1. STROKES/S EIZURES STS 4/13/2015

2. CEREBROVASCULAR ACCIDENT & STROKE CVA: an interruption of blood flow to the brain Stroke: loss of brain function due to a CVA No. 1 risk factor: hypertension Other potential causes: Thrombosis: clotting of cerebral arteries Cerebral embolism: clot that was formed elsewhere and blocks cerebral artery Arterial rupture

3. TYPES OF STROKES Ischemic Blood flow to the brain is cut off by a blockage inside a blood vessel (can be a clot or an air bubble) No. 1 cause: hypertension Hemorrhagic Bleeding in the brain (i.e. arterial rupture) Hypertension is still a risk factor

4. ANEURYSMS/TIA Dissecting aneurysm: Weak arterial wall becomes thin due to the destruction of inner layers of the vessel, causing bulge Transient ischemic attack: Mini-stroke Symptoms usually go away within 24 hours May be a warning sign of a larger stroke

5. SIGNS/SYMPTOMS “worst headache ever” Hemiparesis Difficulty swallowing (alert: airway!) Slow pulse and erratic respirations due to excessive bleeding in the brain Unusually high BP Cushing’s Triad: hypertension, bradycardia, irregular breathing)  indication of ICP Changes in pupil size and reactivity Dysarthria (slurred speech) Aphasia (receptive vs. expressive)

6. ASSESSMENT What are the three components of the Cincinnati stroke scale? 1.Speech: “The sky is blue in Cincinnati” 2.Facial droop 3.Arm drift Should be done anytime in the secondary assessment Ask about MOI If not, and the pt has ICP, assume stroke

7. TREATMENT FOR STROKE TIME IS BRAIN If pt is not paralyzed, left lateral to protect airway (but not always left) Place paralyzed side down and padded Elevate head approximately 6” Determine when pt last appeared normal Perform rapid physical before placing pt on gurney

8. SEIZURE CAUSES Epilepsy Structural problems in the brain Trauma, tumor, infection, stroke Metabolic disorders Hypoglycemia, poisoning, OD, alcohol withdrawal Febrile Usually in kids

9. TYPES OF SEIZURES Grand mal Unconscious and generalized severe twitching of the body’s muscles Usually lasts 3-5 min and followed by postictal state Absence (petit mal) Brief lapse of attention Silent Focal Occurs on one side Can progress to generalized seizure Status Epilepticus 30 min of continuous seizing (regardless of type), without recovery between 2 seizures > 5 min of continuous convulsive seizures 3 discrete confusions within an hour

10. PHASES OF SEIZURES Aura Alterations in smell, taste, visual, perception, hearing, emotional state Tonic-clonic Loss of consciousness Tonic: increased muscle rigidity Clonic: jerking of extremities Postictal Drowsiness and confusion

11. SIGNS/SYMPTOMS Obvious seizing Labored breathing Possible hemiparesis Lethargy, confusion Combativeness

12. TREATMENT FOR SEIZURES If they’re actively seizing, protect them from trauma Afterwards, place in left-lateral position Give O 2 Blow-by Possible spinal immobilization Do not restrain For febrile seizures: passive cooling (in LA County) Document: complete history, description of seizures, whether this is their first seizure Transport may depend May not always want to be transported, especially those who have experience with their condition Ask family members for additional information, or if pt cannot respond

13. SCENARIO Your dispatch call: