History ABCs Level of Consciousness (ask simple questions) Determine MOI (or ask bystander) Ask...
Transcript of History ABCs Level of Consciousness (ask simple questions) Determine MOI (or ask bystander) Ask...
HistoryABCsLevel of Consciousness (ask simple
questions)Determine MOI (or ask bystander)Ask about headacheAsk about nauseaAsk about paralysis/numbness/weaknessAsk about tinnitus (ringing in the ears)
ABCsC – Circulation
Pulse Adult and Child: Carotid artery Infant: Brachial Artery Begin CPR if needed
A – AirwayRemove face mask (if needed)Chin tiltJaw thrust
B – BreathingLook, Listen, and Feel2 breaths
Levels of ConsciousnessLevels
Alert and Oriented?Responsive to Verbal Stimuli?Responsive to Painful Stimuli?Lethargy: DrowsinessStupor: responsive only to vigorous stimulusComa: unresponsive to verbal or physical
stimulus
ObservationUnequal Pupils
PERRLA (Pupils equal, round, and reactive to light and accommodation)
Respiratory RateFace color (red or pale)Abnormal body positionDischarge from ears and nose
Spinal Fluid
Palpation Rate and quality of pulse
60 – 100 bpm Rapid and weak? Strong and slow? Brachycardia (bpm < 60) Tachycardia (bpm > 100)
Signs of Trauma to head and neck LOC Amnesia (retrograde and antrograde) Unable to wake sleeping victim Confusion Vomiting Dizziness Very high blood pressure Very slow pulse Numbness, tingling, pain
Cranial NervesI - Olfactory II - Optic III - Oculomotor IV - Trochlear V - Trigeminal VI - Abducens VII - Facial VIII –
Vestibulocochlear /Auditory
IX - Glossopharyngeal X - Vagus XI – Spinal Accessory XII - Hypoglassal
O - OnO - OldO - OlympusT - ToweringT - TopA - AF - FamousV - VocalG - GermanV - ViewedS - SomeH - Hops
O - OhO - OnceO - OneT - TakesT - TheA - AnatomyF - FinalV - VeryG - GoodV -
VacationsA - AreH -
Heavenly
Cranial Nerve
What? How?
1 Olfactory Smell Place a strong, identifiable odor under the nose; ammonia capsule
2 Optic Vision Read something
3 Oculomotor Mvmt of eyelid Elevate eyelid; cross eyes
4 Trochlear Mvmt of eye Elevate the eye
5 Trigeminal Touch/pain of face; muscles of mastication
Sensory: Touch the skin around the faceMotor: Elevate, depress, protrude, retract, lateral deviate mandible
6 Abducens Lateral mvmt of eye
Abduct or laterally move the eye
7 Facial Mvmt of facial muscles
Motor: close eyelid; scrunch face
8 Vestibulocochlear
Hearing/balance Stand w/eyes closed no support; snapping
9 Glossopharyngeal
Mvmt of pharynx Swallow
10
Vagus Not Tested
11
Spinal Accessory
Mvmt of Sternocleidomastoid and trapezius muscle
Shrugging of shoulders
12
Hypoglassal Mvmt of tongue Stick tongue out
Special Tests (Concussion Tests)Cranial Nerve Testing
Blurred Vision (Optic nerve)Pupillary Response (PERRLA)Tracking (Trochlear, Abducens, and
Oculomotor)Romberg Sign (Vestibulocochlear)
Finger-to-nose test Babinski Test (reflex test)Oppenheim TestOppositionAmnesia
Babinski TestTests Babinski ResponseEither Present or notHow?
Lightly rub thumb up the bottom of the sole from the heel up to the base of the toe
Normal response: Infants: Great toe extends and fanning of other toes
Disappears as infant matures (1yr or less) Adults and children (1 yr or older)
Toes curl under (flex)
Oppenheim TestTests for cranial irritationEither present or notHow?
Rub antro/medial side of tibia Noxious Stimulus
Abnormal response: Similar to Babinski Extension of great toe/toes
Finger-to-Nose TestTests Spacial awareness or proprioceptionHow?
Instruct athlete to close eyes and attempt to touch finger to nose
Positive testAthlete is unable to touch their nose without
the eyes open
Romberg TestTesting balance through the Romberg SignHow?
The essential features of the test are as follows: the subject stands with feet together, eyes open and hands by the
sides. the subject closes the eyes while the examiner observes for a full
minute. Because the examiner is trying to elicit whether the patient
falls when the eyes are closed, it is advisable to stand ready to catch the falling patient. For large subjects, a strong assistant is recommended.
Positive if, and only if, the following two conditions are both met:
The patient can stand with the eyes open; and The patient falls when the eyes are closed.
The test is not positive if either: The patient falls when the eyes are open; or The patient sways but does not fall when the eyes are closed.
OppositionThe ability to touch and hold the thumb and
another finger together.How?
Instruct athlete to touch each finger to the thumb
Then instruct the athlete to hold the two fingers together while you pull them apart.
Positive findingAthlete is unable to touch fingers together or
hold the two fingers together.
PERRLAPupils Equal, Round and Reactive to Light and
AccommodationHow to test?
If in a bright area Cover one eye and remove cover
May also use a pen light Pen lights are used starting from the lateral side and moving
medial Repeat on other eye
If in a darker area Same steps but use Pen Light
Positive if Pupils: Do not constrict Do not constrict equally Are difference sizes Are not round
Positive = Brain Injury