Let’s speak the truth here: Neuro exams for the intubated patient in your ED is difficult. We share our recommendations for best practice in assessing your patient while they wait for their ICU bed upstairs. Or, better yet, if you don’t see neuro patients in your medical ICU, this is the podcast for you.
- You’re looking for effects of secondary injury
- It’s all about the ICP —– MAP – ICP = Cerebral Perfusion Pressure. (You can only measure the ICP with a Bolt or indirectly with an EVD)
- Examine your patient using the GCS as a guide (more on GCS below)
- LEVEL OF AROUSAL FIRST
- Pupil light check
- Cough reflex
- Gag reflex
- Painful stimuli – TRAP squeeze (contralateral to brain lesion if possible)
- Affected arm that crosses midline of the body, and up to your trap squeeze is a GOOD sign
- For the love of all things Godly, don’t say “GCS 12”
- DESCRIBE WHAT YOU SEE!
- GCS has dreadful interrater reliability. There are better scores out there… but really, just describe what you see!
- Pupils will probably stay reactive to light even if paralyzed