Neurological Assessment Flashcards
General Impressions
Sitting: often leaning to one side
Motor Activity: movement in hands?
Primary Survey and potential neurological effects
Airway: potential salivation, cannot clear own airway
Breathing: slow, irregular, deep sighing inhalations
Circulation: bradycardia
Things to consider during a neurological assessment? (9 points)
exact nature of the symptoms
onset
change over time
precipitating factors
exacerbating and relieving factors
ever had anything like this before?
previous investigations and treatment
associated symptoms - such as rashes
other neuro symptoms: AVVV (ataxia, vomiting, vertigo and visual disturbances
Possible neurological symptoms (10)
headaches
dizziness
tingling (paraesthesia)
seziures
tremors
weakness
incoordination
dysphagia (difficulty swallowing)
dysphasia (difficulty speaking)
FAST test
F (facial droop) A (can they hold both arms up) S (is speech slurred) Time
facial droop can indicate stroke of facial nerve palsy
arm drift suggests weakness and potential hemiparesis
state the time patient was last seen well if time of symptoms is not known
pre-alert hyper acute stroke unit
always take glucose test if FAST positive
Level of consciousness
AVPU (alert, verbal, pain, unresponsive)
GCS (best eye response, best verbal response, best motor response)
Decorticate positioning
bringing arms close to the body
indicates an issue with the brainstem
Decerebrate positioning
arms extended and wrists inverted
legs extended and ankles inverted
indicated a lesion in the midbrain
Pupillary assessment: before the torch
are pupils equal
is there changes inn shape
should be 1-6mm
What does an oval shape pupil indicate
Increased intracranial pressure
Pupillary assessment: when using a torch
should be constriction of the pupil - if not there is an issue with the optic nerve
irregularities can be due to trauma
iridectomy: removal of pupil to reduce pressure behind the eye. key hold pupils can suggest an iridectomy has previously happened
Pupillary assessment: conjugate gaze
deviation of both eyes to either side whilst resting
indicates an issue with brain tissue
Pupillary assessment: deconjugate gaze
deviation of both eyes to the opposite side
indicates damage to the brainstem
Vital Signs
RR - slow (CNS depression, drug OD, stroke, raised ICP), irregular, smell of ketones or alcohol (acidosis or stroke)
Temperature
Pulse - tachycardia (infection, increased temp, hypovolemia, postictal state. Bradycardia (cerebral herniation, hypothermia and drug toxicity)
Blood pressure
Blood glucose
