Neurological Assessment Flashcards
What are the three section of GCS and how much score does each one have?
Eye Opening - 4
Verbal Response - 5
Motor Response - 6
GCS what does each score on the eyes section mean.
4 - unprompted eye opening
3 - “Hello open your eyes”
2 - Trap squeeze ( Pain )
1 - No eye opening
GCS what does each score on the verbal section mean?
5 - “what month is is”, “where are you”“name”
4 - Full coherent sentences
3 - Random words out of context
2 - Noise and Sounds
1 - No verbal response
GCS what does each score on the motor section mean?
6- “Grip my finger” - Obeys command
5 - Trap squeeze - Localises pain
4 - Flexion/withdrawal from pain
3 - Abnormal flexion to pain
2 - Extension to pain
1 - No response
Mild to severe head injury score on GCS
Mild head injury = GCS 13-15
Moderate head injury = GCS 9-12
Severe head injury = GCS 3-8 (suggests coma with need for intubation)
What does PEARL stand for in neurological assessment?
Pupils
Equal
And
Reacting to
Light
When should we assess pupils?
Head injury
Haemorrhagic stroke
Opioid overdose
Brain stem function
What are some signs of a skull fracture
Battle signs (bruising around back of ears)
Racoon eyes (bruising around eyes)
What is a Transient Ischemic Attack (TIA)
Temporary disruption in the blood supply to the brain will cause stroke like symptoms.
TIA is a medical emergency, risk of stroke is up to 10% in the week following a TIA.
How long does it take a TIA to resolve
Self Resolves within 24 hours
What are the two type of stroke and what percentage are they likely to occur
Ischemic = 85%
Haemorrhagic = 15%
What increases the risk of strokes in children
Congenital heart disease increases risk by 19x
Thrombolytic stroke risk is 6x higher after a recent illness such as chickenpox.
What does FAST stand for
Face
Arms
Speech
Time
What is expressive aphasia (neurological assessment)
Unable to produce meaningful words or sentences, although their comprehension remains in tact, their ability to express is not.
What is receptive aphasia (neurological assessment) (speech)
unable to produce vast sentences/speech at a normal rate, but there will be no meaning or value to what they are saying.
What is anomic aphasia (neurological assessment) (speech)
Word finding difficulties
Eg A watch is a pen
What is dysphagia (neurological assessment) (speech)
Difficulty with swallowing
What is meningococcal disease
A life threatening infection of the meninges. Its a term to describe to major illnesses - meningitis and septicaemia.
What is a petechial meningitis rash
Small, red pin prick rash. Non blanching
What is purpuric meningitis rash
0.5 cm point rashes. purple/pink. Non blanching.
What are the causes of meningitis
Infection (bacterial, fungal, viral)
Parasite
Inflammatory disease
What are the signs and symptoms of meningitis?
Pyrexia
Rapid progression of fever
Irritability
Seizures (5-20%)
Neck Stiffness
Headache
Confusion (50%)
Altered levels of consciousness
Pallor
Photophobia
Floppy baby (Hypotonia)
What is hypotonia
Loss of muscle control, goes floppy (floppy baby)
Paramedic treatment of meningitis
Think Sepsis
O2 at 15lpm
If suspected septicaemia, put pt on IM/IV ABX - Benzypenicillin
What are the four different types of seizure
Generalised
Febrile
Absence
Focal
What are generalised seizures
Tonic Clonic - loss of consciousness with stiffness and jerking of limbs
What are febrile seizures
3 months to 5 yrs old. Seizure due to high fever.
What are absent seizures
End of activity of responsiveness, the pt has ‘turned of’
What are focal seizures
One portion of the brain with overactive discharge.
Consciousness its sometimes saved.
What are some common causes of seizures
Infection - meningitis
Metabolic derangements (sodium levels)
Drugs (cocaine, amphetamines)
Ethanol withdrawal
Intracranial mass
Head injury
Paramedic seizure management
Recovery position
Consider airway adjuncts
Suctioning
02 - High flow
Diazepam - Rectal if no IV access
What three key questions should we ask regarding headaches
Is this this the worst headache you’ve had
Is it different from your usual headache
Is this a new headache
What are tension headaches
Most common type
Provoked by stress or fatigue
No focal neurology
Generalised or posterior/occiput (back of head)
What are cluster headaches
Sharp, unilateral pressure
Headaches are in a cluster, repeat attacks
Rare
Men affected 3x more than woman
What are migraines
More common in woman
Recurrent
Typically last 4-72 hours
Unilateral
N&V
Can be severe and dehabilitating
What is sinusitis
Caused by inflamed sinuses
Can require Abx (antibiotics) if bacterial
Pain worse if patient leans forward
Chronic sinusitis can require surgery
