EMT Chapter 15

Total Word Count: 2201
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aneurysm

swelling or enlargement of part of a blood vessel, resulting from the weakening of the vessel wall

aphasia

the inability to understand and/or produce speech

aura

a sensation experienced prior to a seizure; serves as a warning sign that a seizure is about to occur

cerebrovascular accident

(CVA/stroke) an interruption of blood flow to the brain that results in the loss of brain function

coma

a state of profound unconsciousness from which one cannot be roused

dysarthria

slurred speech

embolus

a blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage

febrile seizures

seizures that result from sudden high fevers, particularly in children

generalized seizure

a seizure characterized by twitching of all of the body’s muscles that may last several minutes or more; formerly known as a grand mal seizure

hemiparesis

weakness on one side of the body

hemorrhagic stroke

when a blood vessel ruptures, causing increased pressure in the brain and subsequent brain damage

hypoglycemia

a condition characterized by a low blood glucose level

ischemia

a lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred

ischemic stroke

occurs when blood flow to part of the brain is cut off by blockage inside a blood vessel

partial seizure

a seizure affecting a limited portion of the brain

postictal state

a period following a seizure lasting between 5 and 30 minutes; characterized by labored respirations and some degree of altered mental status

seizure

generalized, uncoordinated muscular activity associated with loss of consciousness; a convulsion

status epilepticus

a condition in which seizures recur every few minutes or last more than 30 minutes

stroke

an interruption of blood flow to the brain that results in the loss of brain function; also called cerebrovascular accident (CVA)

thrombosis

a blood clot that forms at the site of blockage

tonic-clonic seizure

a type of seizure that features rhythmic back-and-forth motion of an extremity and body stiffness

transient ischemic attack

(TIA) a disorder of the brain in which cells temporarily stop working because of insufficient oxygen, causing stroke like symptoms that resolve completely within 24 hours of onset

muscle control and body coordination are controlled by the

cerebellum

a 58-year-old male presents with confusion, right-sided weakness, and slurred speech. as your partner is applying oxygen, it is most important for you to

ask his wife when she noticed symptoms

the most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the

brain stem

what glascow coma scale would you assign to a patient who responds to painful stimuli, uses inappropriate words, and flexes his or her arms in response to pain?

8

a patient without a history of seizures experiences a sudden convulsion. the least likely cause of this seizure is

epilepsy

you are caring for a 70-year-old female with signs and symptoms of an acute stroke. she is conscious, has secretions in her mouth, and is breathing as a normal rate with adequate depth. you should

suction her oropharynx and apply 100% oxygen

the mental status of a patient who has experienced a typical seizure

is likely to improve over a period of 5 to 30 minutes

a transient ischemic attack occurs when

the normal body processes destroy a clot in a cerebral artery

you are transporting a semiconscious patient to the hospital. en route, you note that the patient’s mental status is not improving, despite 100% supplemental oxygen. you should suspect that this patient

is hypoglycemic

which of the following most accurately describes the cause of an ischemic stoke?
A) acute atherosclerotic disease
B) narrowing of a carotid artery
C) rupture of a cerebral artery
D) blockage of a cerebral artery

blockage of a cerebral artery

when transporting a stable stroke patient with unilateral hemiparalysis, it is best to place the patient in a

recumbent position with the paralyzed side down

which of the following is not an assessment parameter included in the Cincinnati Stoke Scale?
A) memory
B) arm drift
C) facial droop
D) speech

memory

a patient with an altered mental status is

not thinking clearly or is incapable of being aroused

the principle clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia

usually have an altered mental status or decreased level or consciousness

during the initial assessment of a semiconscious 70-year-old female, you should

ensure a patent airway and support ventilation as needed

when caring for a child with documented hypoglycemia, you should be most alert for

a seizure

a patient whose speech is slurred and difficult to understand is experiencing

dysarthria

successful treatment of a stroke depends on whether or not

clot-buster therapy is given within 2-3 hours of symptom onset

which of the following conditions is not a common cause of seizures?
A) acute alcohol withdrawal
B) severe hypovolemia
C) acute hypoglycemia
D) poisoning or overdose

severe hypovolemia

you are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. your initial assessment reveals that the patient is pulseless and apneic. you should

initiate CPR and attach an AED as soon as possible

you arrive at a grocery store shortly after a 35-year-old male stopped seizing. your assessment reveals that he is confused and incontinent of urine. the patient’s girlfriend tells you that he had a history of seizures and takes Tegretol. when obtaining further medical history from the girlfriend, it is most important to

obtain a description of how the seizure developed

which of the following conditions would most likely affect the entire brain?
A) blocked cerebral artery in the frontal lobe
B) respiratory failure or cardiopulmonary arrest
C) reduced blood supply to the left hemisphere
D) ruptured cerebral artery in the occipital lobe

respiratory failure or cardiopulmonary arrest

you respond to a residence for a child who is having a seizure. upon arrival at the scene, you enter the residence and find the mother holding her child, a male 2-year-old. the child is conscious and crying. according to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. you should

transport the child to the hospital and reassure the mother en route

which of the following most accurately describes the postictal state that follows a seizure?
A) rapidly improving level of consciousness
B) dazed, confused, or combative appearance
C) hyperventilation and hypersalivation
D) gradually decreasing level of consciousness

dazed, confused, or combative appearance

an absence seizure is also referred to as a

petite mal seizure

you are caring for a conscious, confused patient with left-sided hemiparalysis. his airway is patent and his respirations are 22 breaths/min with adequate tidal volume. treatment for this patient should include

oxygen via nonrebreathing mask, left lateral recumbent position, and transport

a patient who is possibly experiencing a stroke is not eligible for thrombolytic (fibrinolytic) therapy if he or she

has bleeding within the brain

which of the following conditions would most likely mimic the signs and symptoms of a stroke?
A) alcohol intoxication
B) acute poisoning
C) hypoglycemia
D) high fever

hypoglycemia

you receive a call to a residence, where a neighbor has found the resident, a 40-year-old female, semiconscious on her living room floor. during your assessment you discover a bottle of Dilantin on a nearby table. you should be most suspicious that this patient

is postictal following a seizure

which of the following medications is not used to treat patients with a history of seizures?
A) Tegretol
B) Dilantin
C) Dilaudid
D) Phenobarbital

Dilaudid

interruption of cerebral blood flow may result from all of the following, except:
A) a thrombus
B) cerebral vasodilation
C) an acute arterial rupture
D) an embolism

cerebral vasodilation

which of the following most accurately describes a focal seizure?
A) a seizure that begins in one extremity
B) generalized seizures without incontinence
C) a seizure that is not preceded by an aura
D) a blank stare without muscle contractions

a seizure that begins in one extremity

individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the

liver

the spinal cord exits the cranium through the

foramen magnum

a patient who is experiencing receptive aphasia is

able to speak clearly but has difficulty understanding

the three major parts of the brain are the

cerebrum, cerebellum, and brain stem

status epilepticus is characterized by

prolonged seizures without a return on consciousness

the most significant risk factor for a hemorrhagic stroke is

hypertension

which of the following clinical signs would be most suggestive of a ruptured cerebral artery?
A) unilateral hemiparesis
B) nasal discharge of blood
C) confusion and weakness
D) sudden, severe headache

sudden, severe headache

which of the following conditions would be least likely to mimic the signs and symptoms of a stroke?
A) postictal state
B) hypoglycemia
C) intracranial bleeding
D) hypovolemia

hypovolemia

when assessing arm movement of a patient with a suspected stroke, you should

ask the patient to close his or her eyes during the assessment

a 35-year-old mildly obese woman is complaining of localized pain in the upper right quadrant with referred pain to the right shoulder. the most likely cause of her pain is

cholecystitis

the most appropriate treatment for a patient with severe abdominal pain and signs of shock includes

transporting the patient without delay

febrile seizures are

usually benign but should be evaluated

a generalized seizure is characterized by

severe twitching of all the body’s muscles

when obtaining medical history information from the family of a suspected stroke patient, it is most important to determine

when the patient last appeared normal

which of the following is a metabolic cause of a seizure?
A) brain tumor
B) massive stroke
C) poisoning
D) head trauma

poisoning

which of the following patients would most likely demonstrate typical signs of infection or fever?
A) an 88-year-old male with chronic renal problems
B) a 17-year-old male with depression and anxiety
C) a 3-month-old female who was born prematurely
D) a 35-year-old female in the later stages of AIDS

a 17-year-old male with depression and anxiety

the anterior aspect of the cerebrum controls

emotion

a patient experiencing a tonic-clonic seizure exhibits

tachycardia, hyperventilation, sweating, and intense salivation

"tips on vowels"

T-trauma I-infection P-psychogenic causes S-seizure/syncope A-alcohol E-electrolytes I-insulin O-opiates U-uremia

in the immediate postictal state you should anticipate

rapid, deep respirations and fast heart rate

You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes phenytoin (Dilantin) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you should:
A) administer one tube of oral glucose and prepare for immediate transport.
B) place her in the recovery position and transport her with lights and siren.
C) monitor her airway and breathing status and assess her blood glucose level.
D) give her small cups of water to drink and observe for further seizure activity.

monitor her airway and breathing status and assess her blood glucose level

when obtaining medical history information from the family of a suspected stroke patient, it is MOST important to determine:
A) when the patient last appeared normal.
B) if there is a family history of a stroke.
C) if the patient has been hospitalized before.
D) the patient’s overall medication compliance

when the patient last appeared normal

you arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. she has a small amount of vomitus draining from the side of her mouth. after protecting her from further injury, you should:

maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen

law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. she is wearing a medical alert bracelet that identifies her as an epileptic. there is an empty bottle of vodka next to the patient. you should:
A) place a bite block in her mouth in case she has a seizure and transport at once.
B) apply oxygen via a nonrebreathing mask, place her on her left side, and transport.
C) assist ventilations, perform a rapid exam, and prepare for immediate transport.
D) apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.

assist ventilations, perform a rapid exam, and prepare for immediate transport.

you are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. his blood pressure is 190/94 mm Hg and his pulse rate is 50 beats/min. his wife tells you that he has hypertension and diabetes. he has MOST likely experienced:
A) acute hypoglycemia.
B) a ruptured cerebral artery.
C) a complex partial seizure.
D) an occluded cerebral artery.

a ruptured cerebral artery

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