EMSTA Block Test 3 Best Answers ALL SOLUTION LATEST GUARANTEED GRADE A+

EMSTA Block Test 3 Best Answers ALL SOLUTION LATEST GUARANTEED GRADE A+ Stroke Secondary Assessment Slow pulse Erratic Respiration High BP Unequal pupil size and reactivity (significant bleeding in brain) Check blood glucose Can the patient say "the sky is blue in cincinnati"? Can the patient smile? Close eyes and hold both arms out with palms up FAST Facial droop Arm drift Speech Time (when last seen normal) 3 Parts of Brain and Functions Brain stem: Basic functions of body - Breathing, blood pressure, swallowing, pupil constriction Cerebellum: Coordinating complex tasks that involve many muscles - balance, walking, writing Cerebrum: Front controls emotion and thought, middle controls sensation and movement, back processes sight -Speech is Left middle Foramen magnum Opening at base of skull through which nerves join the spinal cord and exit the brain Brain is most sensitive to changes in: oxygen, temperature, and glucose Tension headache Caused by muscle contractions in the head and neck Attributed to stress Squeezing, dull, or ache Migraine headaches Caused by changes in blood vessel size in the base of the brain Pounding, throbbing, or pulsating Associated with nausea and vomiting Sinus Headaches Caused by pressure that is the result of fluid accumulation in the sinus cavities Cold-like signs and symptoms of nasal congestion, cough, and fever if have sinus infection Increased pain when they bend over or when head moved forward Serious neurological conditions that include headache Hemorrhagic stroke, brain tumor, meningitis (sudden onset, severe headache with associated symptoms like fever, stiff neck, seizures, altered mental status) Headache Red Flags sudden onset Explosive/thunderclap pain Altered mental status > 50 years old Depressed immune system Neurological deficits Neck stiffness/pain Fever Change in vision One sided paralysis/weakness Early signs of increased intracranial pressure Headache Vomiting Altered mental status Seizures Increased intracranial pressure causes Hemorrhagic stroke Tumor Head trauma Bacterial Meningitis Inflammation of meninges from bacterial infection CNS infection causing headache, stiff neck, fever, light sensitivity Cerebrovascular Accident (CVA) Aka stroke interruption of blood flow to an area within the brain --> loss of brain function -Brain cells stop functioning and begin to die within minutes Ischemia Reduction in blood supply that results in inadequate oxygen being supplied to the brain cells which causes them to stop functioning properly -If normal blood flow supplied in time, cells can be saved from severe damage and death Ischemic Stroke Most common type of stroke (>80%) Blood flow to particular part of brain stopped by blockage (from thrombosis, embolus, or atherosclerosis) Hemorrhagic Stroke 13% Blood vessel ruptures and the accumulated blood forms a blood clot which compresses brain tissue next to it which prevents oxygenated blood from getting into area and brain cells begin to die (usually fatal) Blood can also increase intracranial pressure --> severe headache Occurs in people experiencing stress or exertion and with very high blood pressure or long term untreated elevated blood pressure which weaken blood vessels Aneurysm Swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall Ruptured aneurysm indicated by sudden onset of severe headache (irritation of blood on brain tissue after the artery swells and ruptures) Berry Aneurysm Causes hemorrhagic strokes in otherwise healthy individuals Resembles tiny balloon that juts from artery Subarachnoid hemorrhages When berry aneurysm overstretches and ruptures, blood spurts into area between two of coverings of brain called subarachnoid space Surgical repair possible if quick but often fatal Transient ischemic attack (TIA) Stroke-like symptoms that resolve on their own in less than 24 hours No actual death in tissue occurs but difficult to differentiate between stroke because 24 hrs) Could be warning of future stroke --> emergency TIA:stroke::angina:heart attack Signs of Stroke Facial drooping Sudden weakness or numbness in face or extremities Decreased/absent movement and sensation in one side of body Lack of muscle coordination (ataxia) or loss balance Sudden vision loss in one eye, blurred, double vision Difficulty swallowing Decreased responsiveness Speech disorders Aphasia (difficulty expressing thoughts or understanding words) Slurred speech (dysarthria) Sudden, severe headaches Confusion Weakness Dizziness Combativeness Restlessness Tongue Deviation Coma If Left Hemisphere affected by stroke Aphasia (speech is clear but does not make sense) -Inability to produce or understand speech Paralysis on right side of body If Right hemisphere affected by stroke Difficult muscle movement on left side of body Understand language and can speak but slurred and hard to understand Oblivious to problems (ask to lift left arm and they lift right as if normal) - neglect Neglect in vision Cerebral Hemmorhage Bleeding in brain High BP causes bleeding but since bleeding, BP increases more to compensate blood loss so cycle of increased BP BP can suddenly drop as symptoms worsen Conditions that mimic strok Hypoglycemia -Always check glucose levels in patients with altered mental status Postictal state (period following seizure between 5 and 30 min): labored respiration and altered mental status Subdural/epidural bleeding (collection blood near skill that presses on brain) Seizure Neurologic episode from surge of electrical activity in brain Convulsion (uncoordinated muscle activity) and/or temporary alteration in consciousness Usually from epilepsy Generalized (Tonic-clonic) Seizure Abnormal electrical discharges from large brain areas (usually both hemispheres) Unconsciousness and severe body muscle twitching that lasts several minutes or longer OR Brief lapse consciousness (patient stares off into space and not respond to anyone) - No changes in motor activity - petit mal or absence seizure Tonic phase: constant muscle contraction and trembling, tongue biting, bladder incontinence, bowel incontinence -Bilateral movement of cycle of muscle rigidity and relaxation -Tachycardia, hyperventilation, sweating, intense salivation Partial (focal) seizure Begins in one part of brain can be simple or complex Simple: no change occurs in consciousness, numbness, dizziness, weakness -May report visual changes and unusual smells or tastes -May cause twitching of muscles and extremities that spreads from one part of body to another --Not severe twitching in generalized seizure -May experience brief paralysis Complex: Altered mental status and doesn't interact normally with environment -From abnormal discharges from temporal lobe of brain -Lip smacking, blinking, isolated convulsions or jerking of body or one part of body -Unpleasant smells and visual hallucinations, uncontrollable fear, repetitive physical behavior Aura Warning sign prior to seizure -Visual changes or hallucinations (sight, smell, audio) Status Epilepticus Seizures that continue every few minutes without person regaining consciousness or last longer than 30 minutes -Potentially life threatening situation -Protect patient from self-harm and call ALS Causes of Seizures Congenital seizure disorder (epilepsy) High fevers (febrile seizures) Structural brain problems (tumor, infection, scar tissue, head trauma, stroke) metabolic/chemical problems in body (hypoxia, hypoglycemia, poisoning, OD, withdrawal) Many seizures have undetermined causes (idiopathic) Medications for Seizures Levetiracetam (Keppra) Phenytoin (Dilantin) Phenobarbital Carbamazepine (Tegretol) Valproate (Depakote) Topiramate (topamax) Clonazepam (Klonopin) Incontinence Loss of bowel and/or bladder control May be the result of a generalized seizure. Postictal Sate Muscles relax --> flaccid/floppy Labored breathing (fast and deep) Confusion Unresponsiveness Hemiparesis may occur (weakness of one side of body) Lethargy Patient may be combative Syncope Fainting Not associated with postictal state Altered Mental Status Patient is not thinking clearly or is unable to be aroused Can be unconscious or alert and confused Caused by hypoglycemia, hypoxemia, intoxication, delerium, drug OD, unrecognized head injury, brain infection, body temp abnormalities, brain tumors, poison Delerium Confusion, disorientation, disorganized thoughts, inattention, memory loss, striking personality changes, hallucinations, delusions, decreased level of consciousness Causes of Altered mental status AEIOU TIPS Alcohol Epilepsy, Endocrine, Electrolytes Insulin Opiates Uremia (kidney failure) Trauma, Temperature Infection Poisoning, Psychogenic Causes Shock, Stroke, Seizure, Syncope, space occupying lesion, Subarachnoid hemorrhage 3 Item Stroke Severity Scale (LAG) Everything scores 0-2 (0 = normal, 2 = very severe) Level of consciousness Arm Drift Gaze > 4 indicates stroke likely Solid vs. Hollow Organs Solid: liver, spleen, pancreas, kidneys, ovaries Hollow: stomach, intestines, gallbladder, urinary bladder Glascow Coma Scale (GCS) Eye opening: 4. Spontaneous 3. Response to speech 2. Sesponse to pain 1. none Best Verbal Response 5. Oriented convo 4. Confused convo 3. inappropriate words 2. Incomprehensible souds 1. none Best motor response 6. Obeys command 5. Localizes pain 4. withdraws to pain 3. Abnormal flexion 2. Abnormal extension 1. none 13-15: mild dysfunction 9-12: moderate dysfunction < 8 severe dysfunction gastrointestinal System Mouth: food chewed Stomach: gastric juices break down food Liver: Secretes bile to digest fats and filter toxic substances, creates glucose stores, and produces substances necessary for blood clotting and immune function Gallbladder: below liver, bile reservoir Small intestine: duodenum mixes digestive juices from liver and pancreas -Pancreas secretes juices that break down starches, fats, proteins (like amylase which breaks starches into sugar), produces bicarbonate (neutralizes stomach acid) and insulin Jejunum: absorbs digestive products and does most of work Ileum: absorbs nutrients that were not absorbed earlier and absorbs bile acids to be returned to liver for future use and vitamin B12 for making nerve cells and RBCs Colon/Large intestine uses peristalsis to absorb water and form stool for defecation Spleen Part of lymphatic system and plays role in relation to RBCs and immune system Assists blood filtration, aids RBC development, and acts as blood reservoir Produces antibodies to help fight disease and infection Male Reproductive system testicles, epididymis, vasa deferentia, seminal vesicles, prostate gland, penis Female reproductive system ovaries, fallopian tubes, uterus, cervix, vagina Urinary System Controls discharge of waste materials filtered from blood by kidneys Kidneys regulate pH and BP Ureter connects kidneys to urinary bladder Bladder empties outside body through urethra Peritoneum Lines abdominal cavity (parietal) and covers abdominal organs (visceral) Peritoneal fluid bathes and lubricates organs in abdominal cavity Peritonitis Irritation of peritoneum by blood, pus, pancreatic juice, bile, amniotic fluid, or any foreign material Associated with loss of body fluid into abdominal cavity --> abnormal shifts of fluid from bloodstream into body tissues --> decrease circulating blood volume --> decreased BP and shock -tachycardia hypotension -Can have fever if have diverticulitis or cholecystitis Ileus Paralysis of muscular contractions normally propelling material through intestine Retained gas and feces cause abdominal distention -caused by peritonitis -Stomach can only empty with emesis (vomiting) Acute abdomen Sudden onset of abdominal pain often associated with severe, progressive problems requiring medical attention -Can develop peritonitis Diverticulitis Inflammation in small pockets at weak areas in muscle walls Cholecystitis Inflammation of gallbladder Referred Pain pain that is felt in a location other than where the pain originates Result of connections between body's two separate nervous systems Ulcers Protective layer lining organs is eroded which allows acid to eat into organ Pain: Upper midabdomen or upper part of back Result of infection with H pylori or chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol and smoking (increase gastric acidity) Nausea, vomiting, belching, heartburn Severe --> gastric bleeding --> hematemesis and melena (black, tarry stools containing blood) CONTINUED...