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Prehospital Care of Neurologic Emergencies
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Book description

Prehospital Care of Neurologic Emergencies is a reliable and definitive resource for emergency medical services personnel at multiple levels: physicians, paramedics, nurses and others who encounter these critically ill patients. This focused and succinct book addresses the management of a wide range of neurologic emergencies, including traumatic brain injuries, spinal cord injuries, strokes, and seizures. In these emergencies time is critical, and the simply presented, straightforward format of the patient care and management recommendations help readers to treat patients rapidly and confidently. Each chapter follows a standard format that includes an overview of each neurologic emergency, important background, key challenges, and areas requiring future investigation. This book is unlikely to be placed on your bookshelf; instead, you will keep it nearby for times when you face life-threatening neurologic emergencies. When seconds count, this book has the answers.

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  • Chapter 5 - Spinal cord injury
    pp 97-139
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    Evaluation of the dizzy patient in the prehospital setting is a challenging task. A chief complaint of feeling lightheaded or dizzy is extremely common. Traditionally, dizziness is often subdivided into four different categories: lightheadedness, presyncope, disequilibrium and vertigo. It can be further subdivided into orthostatic dizziness and positional dizziness. This chapter discusses the physiology, categories, and key challenges of dizziness. In order to successfully approach patients who are complaining of dizziness, the EMS professional needs to understand how the brain perceives orientation in space and processes the signals to maintain an upright posture. He should focus on identifying life-threatening entities, including serious cardiac dysrhythmias or cardiac syncope; centrally mediated causes of vertigo; and life-threatening metabolic/electrolyte derangements. Obtaining a blood glucose level, acquiring a 12 lead ECG and performing a focused physical exam may help identify a subgroup of patients with immediately life-threatening conditions.
  • Chapter 6 - Traumatic brain injury
    pp 140-164
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    Evaluation of the headache patient begins with the historical exam. Physical findings of concern associated with the headache include: unequal weakness; generalized malaise and inability to ambulate; fevers; neck stiffness; and unequal pupils. Primary causes for the headache include tension headache, migraine, cluster and caffeine withdrawal, and the secondary causes include infection, subarachnoid hemorrhage (SAH), eye complaints, and tumors. Secondary headache is tending to improve as underlying cause of the headache is treated. This chapter presents a review of the common treatment options for the management of headache in the EMS environment. These include inhaled oxygen, anti-emetics, opioids, nonsteroidal anti-inflammatory drugs (NSAIDS), and analgesics. EMS providers must have a heightened level of concern for the causes of headache requiring emergent treatment. The area of headache evaluation and management in the EMS environment needs further study.
  • Chapter 7 - Altered mental status
    pp 165-188
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    Seizures are a common cause of EMS activation. This chapter discusses the high quality, moderate and low quality recommendations for seizures. Status epilepticus (SE) is defined as persistent or rapidly recurring seizures lasting for more than 5 minutes that generally do not stop by themselves. Psychogenic non-epileptic spells (pseudo-seizures) are challenging to diagnose in any setting and should be an EMS diagnosis in only the most extreme and obvious presentation. Occasionally, breakthrough seizures reflect lowering of the seizure threshold by some other acute pathology or infection or are caused by withdrawal from alcohol or other substances. The Prehospital Treatment of Status Epilepticus (PHTSE) Trial was a randomized, controlled trial of diazepam, lorazepam and placebo in the prehospital treatment of SE. Importantly, the trial showed that early termination of seizures was associated with better clinical outcomes.


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