 Reticular Activating system (RAS) › Network of nerve cells in brain stem › Transmit environmental & sensory stimuli › Will lose consciousness If loss of function

 Altered mental status-indicates illness or injury to patient › May be from simple disorientation to complete unconsciousness  Structural Causes › Brain tumor › Hemorrhage in cranium or brain tissue › Direct brain tissue damage › Degenerative disease › Brain abscess or infection

 Toxic Causes › Severe hypoxia › Abnormal blood glucose › Liver failure › Kidney failure › poisoning  Other causes › Shock › Drugs › Post seizure › Infection › Cardiac rhythm disturbance › Stroke

Medical Conditions Trauma  Abnormal respiratory pattern  Dry or moist skin  Cool or hot skin  Pinpoint, midsize, dilated or unequal pupils  Stiff neck  Lacerations to tongue  High systolic pressure  Loss of bowel or bladder  Abnormally high or low blood sugar  Obvious signs of trauma  Abnormal respiratory pattern  Increased or decreased heart rate  Unequal pupils  High or low BP  Discoloration around eyes or ears  Pale, cool, moist skin  Flexion (decorticate or decerebrate)

 Scene size up  Primary assessment  Secondary assessment › SAMPLE › OPQRST  Emergency medical care › Spinal immobilization › Airway › Suction PRN › Position › Transport › Reassess every 5 minutes

 Neurological deficit  AHA 700,000 people suffer a stroke  158,000 will die  Time is critical-time is tissue › 3 hours from onset of symptoms

 Detection  Dispatch  Deliver  Door  Data  Decision  Drug

 Inadequate blood supply to brain  Ischemic › Embolism  A-fib most common risk factor › Thrombosis  Most common  Hemorrhagic › HTN major cause › Worst headache › Seizures › Stiff neck

 TIA symptoms gone within 24 hours  No permanent neurologic damage  Higher chance of permanent stroke

 Facial droop  Arm drift  Slurred speech

 History taking becomes very important › Mimic hypoglycemia › Sample History › Treatment  Airway  Oxygen  Position of comfort

 Vascular  Cluster  Tension  Organic, traction, or inflammatory

 Altered mental status  Motor or sensory deficit  Behavior change  Seizure  First experience with this type of HA  Worst pain with coughing, sneezing, or bending over  Fever or stiff neck  Change in quality of chronic HA

 Airway  Oxygen  Position of comfort  Be prepared for seizures