Concussion Evaluation

history (9)

• MOI

• previous injury/hx

• headache

• nausea

• dizziness

• neck pain

• tinnitus

• loss/level of consciousness

• radiating pain/numbness/tingling

observation (6)

• gait/balance, facial expression, ability to communicate

• pupil response (PEARL)

• respiration (rate and quality)

• visible trauma

• blood or CSF

• obvious signs of shock

palpation (3)

• skull

• cervical spine (begin at C7 and work superiorly)

• pulse, skin temp, skin texture

examination (4)

• monitor BP and pulse

• reflexes (biceps and patellar)

• motor strength (grip strength and gas pedal)

• balance (romberg test)

CN I

olfactory: smell something

CN II

optic: read a card

CN III

oculomotor: PEARL

CN IV

trochlear: H pattern eyes

CN V

trigeminal: open and close mouth, bite down

CN VI

abducens: H-pattern eyes

CN VII

facial: expression

CN VIII

acoustic/vestibulococchlear: hear, tandem stance

CN XI

glossopharyngeal: swallow, speak, taste

CN V

vagus: gag reflex

CN XI

accessory: shoulder shrug

CN XII

hypoglossal: stick out tongue

mental status (3)

• orientation (person, place, time)

• concentration (serial 7s, add quarter, dime, nickel, and penny)

• memory

  • post-traumatic - what happened after the trauma

  • retrograde - information before the trauma