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Neurological Assessment

Neurological Assessment. Neurological Assessment. Patient history Pre-existing conditions Medical record Current event Does the clinical picture match the mechanism of injury?. Brain Function Exam. External examination LOC assessment Motor response Eye and pupil response

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Neurological Assessment

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  1. Neurological Assessment Neurological Management

  2. Neurological Assessment • Patient history • Pre-existing conditions • Medical record • Current event • Does the clinical picture match the mechanism of injury? Neurological Management

  3. Brain Function Exam • External examination • LOC assessment • Motor response • Eye and pupil response • Vital signs alterations Neurological Management

  4. External Examination • Battle’s sign • Raccoon’s eyes • CSF leakage Neurological Management

  5. LOC Assessment • Alteration of consciousness is the hallmark of brain injury. Neurological Management

  6. Arousal (AVPU) Mental status exam Awareness Judgment Affect Memory Intelligence Orientation LOC Assessment Neurological Management

  7. Response Obeys commands Localizes Withdrawal from pain Flexion / extension Pain or altered sensorium with movement No response Medications Motor Response Neurological Management

  8. Motor Response • Strength • Grip strength • Flexion / extension • Equality of left and right side of body Neurological Management

  9. Motor Response • Coordination • Cerebellar • Medication considerations • Pre-existing conditions Neurological Management

  10. Motor Response • Abnormal or involuntary movements • Pre-existing conditions • Medications • Tics • Tremors • Seizures Neurological Management

  11. Motor Response: Seizures • Paroxysmal episodes of excessive and erratic neurona discharge • Tonic • Clonic • Focal • Unilateral • Bilateral Neurological Management

  12. Motor Response: Seizures • Etiology of seizures • Inadequate seizure therapy • Drugs • Brain tumors • Electric shock • CNS infection Neurological Management

  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 Neurological Management

  14. Motor Response: DTRs • Correlation with level of spinal cord innervation • Biceps C5-C6 • Triceps C7-C8 • Quadriceps L3-L4 • Achilles S1-S2 Neurological Management

  15. Motor Response • Abnormal reflexes • Babinski’s • Snout • Grasp Neurological Management

  16. Motor Response • Sensation • Performed on awake patients with intact cognition • Stereognosis • Two point discrimination • Graphesthesia • Point location • Extinction phenomena Neurological Management

  17. Vision Shape Pupil size / equality Reaction Nystagmus Eye reflexes Gaze preferences Cranial nerves Eye and Pupil Response Neurological Management

  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 Neurological Management

  19. Eye Response • Nystagmus • PCP • Alcohol • Barbituates Neurological Management

  20. Eye Response • Eye movement • Deviate toward obstructive hemispheric lesions • Deviate away from irritative hemispheric lesions and various brainstem lesions Neurological Management

  21. Vital Signs Alterations • Tachycardia / bradycardia • Tachypnea / bradypnea • Hypertension / hypotension Neurological Management

  22. Spinal Cord Exam • External examination • Motor response • Vital signs alterations Neurological Management

  23. External Examination • Deformity • Line of demarcation • Priapism Neurological Management

  24. Motor Response • Strength • Reflexes • Range of motion • Motor nerve function Neurological Management

  25. Motor Response • Sensation • Sharp / dull perception • Proprioception Neurological Management

  26. Motor Response • Neurological Assessment • Comprehensive • Serial • Well documented Neurological Management

  27. Vital Signs Alterations • Bradycardia / normocardia with shock • Hypoventilation • Denervation of respiratory muscles • Hypotension • Loss of thermoregulation Neurological Management

  28. Transport Considerations • Assess ability to maintain airway • Assess hemodynamic status • Review physician’s orders • Assess skin Neurological Management

  29. Transport Considerations • Bowel and bladder assessment • Feeding schedule • Equipment requirements • Other requirements Neurological Management

  30. Transport Considerations • Dressing integrity • Pressure changes • Transducer zeroing • Patient movement • Transport length Neurological Management

  31. Neurological Assessment • Mental status assessment • Cranial nerves assessment • Motor function assessment • Deep tendon reflexes • Cerebellar function assessment Neurological Management

  32. Neurological Assessment Conclusion Neurological Management

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