General
Rule out cervical injury/determine symptoms
Check LOC (Glasgow Coma Scale)
Ask “Did u black out?”
Eye opening Response (Are you ok?):
4 - Purposeful and spontaneous
3 - to verbal command
2 - to painful stimuli
1 - no response
Best Verbal Response (What happened?):
5 - oriented and converses 4 - disoriented and converses 3 - inappropriate words 2 - incomplete sounds 1 - no response
Best Motor Response (Where does it hurt?):
6 - obeys verbal commands 5 - localizes pain 4 - withdrawls from pain 3 - decorticate (arms flexed) rigidity 2 - decerebrate (arms extended) rigidity 1 - no response
Memory/Amnesia (Atleast 1)
What is your name? Do you know where you are? What day is it? What month? Remember 3 things (ask to recall in 10 min) ABCs backwards, count by 3s etc.
Head
Signs of Skull Fracture -Battle's sign (behind ear bruise) -Raccoon Eyes Does your head hurt? Where? Is the headache moving?
Eyes
Do you have blurred/double vision? Is it hard to focus? How many fingers am I holding up? What does the scoreboard/sign say? What does the scoreboard/sign say? Check for unequal pupils (internal bleeding) Check PEARL Check tracking & peripheral vision
Face & Neck
Familiar smell (icy hot) Facial Expressions Facial Sensations (bi-lateral comparison) Stick out tounge (hypoglossal) Shoulder shrug (accessory nerve #5)
Coordination & Balance
Dizzy or nauseous Is there ringing in ears (tinitis)? Romberg's sign (close eyes>sway) -modified = arms out, head back Stork stand (one legs, hands on hips, lean backwards) -Rub fingers together (adds difficulty)
Cranial Nerves
#1. Olfactory (smell>bengay) #2. Optic (fingers/scoreboard) #3. Oculomotor (PEARL-finger up & in) #4. Trochlear (Finger down & out) #5. Trigeminal (touch face & bite) #6. Abducens (peripheral vision) #7. Facial (smile, wrinkle forehead) #8. Vestibulocochlear/Acoustic (Rhomberg) #9. Glossopharyngeal (Swallow, gag, taste) #10. Vagus (talking/breathing) #11. Accessory (resist shoulder shrug) #12. Hypoglossal (stick out tounge)
When to refer (know 5)
Signs of skull fx Rapid LOC Abnormal breathing patterns Slowing heart rate Increasing BP Prolonged mental confusion Prolonged amnesia Increasing headache Unequal or fixed pupils Uncoordinated/involuntary eye movements Positive test for any cranial nerves that doesn't improve in few hrs
Head Injury Instruction Sheet includes:
Periodic reevaluation of symptoms
Instructions if symptoms worsen
Emergency numbers - hospital, AT staff, physician