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Neurology my version
- 2. Anatomy and Physiology • Neuron: – Dendrites – Cell body (soma) – Axon
- 3. The Nervous System • Peripheral – Somatic – Automatic • Sympathetic • Parasympathetic • Central – Brain – Spinal Cord
- 4. Depolarization • At rest, neuron is positively charged on outside and negatively charged inside.
- 5. Neurotransmitters • Norepinephrine • Seratonin • Acetylcholine • Dopamine
- 6. Neurotransmitters • Acetylcholine – Somatic (voluntary) – Parasympathetic • Norepinephrine – Sympathetic
- 7. Meninges
- 9. Brain Anatomy • Cerebrum-All sensory and motor.. Intelligence, memory, learning, analysis • Diencephalon (interbrain)- contains thalmus and hypothalmus
- 10. More Brain Anatomy • Hindbrain – Cerebellum: Fine motor movement, equilibrium, muscle tone – Brainstem • Mesencephalon (eye movement) • Pons – connection between brain and spinal cord • Medulla Oblongata- Division between brain and spinal cord – Respiration, cardiac activity, vasomotor activity
- 11. Normal Brain
- 13. Central Nervous System • The Brain – Vascular Supply • Carotid system • Vertebro-basilar • Circle of Willis
- 16. Cranial Nerves
- 17. Central Nervous System • The Spinal Cord – Responsible for • Conducting impulses to and from the peripheral nervous system • Reflexes • 31 pair of nerves exit spinal cord
- 18. Central Nervous System • The Spinal Cord – Dorsal Roots • Afferent fibers (To) – Ventral Roots • Efferent fibers (Away)
- 19. Dermatomes
- 20. The Autonomic Nervous System • The Sympathetic Nervous System – “Fight-or-flight” – Neurotransmitters epinephrine and norepinephrine • The Parasympathetic Nervous System – “Feed-or-breed” or “rest-and-repair” – Mediated by the neurotransmitter acetylcholine
- 21. Altered Mental Status • Structural Lesions – Tumors – Bleeds – Trauma • Toxic Metabolic States – Diabetic Ketoacidosis – Thiamine insufficiency
- 22. • Respiratory Patterns –Any of five abnormal respiratory patterns may be observed General Assessment Findings
- 24. PaCO2
- 25. Posturing
- 26. Dolls Eyes
- 27. Cushing’s Triad • Increased Blood Pressure • Decreased Pulse • Irregular Respirations
- 28. General Assessment Findings • Vital Signs – Cushing’s Reflex
- 29. AEIOU TIPS • A = acidosis or alcohol • E = epilepsy • I = infection • O = overdose • U = uremia • T = trauma • I = insulin • P = psychosis • S = stroke
- 30. Why do we give Thiamine? • Needed for conversion of pyruvic acid to acetyl-coenzyme-A
- 31. Chronic Alcoholism • Wernicke’s Syndrome • Korsakoff’s Psychosis
- 32. Altered Mental Status • Wernicke-Korsakoff • Thiamine deficient – Wernicke’s Syndrome – Korsakoff’s Psychosis
- 33. Stroke • Occlusive – Embolitic – Thrombotic • Hemorrhagic
- 34. Stroke and Intracranial Hemorrhage • General term that describes injury or death of brain tissue – Usually due to interrupted blood flow – “Brain attack” • Transport considerations – CT – Neurological services – Fibrinolytics available – Warrants rapid recognition and prompt transport
- 35. Stroke and Intracranial Hemorrhage • Occlusive Strokes – Embolic and Thrombotic Strokes • Hemorrhagic Strokes
- 37. Stroke and Intracranial Hemorrhage • Signs – Facial Drooping – Headache – Aphasia/Dysphasia – Hemiparesis – Hemiplegia – Paresthesia – Gait Disturbances – Incontinence • Symptoms – Confusion – Agitation – Dizziness – Vision Problems
- 42. Stroke and Intracranial Hemorrhage • Management – Scene safety and standard precautions – Maintain the airway – Support breathing – Obtain a detailed history – Position the patient – Determine the blood glucose level – Establish IV access – Monitor the cardiac rhythm – Protect paralyzed extremities
- 43. Stroke and Intracranial Hemorrhage • Transient Ischemic Attacks – Indicative of carotid artery disease – Symptoms of neurological deficit: • Symptoms resolve in less than 24 hours • No long-term effects – Evaluate through history taking: • History of hypertension, prior stroke, or TIA • Symptoms and their progression
- 44. Seizures • Generalized Seizures – Tonic-Clonic • Aura • Loss of consciousness • Tonic phase • Hypertonic phase • Clonic phase • Postseizure • Postictal – Absence • Petit-mal • 10- to 30-second loss of consciousness or awareness • Eye or muscle twitching
- 45. Seizures • Generalized Seizures (cont.) – Pseudoseizures • Hysterical seizures • Stems from psychological disorders • Can often be interrupted with a terse command
- 46. Seizures • Partial Seizures – Simple Partial Seizures • Involve one body area • Can progress to generalized seizure – Complex Partial Seizures • Characterized by auras • Typically 1–2 minutes in length • Loss of contact with surroundings
- 47. Seizures • Assessment – Ascertain exactly what the patient may recall or what bystanders witnessed • Other problems mimic seizure – Differentiating Between Syncope and Seizure
- 48. Seizures • Patient History – History of Seizures – History of Head Trauma – Any Alcohol or Drug Abuse – Recent History of Fever, Headache, or Stiff Neck – History of Heart Disease, Diabetes, or Stroke – Current Medications • Phenytoin (Dilantin), phenobarbitol, valproic acid (Depakote), or carbamazepine (Tegretol) – Physical Exam • Signs of head trauma or injury to tongue • Alcohol or drug abuse
- 49. • Management – Scene safety and standard precautions – Maintain the airway – Administer high-flow, high-concentration oxygen – Establish IV access – Treat hypoglycemia if present – Do not restrain the patient • Protect the patient from the environment – Maintain body temperature Seizures
- 50. Seizures • Management (cont.) – Position the patient – Suction if required – Monitor cardiac rhythm – Treat prolonged seizures • Anticonvulsant medication – Provide a quiet atmosphere – Transport
- 51. Seizures • Status Epilepticus – Two or More Generalized Seizures • Seizures occur without a return of consciousness – Management • Management of airway and breathing is critical • Establish IV access and cardiac monitoring • Administer 25 g 50% dextrose if hypoglycemia is present • Administer 5–10 mg diazepam IV • Monitor the airway closely
- 52. • http://www.youtube.com/watch?v=MRZY2a2jnu w • http://www.youtube.com/watch?v=rtjPs_B99Bo • http://www.youtube.com/watch?v=H3iLQi6wt9 4 • http://www.youtube.com/watch?v=wmAiABeP0 8k • http://www.youtube.com/watch?v=ivXW5sjcRic &feature=related
- 54. Syncope • A sudden, temporary loss of consciousness • Assessment – Cardiovascular: • Dysrhythmias or mechanical problems – Noncardiovascular: • Metabolic, neurological, or psychiatric condition – Idiopathic: • The cause remains unknown even after careful assessment – Extended unconsciousness is NOT syncope
- 55. Headache • Types – Vascular • Migraines – Throbbing pain, photosensitivity, nausea, vomiting, and sweats; more frequent in women – May last for extended periods of time • Cluster – One-sided with nasal congestion, drooping eyelid, and irritated or watery eye; more frequent in men – Typically last 1–4 hours
- 56. Headache • Types – Tension – Organic • Occur due to tumors, infection, or other diseases of the brain, eye, or other body system • Headaches associated with fever, confusion, nausea, vomiting, or rash can be indicative of an infectious disease
- 57. “Weak and Dizzy” • Assessment – Symptomatic of Many Illnesses – Focused Assessment • Include a detailed neurological exam • Specific signs and symptoms: – Nystagmus – Nausea and vomiting – Dizziness
- 58. “Weak and Dizzy” • Management – Scene safety and standard precautions – Maintain airway and administer high-flow, high-concentration oxygen – Position of comfort – Establish IV access and monitor cardiac rhythm – Determine blood glucose level – Consider medication: • Antiemetic – Transport and reassure patient
- 59. Neoplasms • Tumors – Benign – Malignant • Assessment – Signs and Symptoms • Recurring or severe headaches • Nausea and vomiting • Weakness or paralysis • Lack of coordination or unsteady gait • Dizziness, double vision • Seizures without a prior history of seizures
- 60. Neoplasms • Assessment (cont.) – History • Surgery, chemotherapy, radiation therapy, or holistic therapy • Experimental treatments • Management – Scene size-up and BSI – Maintain airway and administer high-flow, high-concentration oxygen – Position of comfort – Establish IV access and monitor cardiac rhythm – Consider medication administration: • Analgesics, antiseizure meds, anti-inflammatory meds – Transport and reassure patient
- 61. Brain Abscess • Abscess – Collection of Pus • Assessment – Signs and Symptoms • Lethargy, hemiparesis, nuchal rigidity • Headache, nausea, vomiting, seizures • Management – Similar to Neoplasm
- 62. Degenerative Neurological Disorders • Types of Disorders – Alzheimer’s Disease • Most frequent cause of dementia in the elderly • Results in atrophy of the brain due to nerve cell death in the cerebral cortex – Muscular Dystrophy • Characterized by progressive muscle weakness – Multiple Sclerosis • Unpredictable disease resulting from deterioration of the myelin sheath – Dystonias
- 63. Degenerative Neurological Disorders • Types of Disorders (cont.) – Parkinson’s Disease • Tremor, rigidity, bradykinesia, postural instability – Central Pain Syndrome – Bell’s Palsy – Amytrophic Lateral Sclerosis – Spina Bifida – Poliomyelitis
- 65. Pick’s Disease
- 71. Dystonia
- 72. Parkinson’s
- 73. Bell’s Palsy
- 74. ALS • Amyotrophic Lateral Sclerosis
- 75. Spinal Bifida
- 76. Polio
- 78. Degenerative Neurological Disorders • Assessment – Obtain history – Exacerbation of chronic illness or new problem? • Management – Special Considerations • Mobility, communication, respiratory compromise, and anxiety – Interventions • Determine blood glucose level • Establish IV access • Monitor cardiac rhythm • Transport and reassure the patient
- 79. • Low Back Pain • Causes – Disk Injury – Vertebral Injury – Cysts and Tumors – Other Causes Back Pain and Non-Traumatic Spinal Disorders
- 80. Disc Issues
- 81. Back Pain and Non-Traumatic Spinal Disorders • Assessment – Evaluate history • Speed of onset • Risk factors such as vibration or repeated lifting • Determine if pain is related to a life-threatening problem • Management – Consider c-spine • Immobilize if in doubt – Consider analgesics
- 82. Overuse/Repetitive-Motion Disorders • Tennis Elbow • Golfer’s Elbow • Tenosynovitis- similar to tendonitis • Bursitis • Myalgias-muscle pain • Carpal Tunnel- median nerve
- 83. Osteoarthritis
- 84. Osteoporosis
- 87. Lupus
- 88. Gout
- 89. Cellulitis
- 90. Fasciitis
- 92. Gangrene
- 93. Osteomyelitis
- 97. Slipped Capital Femoral Epiphysis
- 103. Epidural Hematoma