Neurologic Emergencies
Neuro calls are time-critical destinations. Recognize the stroke, treat the seizure airway, and reverse the reversible cause of altered mental status before you transport.
EMT · AEMT · Paramedic
Stroke recognition
Use Cincinnati (facial droop, arm drift, slurred speech) for screening and LAMS or RACE for large-vessel occlusion. Establish last-known-well time — it drives thrombolytic and thrombectomy eligibility.
- Cincinnati positive: any one finding = 72% probability of stroke
- LVO screens (LAMS ≥ 4, RACE ≥ 5) → thrombectomy-capable center
- Glucose on every altered patient — hypoglycemia mimics stroke
Seizure management
Protect the airway, don't put anything in the mouth, and time the seizure. Status epilepticus = > 5 min continuous or back-to-back without recovery. Treat with benzos (midazolam 10 mg IM or 5 mg IN adult) and transport.
Altered mental status workup
AEIOU-TIPS: Alcohol, Epilepsy/Electrolytes, Insulin, Overdose/Oxygen, Uremia, Trauma, Infection, Psych, Stroke. Get a fingerstick glucose, pulse ox, and ETCO₂ before you commit to a differential.
Increased intracranial pressure
Cushing's triad (bradycardia, hypertension, irregular respirations) is a late finding. Elevate head 30°, ventilate to ETCO₂ 35–40 (avoid routine hyperventilation), and transport to a neurosurgical center.
Frequently asked
- Should I ventilate hyperventilate a head-injured patient?
- No. Routine hyperventilation worsens outcomes. Target ETCO₂ 35–40. Brief hyperventilation to 30–35 is only reserved for signs of active herniation.
- How long is the stroke window?
- Tissue plasminogen activator: usually within 4.5 hours of last-known-well. Thrombectomy: extended to 24 hours in select LVO patients.
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