Neuro assessment

• Glasgow coma scale 


  Eyes (4), Verbal (5), Motor (6)
• Explain GCS rating


  EYES - 1: no response, 2.) To pain, 3.) To speech, 4.) Spntaneous. VERBAL RESPONSE - 1.) No response, 2.) Sounds, 3.) Words, 4.) Confused, 5.) Orientated. MOTOR RESPONSE - 1.) No response 2.) Extension to pain 3.) Abnormal flexation 4.) Withdrawel to pain 5.) Localises pain 6.) Obeys commands.
• PEARL


  Pupils, Equal, And, Reacting to, Light
• What is a blown pupil?

  Sign of brain damage, trauma/stroke.
• Pinpoint pupil


  Sign of a opioid overdose (heroin)
• Cerebrovascular accident


  Stroke - Blood supply cut of to brain depriving brain tissue of oxygen.
• Two types of strokes

  Ischaemic - Blockage cuts of blood supply, blood clots (85% of strokes) Hemorrhagic - Due to bleeding into the brain following a blood vessel rupturing.
• FAST Test: 


  Face, arms, speech, time
• Expressive aphasia 


  Unable to produce meaningful words or sentences but can comprehend everything going on - frustrated
• Receptive aphasia 


  Able to produce vast sentences but make no sense or value
• Anomic aphasia 


  Cant find the right word so a "Watch becomes a pen"
• Transient Ischaemic Attack (TIA) 


  Temproary distruption to the brain, TIA symptoms resolves themself. If one FAST positive - blue light to HASU
• Paeds stroke


  -400 paeds stoke a year. 6x higher after a recent illness like chicen pox
• Hypoglycaemia presentations 


  Sweating, Warmth, Anxiety, Tremor, Nausea, Palpitations, Tachychardia, Hunger, Behavioural changes, changes in vision or speech, confusion, dizzieness, lethargy, seizure, Loss of consciousness, coma
• Hypoglycaemia 


  Can present as a CVA. If conscious - give glucose gel or toast, jam, banana or pasta. If unconsciousness we can give glucagon to convert glycogen stores in the liver to rise sugar levels.
• Hyperglycaemia symptoms


  Polypipsia, polyuria, sunken eyes, poor skin, dry, coma or <GCS. Weakness. Abdo pain, Hypotension, Acetone breath, Tachycardia, seizures
• Hyperglycaemia treatment


  Assist breathing with BVM, Paramedics give sodium chloride. Depends on obs - blue light to hosp
• Meningococcal disease


  Meningitis and septicaemia.
• Meningitis disease and symtpoms


  Non blanching rash, pyrexia, Rapid progression of illness, Seizures, Neck stifness, Headache, confusion, ALtered level of conciousness, Pallor or mottles skin, Photophobia, Hypotonia. Infection of the meninges
• Septicaemia 


  Blood poisening - bacteria enters the bloodstream. Treat as sepsis, immune system overreacts to an infection and starts to damage your bodys own tissues and organs - can kill in hours
• Managment for meningoccal disease

  High flow oxygen, Paramedics can give benzylpenicillin and fuids, blue call to hosp.
• Focal seizures 


  Electrical impulses start in one area on one side of the brain
• Febrile seizures 


  3months-5years. Due to a high fever
• Generalised


  Brain firing off impulses
• Absent seizures


  Someone to 'blank out' or stare. Caused by flashing lights or episodes of hyperventilation
• Myoclonic seizures


  Sudden, short lasting jerks affect some or all of the body. Dont impair consciousness and sometimes last seconds. Can be forceful.
• Clonic seizures


  Stiffening and relaxation of a muscle in quick succession - repeated jerking. Can happen in one lobe (one side of body moves) or both (whole body jerk). patients can be conscious.
• Tonic seizures


  Body becomes overly stiff and can be awake when this happens.
• Tonic - clonic seizures


  1-3 mins. Whole body stiff and jerking leads to tongue biting and incontinence. Beomce post-ictal after
• Causes of seizures


  Discontinuation of meds, infections, metabolic derangement, Drugs, Alcohol withdrawel, CVA, Intercranial mass, head injury
• History taking for seizures

  Convulsion, Post ictal confusion, Incontinence, Tongue biting, Auras
• Seizure managment


  Reconvery position, NP airway, Highflow oygen, midaz for paramedics.
• Headaches history taking:


  Is this the worst headache youve had? Is this different from usual headaches? Is this a new headache?
• Tension headache


  Stress or fatigue, pain is generalised or posterior. No numbness or tingling
• Sinus headache


  Sinus blocked and inflammed, Deep ache is cheekbones forehead or bridge if nose. Pain worsens with leaning forward
• Exertion headaches


  Intense physical acitivity - shortlives but throbbing on both sides of head
• Migrane headache


  Blood vessel constriction and triggered by weather, stress or sleep. Throbbing on head and cause nausea, dizziness, fatigue, light, noise and smell sensitivty.
• Cluster headache


  Burning or piercing pain around or behund one eye or side of face and face swelling. Flushing, sweating, nasal congestion, drooping eyelids
• THunderclap headache


  peak within 60 seconds. Uncommon but warn of life threatning conditions - usually bleeding around brain