© 2001 umbc neurological managementccemt-p sm 12/98 1 neurological assessment
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© 2001 UMBC Neurological Management CCEMT-P SM 12/98 2
Neurological Assessment
• Patient history– Pre-existing conditions– Medical record– Current event
• Does the clinical picture match the mechanism of injury?
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 3
Brain Function Exam
• External examination
• LOC assessment
• Motor response
• Eye and pupil response
• Vital signs alterations
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 4
External Examination
• Battle’s sign
• Raccoon’s eyes
• CSF leakage
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 5
LOC Assessment
• Alteration of consciousness is the hallmark of brain injury.
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 6
LOC Assessment
• Arousal (AVPU)
• Mental status exam– Awareness
– Judgment
– Affect
– Memory
– Intelligence
– Orientation
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Motor Response
• Response– Obeys commands
– Localizes
– Withdrawal from pain
– Flexion / extension
• Pain or altered sensorium with movement
• No response – Medications
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 8
Motor Response
• Strength– Grip strength – Flexion / extension– Equality of left and right side of body
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Motor Response
• Coordination– Cerebellar– Medication considerations– Pre-existing conditions
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 10
Motor Response
• Abnormal or involuntary movements– Pre-existing conditions – Medications– Tics – Tremors– Seizures
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 11
Motor Response: Seizures
• Paroxysmal episodes of excessive and erratic neurona discharge– Tonic – Clonic– Focal – Unilateral– Bilateral
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 12
Motor Response: Seizures
• Etiology of seizures– Inadequate seizure therapy– Drugs– Brain tumors– Electric shock– CNS infection
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 13
Motor Response
• Deep tendon reflexes (DTRs)– 0 - no response – 1 - slow or reduced response– 2 - brisk or expected response– 3 - slightly hyper reflexive– 4 - greatly hyper reflexive
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Motor Response: DTRs
• Correlation with level of spinal cord innervation– Biceps C5-C6– Triceps C7-C8– Quadriceps L3-L4– Achilles S1-S2
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Motor Response
• Abnormal reflexes– Babinski’s– Snout– Grasp
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Motor Response
• Sensation– Performed on awake patients with intact cognition– Stereognosis – Two point discrimination– Graphesthesia – Point location– Extinction phenomena
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 17
Eye and Pupil Response
• Vision • Shape• Pupil size / equality • Reaction
• Nystagmus • Eye reflexes• Gaze preferences • Cranial nerves
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Pupil Response
• Direct response absent– CNIII compression, CNII lesion
• Direct and consensual response absent– CNIII compression
• Direct response absent and consensual response intact– CNII lesion
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 19
Eye Response
• Nystagmus– PCP– Alcohol– Barbituates
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 20
Eye Response
• Eye movement– Deviate toward obstructive hemispheric lesions– Deviate away from irritative hemispheric
lesions and various brainstem lesions
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 21
Vital Signs Alterations
• Tachycardia / bradycardia
• Tachypnea / bradypnea
• Hypertension / hypotension
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Spinal Cord Exam
• External examination
• Motor response
• Vital signs alterations
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External Examination
• Deformity
• Line of demarcation
• Priapism
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Motor Response
• Strength
• Reflexes
• Range of motion
• Motor nerve function
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Motor Response
• Sensation– Sharp / dull perception– Proprioception
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Motor Response
• Neurological Assessment– Comprehensive– Serial– Well documented
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 27
Vital Signs Alterations
• Bradycardia / normocardia with shock
• Hypoventilation– Denervation of respiratory muscles
• Hypotension
• Loss of thermoregulation
© 2001 UMBC Neurological Management CCEMT-P SM 12/98 28
Transport Considerations
• Assess ability to maintain airway
• Assess hemodynamic status
• Review physician’s orders
• Assess skin
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Transport Considerations
• Bowel and bladder assessment
• Feeding schedule
• Equipment requirements
• Other requirements
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Transport Considerations
• Dressing integrity
• Pressure changes
• Transducer zeroing
• Patient movement
• Transport length
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Neurological Assessment
• Mental status assessment
• Cranial nerves assessment
• Motor function assessment
• Deep tendon reflexes
• Cerebellar function assessment
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