Chapter 17 Neurological Emergencies

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A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport?

He is currently not prescribed any medications

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

has bleeding within the brain.

A patient whose speech is slurred and difficult to understand is experiencing:


A patient with an altered mental status is

not thinking clearly or is incapable of being aroused.

During the primary assessment of a semiconscious 70-year-old female, you should:

ensure a patent airway and support ventilation as needed.

Interruption of cerebral blood flow may result from all of the following, EXCEPT:

cerebral vasodilation.

The left cerebral hemisphere controls:

the right side of the body.

The MOST significant risk factor for a hemorrhagic stroke is:


The three major parts of the brain are the:

cerebrum, cerebellum, and brain stem.

When assessing for arm drift of a patient with a suspected stroke, you should:

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

When caring for a patient with documented hypoglycemia, you should be MOST alert for:

a seziure

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine:

when the patient last appeared normal.

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke?


Which of the following conditions would MOST likely affect the entire brain?

Respiratory failure or cardiopulmonary arrest

Which of the following MOST accurately describes a simple partial seizure?

A seizure that begins in one extremity

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?

Confusion and fatigue

Which of the following symptoms would lead the EMT to believe that a patient’s headache is caused by sinus congestion?

The pain is worse when bending over

You are caring for a 68-year-old man with sudden onset of left-sided paralysis and slurred speech. His airway is patent, his respirations are 14 breaths/min with adequate depth, and his oxygen saturation is 98%. Treatment for this patient should include:

recovery position and transport

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 2-year-old male. 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.

Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of:


A generalized (tonic-clonic) seizure is characterized by:

severe twitching of all the body’s muscles.

The brain is divided in three major parts

1. The brain stem 2. The Cerebellum 3. The cerebrum

Function of the brain stem

Controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction.

Function of the Cerebellum

Controls muscle and body coordination responsible for coordinating complex tasks that involve many muscles


A state of profound unconsciousness from which the patient cannot be roused.

The brain is most sensitive to changes in ________, _________, and ________levels

oxygen; glucose; temperature

Most common types of headaches are:

Tension headache, migraines, and sinus headaches

Tension headaches

Caused by muscle contractions in the head and neck Attributed to stress


Thought to be caused by changes in blood-vessel size in the base of the brain; often associated with nausea and vomiting and may be preceded by visual warning signs such as flashing lights or partial vision loss.

Sinus headaches

Caused by pressure that is the result of fluid accumulation in the sinus cavities

Hemorrhagic stroke (bleeding in the brain)

The blood from a ruptured blood vessel irritates the tissues of the brain and can cause increased intracranial pressure.


A central nervous system infection in which the patient may complain of a headache, stiff neck, fever, and sensitivity to light

cerebrovascular accident (CVA) or Stroke

An interruption of blood flow to the brain that results in the loss of brain function


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

Two main type of stroke

Ischemic and Hemorrhagic Stroke

ischemic stroke

A type of stroke that occurs when blood flow to a particular part of the brain is cut off by a blockage (eg, a blood clot) inside a blood vessel.


A blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke.


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


A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, eventually leading to a partial or complete blockage of blood flow; an accumulation of fat and cholesterol in the arteries.

hemorrhagic stroke

A type of stroke that occurs as a result of bleeding inside the brain.


An abnormal enlargement of the wall of a blood vessel that results from weakening of the vessel wall.

transient ischemic attack

A disorder of the brain in which brain cells temporarily stop functioning because of insufficient oxygen, causing stroke-like symptoms that resolve completely within 24 hours of onset.


The inability to understand and/or produce speech.


Slurred speech

postictal state

The period following a seizure that lasts 5 to 30 minutes; characterized by labored respirations and some degree of altered mental status.

________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion.

Low oxygen levels in the bloodstream will affect the entire brain, often causing anxiety, restlessness, and confusion.


A neurologic episode caused by a surge of electrical activity in the brain; can be a convulsion characterized by generalized, uncoordinated muscular activity, and can be associated with loss of consciousness.


A disorder in which abnormal electrical discharges occur in the brain, causing seizure and possible loss of consciousness.


A sensation experienced before a seizure; serves as a warning sign that a seizure is about to occur.

status epilepticus

A condition in which seizures recur every few minutes or last longer than 30 minutes.

partial (focal) seizure

A seizure affecting a limited portion of the brain.

generalized (tonic-clonic) seizure

A seizure that features rhythmic back-and-forth motion of an extremity and body stiffness, or extreme twitching of all of the body’s muscles, that may last several minutes or more; formerly known as a grand mal seizure.

febrile seizures

Seizures that result from sudden high fevers; most often seen in children.


An abnormally low blood glucose level.

Medications used most often to treat seizures include:

Levetiracetam (Keppra) Phenytoin (Dilantin) Phenobarbital Carbamazepine (Tegretol) Valproate (Depakote) Topiramate (Topamax) Clonazepam (Klonopin)


Loss of bowel and/or bladder control; may be the result of a generalized seizure.


Weakness on one side of the body


A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain

Causes of altered mental status

Hypoglycemia, Delirium, unrecognized head injury, sever alcohol intoxication, psychologic disorders and medication, infections (in brain), drug overdose, and/or poisoning

Stroke Assessment Tools include:

3-Item Stroke Severity Scale (LAG Scale); FAST: and Glasgow Coma Scale

When you are assessing for a stroke, which of the following neurologic tests should be included in the assessment as a minimum?

Facial movement, arm movement, and speech

You are treating a patient who is exhibiting slurred speech, facial droop, and an inability to move his left arm. Which neurologic examination emphasizes these possible stroke signs?

The Cincinnati Prehospital Stroke Scale looks at facial droop, arm lift, and speech.

What is the name of the condition when the patient forgets about the injured side after a stroke?


What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage?

Ischemic stroke

What criteria must be met for a patient to have status epilepticus?

seizures that recur every few minutes or last longer than 30 minutes.

Which of the following is a metabolic cause for a seizure?

Hypoglycemia is a metabolic cause of seizures.

Which of the following mimics a stroke and also causes a seizure?


What is the difference between a stroke and a transient ischemic attack?

A TIA resolves completely within 24 hours of onset.

You are examining a patient whose signs include lip smacking, jerking of the left arm, and agitation. Based on these signs, what type of seizure is this patient experiencing?

complex partial seizure.

You are dispatched to a home where you find a 70-year-old man. He is exhibiting facial drooping and, when you ask him to tell you what day it is, he says "January." Which part of the brain is most likely to have been affected?

Aphasia is the inability to produce or understand speech. This occurs when the left hemisphere of the cerebrum is impacted by a stroke.

A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is:


Which of the following conditions is NOT a common cause of seizures?


The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:

usually have an altered mental status or decreased level or consciousness

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to:

ask his wife when she noticed symptoms

Which of the following clinical signs is MOST suggestive of a ruptured aneurysm?

sudden severe headache

The anterior aspect of the cerebrum controls:


Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache?

history of migraines

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:

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

Muscle control and body coordination are controlled by the:


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 has a history of seizures and takes topiramate (Topamax). 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 patients would MOST likely demonstrate typical signs of infection, such as a fever?

A 17-year-old male with anxiety

Which of the following medications would indicate that a patient has a history of seizures?

Levetiracetam (Keppra)

A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min. Treatment should include:

dimming the lights in the back of the ambulance and transporting without lights and siren.

Which of the following MOST accurately describes the cause of an ischemic stroke?

Blockage of a cerebral artery

Components of the Cincinnati Prehospital Stroke Scale include:

arm drift, speech, and facial droop.

Successful treatment of a stroke depends on whether:

thrombolytic therapy is given within 3 hours of symptoms beginning.

A patient who is experiencing aphasia is:

unable to produce or understand speech.

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