweating, unusual strength, lack of tiring.

108
Think About It

• Mini Mental State Exam (MMSE) tool to screen
  for dementia.
• Research found that there was a higher proportion
  of elderly patients with cognitive impairment who
  arrived at the emergency department by ambulance
  than by other means.
• Screening for cognitive impairment may be useful
  in the prehospital setting.

109
Vertigo

• Vertigo
• Subjective sensation of movement when there is
  none dizziness.
• Nausea, vomiting, abnormal eye movements.
• Precipitated by sudden movement of head.

110
Vertigo

• Vertigo
• Caused by problems with structures of inner ear,
  eighth cranial nerve, or problem with brainstem.
• History from benign paroxysmal positional vertigo
  (BPPV) or Ménière disease.

111
Think About It

• Vertigo is a subjective sensation of movement
  when there is none
• Described by patients as dizziness.
• Patients often confuse dizziness and
  lightheadedness.
• Verify whether the patient is experiencing a
  sensation of spinning or other movementor he is
  feeling like he may faint (lightheadedness).

112
NontraumaticBack and Neck Pain

• Impingement of spinal nerves due to herniation
  or rupture of intervertebral disc.
• Weakness, numbness, tingling, pain along
  distribution of nerve.
• Spinal immobilization not indicated may worsen
  patients pain.

113
NontraumaticBack and Neck Pain

• Impingement of spinal nerves due to herniation
  or rupture of intervertebral disc.
• Neurologic or musculoskeletal in origin.
• Consider serious medical conditions and
  potentially life-threatening causes.

114
Think About It

• A common cause of severe back pain on one side,
  particularly in older and immunosuppressed
  patients, is herpes zoster (shingles.)
• A re-emergence of the virus that causes chicken
  pox.

115
Think About It

• Virus lies dormant in a spinal nerve root for
  many years and emerges when there is a decline in
  immune system function.

116
Central NervousSystem Infections

• Encephalitis, meningitis, brain abscess all
  produce neurologic signs and symptoms.
• Encephalitis inflammation of brain by viral
  infection.
• Meningitis either viral or bacterial.
• Brain abscess focal, or localized, bacterial or
  fungal infection in brain.

117
Think About It

• A brain abscess is a focal, or localized,
  bacterial or fungal infection in the brain.
• An abscess can occur from extension of an ear,
  sinus, or tooth infection, or from pathogens
  introduced into the blood.
• Patients who are immunocompromised are at greater
  risk.

118
Other Neurologic Disorders

• Bells Palsy
• Temporary weakness or paralysis of facial nerve.
• Drooping of affected side, drooling, lose sense
  of taste, numbness on affected side, dry eye or
  excessive tearing.
• Forehead generally involved only.
• Majority of cases resolve in several weeks.

119
Other Neurologic Disorders

• Normal Pressure Hydrocephalus (NPH)
• CSF produced within ventricles of brain cannot be
  properly reabsorbed or drained collects in
  abnormal amounts.
• Characterized by ataxia, dementia, urinary
  incontinence.
• Shunt may be placed to drain excess fluid.

120
Other Neurologic Disorders

• Parkinsons Disease
• Patients over age of 50 can occur earlier.
• Loss of dopamine-producing cells in brain,
  resulting in movement disorder.
• Signs and symptoms tremors, muscle rigidity,
  slowed movements, problems with balance and
  coordination.
• Disease is progressive.

121
Other Neurologic Disorders

• Multiple Sclerosis
• Autoimmune disease myelin sheath of nerves
  destroyed problems with nerve conduction.
• Onset of disease between ages of 20 and 40.
• Initial symptom is difficulty with vision.
• Muscle weakness (may progress to paralysis),
  tingling sensations, and, frequently, cognitive
  symptoms.

122
Other Neurologic Disorders

• Myasthenia Gravis
• Autoimmune condition acetylcholine receptors in
  skeletal system blocked or destroyed.
• Muscle weakness during activity improves with
  rest.
• Facial and respiratory muscles often affected.

123
Other Neurologic Disorders

• Myasthenia Gravis
• Myasthenic crisis patient does not receive
  adequate amount of medication.
• Cholinergic crisis patient is overmedicated.

124
Other Neurologic Disorders

• Peripheral Neuropathy
• Disorders of nerves of peripheral nervous system.
• Patients with diabetes especially prone.
• May be autoimmune, result of injury, due to
  toxins, infection, malnutrition.
• Signs and symptoms pain, burning sensations,
  numbness, tingling, weakness, wasting of affected
  muscle groups.

125
Other Neurologic Disorders

• Tardive dyskinesia permanent side effect of
  taking certain classes of medications, often
  antipsychotics.
• Repetitive, involuntary, purposeless movements.
• Grimacing, blinking eyes, tongue protrusion,
  smacking or puckering lips.

126
Other Neurologic Disorders

• Acute dystonic reaction temporary side effect of
  taking types of medications implicated in tardive
  dyskinesia.
• Seen often in patients who have used illegal
  drugs.
• Onset within hours or days.

127
Other Neurologic Disorders

• Acute dystonic reaction temporary side effect of
  taking types of medications implicated in tardive
  dyskinesia.
• Sudden onset of sustained or intermittent
  involuntary muscle contractions.
• Reaction frightening and confusing for patient.

128
Other Neurologic Disorders

• Wernicke-Korsakoff Syndrome
• Spectrum of degenerative neurologic disorders
  Wernickes encephalopathy and Korsakoffs amnesic
  syndrome.
• Common in alcoholics, those with eating
  disorders, patients who are malnourished.
• Wernickes encephalopathy acute phase of
  disorder.

129
Think About It

• Has your thinking about the case study changed
  since the beginning of the chapter?

130
Chapter Summary

• Neurologic emergencies signs and symptoms
• Altered mental status.
• Weakness.
• Fatigue.

131
Chapter Summary

• Complaints and signs that indicate neurologic
  problem may be caused by other problems.
• Patients presentation, medical history, list of
  medications help to focus investigation.

132
Chapter Summary

• Know function of nervous system and
  pathophysiology of neurologic disorders.

133
Chapter Summary

• Goals for managing patients with suspected
  neurologic problems
• Manage airway, breathing, circulation.
• Look for immediately correctable causes of
  problem.
• Ensure open airway adequate ventilation and
  oxygenation.

134
Chapter Summary

• Perfusion of brain may be affected by
• Dehydration.
• Impairment of fluid regulation.
• Decreased metabolism.
• Cardiac dysrhythmia.
• Administer fluids as needed.
• Hypoglycemia requires
• Oral or IV administration of glucose OR
• IM administration of glucagon.

135
Chapter Summary

• Altered mental status may be due to narcotic
  overdose.
• With decreased respirations, consider
  administering naloxone.
• Neurologic problems can be frightening and
  frustrating for patients and families.
• Be empathetic and provide reassurance.