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Nervous system. & Emergencies. Nervous System. Look up in text Central Nervous System Brain & Spinal cord Peripheral nervous system All the rest of the nerves. Central Nervous System. Look up anatomy in TEXT! Chapter 4. CNS Parts. Cerebrum - Center of intellect

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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 body’s 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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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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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)

  • MVA’s

  • 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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Congenital

High fevers

Structural problems in the brain

Metabolic disorders

Chemical disorders

Causes of Seizures


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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

  • ABC’s

  • 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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Hypoglycemia

Hypoxemia

Intoxication

Drug overdose

Unrecognized head injury

Brain infection

Body temperature abnormalities

Brain tumors

Glandular abnormalities

Poisoning

Altered Mental Status (AMS)


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END

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