© 2001 UMBC Neurological ManagementCCEMT-P SM 12/98 1 Neurological Assessment.

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 1

Neurological Assessment

© 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

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 7

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

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 9

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

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 14

Motor Response: DTRs

• Correlation with level of spinal cord innervation– Biceps C5-C6– Triceps C7-C8– Quadriceps L3-L4– Achilles S1-S2

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 15

Motor Response

• Abnormal reflexes– Babinski’s– Snout– Grasp

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 16

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

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 18

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

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 22

Spinal Cord Exam

• External examination

• Motor response

• Vital signs alterations

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 23

External Examination

• Deformity

• Line of demarcation

• Priapism

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 24

Motor Response

• Strength

• Reflexes

• Range of motion

• Motor nerve function

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 25

Motor Response

• Sensation– Sharp / dull perception– Proprioception

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 26

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

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 29

Transport Considerations

• Bowel and bladder assessment

• Feeding schedule

• Equipment requirements

• Other requirements

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 30

Transport Considerations

• Dressing integrity

• Pressure changes

• Transducer zeroing

• Patient movement

• Transport length

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 31

Neurological Assessment

• Mental status assessment

• Cranial nerves assessment

• Motor function assessment

• Deep tendon reflexes

• Cerebellar function assessment

© 2001 UMBC Neurological Management CCEMT-P SM 12/98 32

Neurological Assessment

Conclusion