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

2. © 2001 UMBCNeurological ManagementCCEMT-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?

3. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 3 Brain Function Exam External examination LOC assessment Motor response Eye and pupil response Vital signs alterations

4. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 4 External Examination Battle’s sign Raccoon’s eyes CSF leakage

5. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 5 LOC Assessment Alteration of consciousness is the hallmark of brain injury.

6. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 6 LOC Assessment Arousal (AVPU) Mental status exam –Awareness –Judgment –Affect –Memory –Intelligence –Orientation

7. © 2001 UMBCNeurological ManagementCCEMT-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

8. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 8 Motor Response Strength –Grip strength –Flexion / extension –Equality of left and right side of body

9. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 9 Motor Response Coordination –Cerebellar –Medication considerations –Pre-existing conditions

10. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 10 Motor Response Abnormal or involuntary movements –Pre-existing conditions –Medications –Tics –Tremors –Seizures

11. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 11 Motor Response: Seizures Paroxysmal episodes of excessive and erratic neurona discharge –Tonic –Clonic –Focal –Unilateral –Bilateral

12. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 12 Motor Response: Seizures Etiology of seizures –Inadequate seizure therapy –Drugs –Brain tumors –Electric shock –CNS infection

13. © 2001 UMBCNeurological ManagementCCEMT-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

14. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 14 Motor Response: DTRs Correlation with level of spinal cord innervation –BicepsC5-C6 –TricepsC7-C8 –QuadricepsL3-L4 –AchillesS1-S2

15. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 15 Motor Response Abnormal reflexes –Babinski’s –Snout –Grasp

16. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 16 Motor Response Sensation –Performed on awake patients with intact cognition –Stereognosis –Two point discrimination –Graphesthesia –Point location –Extinction phenomena

17. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 17 Eye and Pupil Response Vision Shape Pupil size / equality Reaction Nystagmus Eye reflexes Gaze preferences Cranial nerves

18. © 2001 UMBCNeurological ManagementCCEMT-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

19. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 19 Eye Response Nystagmus –PCP –Alcohol –Barbituates

20. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 20 Eye Response Eye movement –Deviate toward obstructive hemispheric lesions –Deviate away from irritative hemispheric lesions and various brainstem lesions

21. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 21 Vital Signs Alterations Tachycardia / bradycardia Tachypnea / bradypnea Hypertension / hypotension

22. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 22 Spinal Cord Exam External examination Motor response Vital signs alterations

23. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 23 External Examination Deformity Line of demarcation Priapism

24. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 24 Motor Response Strength Reflexes Range of motion Motor nerve function

25. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 25 Motor Response Sensation –Sharp / dull perception –Proprioception

26. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 26 Motor Response Neurological Assessment –Comprehensive –Serial –Well documented

27. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 27 Vital Signs Alterations Bradycardia / normocardia with shock Hypoventilation –Denervation of respiratory muscles Hypotension Loss of thermoregulation

28. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 28 Transport Considerations Assess ability to maintain airway Assess hemodynamic status Review physician’s orders Assess skin

29. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 29 Transport Considerations Bowel and bladder assessment Feeding schedule Equipment requirements Other requirements

30. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 30 Transport Considerations Dressing integrity Pressure changes Transducer zeroing Patient movement Transport length

31. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 31 Neurological Assessment Mental status assessment Cranial nerves assessment Motor function assessment Deep tendon reflexes Cerebellar function assessment

32. © 2001 UMBCNeurological ManagementCCEMT-P SM 12/98 32 Neurological Assessment Conclusion