Nervous system

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Nervous system

• Emergencies

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Nervous System

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

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Central Nervous System

• Look up anatomy in TEXT!
• Chapter 4

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CNS Parts

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

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Lobes of cerebrum function

• Frontal - Cognition and motor
• Parietal - Touch and orientation
• Temporal - Speech Hearing
• Occipital - Sight

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Brainstem is Location of

• Cardiac center
• Respiratory center
• Vasomotor center
• RAS - reticular activating system

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and...

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

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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.

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The Nervous System

• The nervous system controls the bodys voluntary
  and involuntary actions.
• Somatic nervous system
• Autonomic nervous system

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Sympathetic

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

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Parasympathetic

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

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Neurologic Emergencies
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Neurologic Trauma
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Concussion

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

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Intracranial bleeding

• Subdural
• Intracranial
• Epidural
• All bleeds causes increased intracranial pressure
  brain damage

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EPIDURAL BLEED
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Intracranial Bleed
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signs of increasing intracranial pressure

• ALOC
• vomiting
• unequal pupils
• hypertension decreasing heart rate
• expanding pulse pressure
• Seizure
• Abnormal respiratory patterns
• Posturing

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Posturing

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

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ALOC

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

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Change in Pupil Size

• Unequal pupil size may indicate increased
  pressure on one side of the brain.

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Shock

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

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Basilar skull fracture

• Indicates SIGNIFICANT force
• CSF fluid in ears nose
• battle sign
• raccoon eyes

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Signs and Symptoms of Spinal Injury

• Pain, swelling, deformity
• Tingling in the extremities
• Paralysis or paresis
• Incontinence
• Injuries to the head

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Spinal cord injury

• Paraplegia paralysis of lower
  extremities
• Quadriplegia paralysis of all extremities

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Identifying C-spine candidates

• Mechanism of injury
• pain
• numbness or tingling in extremities

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Significant Mechanisms of Injury (MOI)

• MVAs
• Auto vs. Peds/bicycle/motorcycle
• Falls
• Blunt or penetrating trauma
• Hangings
• Recreational accidents

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Rx for Head Spine Injury

• Maintain airway (jaw thrust)
• Oxygen
• Hyperventilate
• Stabilize C-spine

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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

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notes

• PMSC before and after AND DOCUMENT!
• Manual head stabilization

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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.

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More Neurologic Emergencies

• Seizure
• Stroke
• Altered Mental Status (AMS)

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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

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Causes of Seizures

• Congenital
• High fevers
• Structural problems in the brain
• Metabolic disorders
• Chemical disorders

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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

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Status Epilepticus

• 1 seizure over 10 minutes
• 2 seizures without regaining consciousness
• 3 seizures within 1 hour

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Complications

• Hypoxia
• Trauma
• Hyperthermia
• Hypoglycemia
• Aspiration
• Dehydration

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Common medications

• Dilantin
• Tegretol
• Pheno-Barbitol
• and ...

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Treatment

• ABCs
• Protect patient from injuring self
• Oxygen
• Supine or left lateral
• Transport

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Stroke

• CVA
• TIA
• Hemorrhagic stroke
• Ischemic stroke

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Signs and Symptoms of Stroke

• Left Hemisphere
• Aphasia
• Receptive aphasia
• Expressive aphasia
• Right Hemisphere
• Dysarthria

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Stroke Mimics

• Hypoglycemia
• Postictal state
• Subdural or epidural bleeding

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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

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Cincinnati Stroke Scale

• Facial droop
• Arm drift
• Speech

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Altered Mental Status (AMS)

• Hypoglycemia
• Hypoxemia
• Intoxication
• Drug overdose
• Unrecognized head injury

• Brain infection
• Body temperature abnormalities
• Brain tumors
• Glandular abnormalities
• Poisoning

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END

• Questions?