Neurological Conditions

Question 1

Methods to asses a patients neurological state

Answer 1

AVPU
Alert & Orientated (A&O) Assessment 
Glasgow Coma Scale (GCS) 
PEARL Assessment –
Patient Observation

Question 2

assessing neurological state, Alert and Oriented method A&O

Answer 2

Alert and Orientated
There are four areas to consider
Person, Place, Day and Event
Can they recall their name? Where they are? What time or day it is? What’s just happened?
Day tests long term memory
Place & event tests short term memory
However be aware of patients normal mental state (dementia).

Question 3

Glasgow Coma Scale, scores and areas assessed

Answer 3

9-12 = Moderate LOC
Less than8 = Severe LOC

EYE OPENING RESPONSE - 1-4

4. spontaneously
5. to speech
6. To pain
7. No Response

VERBAL RESPONSE 1-5

5. orientated to time, place etc
6. confused
7. inappropriate words
8. incomprehensible Sounds
9. No Response

MOTOR RESPONSE 1-6

6. Obeys Command
7. Moves to Localised Pain
8. Flex to withdraw from pain
9. abnormal flexion
10. abnormal extension
11. No response

Question 4

PEARL - what can cause changes to pupil size or reaction

Answer 4

Shape can be changed by trauma, glaucoma or increased ICP
Stimulants, Alcohol & Hypoxia tend to cause bi-lateral dilation
Opiates however cause bi-lateral constriction
Unequal pupils can be a sign of increase Intra Cranial Pressure
Anything greater than 1mm of difference is worth noting
As pressure in the skull increases the brainstem is squeezed interrupting the signal to a pupil.

Question 5

3 types of skull fracture

Answer 5

Fractured vault
Depressed fracture
Basal skull fracture.

Question 6

Treatment of a head injury

Answer 6

Primary survey with C-Spine consideration CAcBCDE!

Secondary survey top to toe

Treat any injuries

Monitor casualty including GCS.

Question 7

4 Types of Brain Injury

Answer 7

Concussion -

Compression

Laceration

Herniation

Question 8

Describe a Concussion

Answer 8

Due to trauma, the brain can literally be shaken inside the cranium
May cause temporary symptoms and brief reduction in LOC but the casualty makes a full recovery

Question 9

Concussion Signs and Symptoms

Answer 9

Dizziness
Nausea
Amnesia around the time of injury or immediately preceding
Headache
Confusion
Brief loss of consciousness
Possible head wound
Should make full recovery.

Question 10

Describe Inter-cranial Pressure

Answer 10

More serious brain injuries, which can cause increased pressure within the vault due to bleeding or swelling and inflammation can cause Increase ICP. This may be due to trauma, hemorrhagic stroke, infections and other medical problems.
Comes in 3 levels

Question 11

3 Symptoms of Intercranial pressure ICP known as?

Answer 11

Cushings Triad
Hypertension (with widening pulse pressure)
Bradycardia,
Irregular Respirations

Question 12

Signs and Symptoms of the 3 Levels of Intercranial Pressure

Answer 12

Level One
BP rises, pulse slows
Pupils constrict but react
Cheyne-Stokes breathing
Localises to pain
Decorticate posturing.

Level Two
BP continues to rise, pulse rate decreases further
Pupils fixed at 3-5 mm, or may react slowly
breathing or neurogenic hyperventilation
Reacts to pain with decerebrate posturing.

Level Three
One or both pupils fixed and dilated (“blown”)
Ataxic or medullary ventilation
Unresponsive
BP drops, pulse becomes rapid and irregular
Flaccid (soft, hanging loosely or no tone).

Question 13

Assessing Pain SOCRATES

Answer 13

Site
Onset
Character
Radiates
Associated Symptoms
Time/duration
Exacerbating or relieving factors
Severity.