1. Illinois EMSC1 Upon completion of this lecture, you will be better able to: n Describe assessment considerations for a student who exhibits an altered level of consciousness n List assessment findings that indicate a neurologic problem requiring urgent or emergent care n Describe appropriate interventions for a student with abnormal neurologic findings NEUROLOGIC OBJECTIVES

2. Illinois EMSC2 NEUROLOGIC EMERGENCIES

3. Illinois EMSC3 Causes of Altered Level of Consciousness Trauma Cerebral thrombosis Infection Tumor Shock Hypoglycemia or Diabetic ketoacidosis Alcohol/substance abuse Anoxia Seizures/postictal states Ingestion/poisoning

4. Illinois EMSC4 ASSESSMENT n Initial Assessment –ABCD’s n Detailed Assessment –Head-to-toe survey –Detailed neurologic exam –LOC –Motor function –Sensory function n History

5. Illinois EMSC5 n Orientation n AVPU n Glasgow Coma Scale Level of Consciousness Assessment

6. Illinois EMSC6 INITIAL APPROACH n ABC’s n Activate EMS n Manual C-spine stabilization n Oxygen assisted ventilations if AVPU is less than verbal level

7. Illinois EMSC7 GENERAL APPROACH n Standing orders, if appropriate n Protect from further injury n Provide psychosocial support

8. Illinois EMSC8 TRIAGE AND TRANSPORT EMERGENT n Altered LOC n Acute neurologic deficit n Generalized seizure or first time seizure n Seizure > 15 minutes or multiple seizures n Head injury with altered LOC n Head injury in child with bleeding disorder

9. Illinois EMSC9 TRIAGE AND TRANSPORT URGENT n Student with VP shunt exhibiting early signs of shunt malfunction n Syncopal episode n Severe headache without neurologic deficit

10. Illinois EMSC10 TRIAGE AND TRANSPORT NON-URGENT n Mild to moderate headache n Minor closed head injury, no LOC and asymptomatic

11. Illinois EMSC11 HEAD AND SPINAL CORD TRAUMA n Most common type of injury in children n Causes: –Falls –Motor vehicle crashes (MVCs) –Pedestrian vs. motor vehicle –Inflicted injury –Sports/recreational related injury

12. Illinois EMSC12 INTERVENTIONS n Primary survey with C-spine stabilization n General approach n Transport by EMS and maintain C-spine immobilization

13. Illinois EMSC13 SYNCOPE n TYPES –Intrapsychic –Vascular n CAUSES –Vasovagal –Cardiac problem –Hypoglycemia –Hyperventilation –Other causes

14. Illinois EMSC14 SEIZURES n PARTIAL n GENERALIZED

15. Illinois EMSC15 SEIZURE SYNDROMES n FEBRILE –Most common seizure disorder –Occurs most frequently in children 3 months to 5 years old –Can be simple or complex n STATUS EPILEPTICUS –Generalized tonic-clonic –Lasts more than 15-20 minutes or are repeated

16. Illinois EMSC16 CAUSES OF SEIZURES n Fever n Infection n Trauma n Intracranial bleeding n Toxic disturbances n Metabolic disturbances n Anoxia n Tumors n Congenital or degenerative disorders

17. Illinois EMSC17 INTERVENTIONS n Follow generalized approach n Do not put anything in the mouth n Protect student from injury n Maintain airway n Place student on side n Observe duration and characteristics

18. Illinois EMSC18 TRIAGE AND TRANSPORT: EMERGENT n Seizure lasting longer than 15 minutes n Respiratory compromise n Seizure following head injury n Atypical seizure in child with known seizure disorder

19. Illinois EMSC19 CSF/VP SHUNT DYSFUNCTION SIGNS AND SYMPTOMS - Secondary to Increased Intracranial Pressure –Vomiting, nausea –Decreased activity –Change in gait –Headache –Irritability or lethargy –Vision changes –Seizures

20. Illinois EMSC20 CSF/VP SHUNT DYSFUNCTION TREATMENT –General approach –Transport based on signs and symptoms –Contact parent/guardian and MD

21. Illinois EMSC21 n Seen in students with quadriplegia or spinal cord damage at or above the sixth thoracic vertebra n Causes –Bladder distension –Fecal impaction n Signs include: –Upper body erythema –Acute hypertension –Bradycardia Hyperreflexia

22. Illinois EMSC22 HEADACHE n TYPES –Inflammatory –Vascular –Traction –Muscle Contractions n HISTORY –Quality of pain –Location –Relief measures –What makes it worse –Duration/frequency

23. Illinois EMSC23 SPECIAL NEEDS STUDENTS CHRONIC HEALTH CONDITIONS –Seizure disorder –Sickle cell disease –Hemophilia –VP shunts –Congenital Heart Disease –Diabetes –Cystic Fibrosis

24. Illinois EMSC24 n Educate students and staff regarding safe practices to prevent/decrease head & spinal injury –Bicycle helmets and other protective sports gear –Personal floatation devices –Seat belts/shoulder harness n Invite a speaker who has suffered a spinal cord injury to recount their post-injury experiences PREVENTION

25. Illinois EMSC25 Your assessment of students with acute injury or illness should always include a thorough evaluation to identify neurologic deficits or increased risk for neurologic deterioration. Except for mild headaches and minor asymptomatic head injury, any illness or injury with neurologic manifestations should be triaged as urgent or emergent. SUMMARY

26. Illinois EMSC26 ANY QUESTIONS??