protected, being encased in a hard non-expandable box called the skull. The spinal cord is protected by the articulating spinal vertebrae. With a consistency of toothpaste, the spinal cord needs this high level of protection.
LEVEL OF
CONSCIOUSNESS The level of consciousness (LOC) your patient is displaying is a major sign of what is transpiring inside his or her brain. Patients who are suffering some type of central nervous system emergency, will have an altered LOC.
A change in the patient’s level of consciousness can be due to head or brain trauma, fever, seizure, diabetes, stroke or a myriad of other things. The most important thing is to recognize a change. Level of consciousness is one of the vital signs that will be necessary to determine and convey to the PIC and Aircare Access. Begin by determining if your patient is conscious and alert.
Next, ask some simple questions. Ask the patient, “What is your name?” If the patient is able to tell you, we would say “alert and oriented to person” or A & O times 1. Now ask about surroundings (or where the patient is going). If this is correctly answered, we would say “alert and oriented to person and place” or A & O times 2.
Ask the patient the date, day of the week, number of the day or year depending on responsiveness. If the patient can tell you his or her correct name, the correct location and the current day, date, or year, we would describe this patient as “alert and oriented to person, place and time” or A & O times 3. Lastly, ask your patient about recent history or what happened in the recent past. If the patient can tell you he or she was eating a shrimp salad on the plane for lunch, the patient is alert to recent history. We would say the patient is “alert and oriented to person, place, time and recent history” or A & O times 4.
It may be necessary to repeat this evaluation as you complete your patient assessment or as the situation changes. You may notice a decrease in the level of consciousness, in which case you should be alert for airway concerns or the need for CPR. You may also see an increase in the patient’s LOC. This happens in the case of seizures, where the patient will become more oriented as recovery occurs.
56 Central Nervous System
MEDICAL EMERGENCIES Medical emergencies begin inside the body and a
variety of conditions can result. The key to many emergencies is quick identification of symptoms that go along with these problems, and acting quickly and appropriately to get people much needed help. Knowledge of different body systems is important to begin identifying and treating many conditions.
FAINTING
Fainting is normally a fairly benign condition, also known as passing out. Simply put, fainting is a temporary state of very low blood pressure brought about by the dilation of blood vessels. As these vessels dilate, the blood pressure drops quickly. This results in a decrease of blood to the brain and the patient can lose consciousness. In other words, this is the brain’s way of telling you to lie down!
People faint for a variety of reasons; some serious, some not so serious. Some basic reasons for passing out include stress, too much heat, too little food or something they see. Needles and blood are most often the visual culprits. The patient who is about to faint will become pale and sweaty and may complain of nausea.
Treatment
Treatment for a fainting patient centers on trying to raise blood pressure. Keep the patient lying down, not sitting up! Elevate the patient’s legs, treat any injuries suffered if a fall occurred and give O2. Once the patient is alert, it is common to want to get up. Keep the patient lying down for about 10 more minutes. Continue to monitor and reassure the patient, remaining close if assistance is needed. If the underlying cause is unknown, call Aircare Access for medical assistance and evaluation.
HIGH BLOOD PRESSURE
High blood pressure, also known as hypertension, kills over 50,000 people each year. It is a contributing factor in nearly 250,000 more deaths. Your blood pressure reading represents the contraction and relaxation phases of the heart. A normal blood pressure for an adult is about 100 + your age (max. 130)/60-80. High blood pressure begins at anything above 140/90. It is estimated that 25% of the population suffers from high blood pressure.
The vast majority of people with high blood pressure have no symptoms at all and would have no idea their
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