neurogenic emergencies

• Metabolic brain issues are caused by internal factors like hypoxia, leading to changes in mentation; structural brain issues are usually external like brain tumors or traumatic brain injuries
• Peripheral nervous system consists of

  • All nerves exiting the spinal cord and entering body tissues
• Sensory nerves


  Carry impulses to CNS
• Ischemic stroke is caused by a blocked blood vessel in a cerebral artery causing infarction in the brain; more common
• Decrease salivation

  Patient will have thirst if in shock, blood pressure tries to rise, pulse increases, pupils dilate, airways relax, bladder relaxes
• Prehospital care for stroke

  Support ABCs, determine LKW, provide supportive care, transport to appropriate stroke center
• Cushing’s triad includes elevated BP, falling pulse, ragged respiratory pattern; Cheyne-Stokes is a hallmark of respiratory pattern late into a neuro emergency
• FSBG

  Check glucose; hypoglycemia can mimic stroke; if <60 mg/dL, increase glucose; if neurologic deficit and FSBG >60 mg/dL, transport to PSC or appropriate ED
• At the lumbar spine

  Nerves branch out
• CNS

  Brain and spinal cord
• Reflex arc

  In spinal cord, do not connect to brain directly
• Delirium tremens results from withdrawal of alcohol
• Hemorrhagic stroke is caused by a bleed in the brain, with leakages around or in brain tissue itself; 20% of strokes, 70% are fatal
• Risk factors for strokes include high blood pressure, high cholesterol, and hereditary factors
• Stroke presentation may include hemispheric problems, unequal pupils, facial droop, aphasia, weakness, numbness, paralysis, nausea, vomiting, bowel or bladder incontinence, headaches
• Stroke is a cerebrovascular accident resulting from interruption of blood flow to the brain
• Transport decision based on assessment scores

  If at or >4, check for exclusion criteria; if no exclusion, go to TSC; if exclusion, go to PSC or ED
• Stroke mimics include migraines, hypoglycemia, seizures, Bell’s palsy, intoxication, brain injury, and TIA (transient ischemic attack)
• Motor nerves


  Carry impulses from CNS
• Focal seizures maintain some awareness, have decreased level of awareness, and may involve repetitive non-purposeful actions
• Causes for seizures

  • Trauma
  • Head injury
  • Changes in blood glucose levels
  • Hypoxia
  • Epilepsy
  • Febrile seizures in children
  • Change in body temperature quickly
• Generalized seizures may include convulsions
• Decorticate posture involves wrists flexed in front of the abdomen, while decerebrate posture involves flexion outward
• Scene size-up, identifying MOI/NOI, assessing visible injuries, and addressing primary and secondary concerns are important in managing neurologic emergencies
• Seizures involve random impulses generated in the brain and sent through motor nerves, leading to intermittent twitching and muscle contractions
• Status epilepticus is when seizures continue every few minutes without the person regaining consciousness, posing a life-threatening emergency due to respiratory compromise
• Absence seizures involve loss of awareness, eyelid fluttering, and no convulsions
• Seizure stages

  1. Tonic phase - pre-seizure with muscle rigidity and limbs may extend

  2. Clonic phase or convulsive phase - convulsions with intermittent muscle contractions

  3. Postictal phase - suppressed level of consciousness, slowly waking up and becoming aware
• Tools for assessing neurologic emergencies include checking orientation, establishing baseline mental status, and using tools like AVPU and Glasgow Coma Scale
• OPQRST can be used for assessing altered mental status, focusing on describing the episode, provoking factors, associated symptoms, and duration
• Syncope, orthostatic hypotension, psychogenic shock, cardiac issues, and inadequate brain perfusion are potential causes of neurologic problems