neurology and endocrine

Mental Status

The total expression of a person's emotional responses, mood, cognitive functioning, and personality.

Mental status

Assessed continuously throughout the entire interaction with a patient by evaluating the patient's alertness, orientation, cognitive abilities, and mood.

Grooming

May indicate depression; note poor hygiene in a previously well-groomed individual

Mood and Feelings

Ask the patient, "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past 2 weeks, have you felt little interest or pleasure in doing things?"

Patient consciousness

Patient should be oriented to person, place, and time and should make appropriate responses.

Memory

Evaluate immediate memory by reading the patient a list of five words and then asking them to repeat the same words. Evaluate delayed recall by asking the patient to repeat the same 5 words from the immediate memory test a few minutes later.

Voice Quality

The patient's voice should have inflections, be clear and strong, and be able to increase in volume.

Pre Hospital Skull Fractures and Brain Injuries Assessment

Evaluate the patient's Airway, Breathing, and Circulation

Pre Hospital Skull Fractures and Brain Injuries Assessment

Assess AVPU

Signs and symptoms of skull fractures and brain injuries

Visible bone fragments and perhaps bits of brain tissues

Signs and symptoms of skull fractures and brain injuries

Altered mental status

Signs and symptoms of skull fractures and brain injuries

Deep laceration or severe bruise or hematoma to the scalp or forehead

Signs and symptoms of skull fractures and brain injuries

Depressions or deformity of the skull, large swellings, or anything unusual about the shape of the cranium

Signs and symptoms of skull fractures and brain injuries

Severe pain at the site of head injury

Signs and symptoms of skull fractures and brain injuries

"Battle's sign" (late sign) may be present

Signs and symptoms of skull fractures and brain injuries

Pupils unequal or nonreactive to light

Signs and symptoms of skull fractures and brain injuries

"Raccoon eyes," black eyes, or discoloration of the soft tissues under both eyes (late sign)

Signs and symptoms of skull fractures and brain injuries

Clear fluid flowing from ears and/or nose, indicative of CSF

Signs and symptoms of skull fractures and brain injuries

Personality change, ranging from irritable to irrational behavior (major sign)

Signs and symptoms of skull fractures and brain injuries

Increased blood pressure and decreased pulse rate (Cushing's reflex)

Signs and symptoms of skull fractures and brain injuries

Irregular breathing patterns

Signs and symptoms of skull fractures and brain injuries

Blurred or multiple-image vision in one or both eyes

Signs and symptoms of skull fractures and brain injuries

Impaired hearing or ringing in the ears

Signs and symptoms of skull fractures and brain injuries

Equilibrium problems

Signs and symptoms of skull fractures and brain injuries

Forceful or projectile vomiting

Signs and symptoms of skull fractures and brain injuries

Decorticate or decerebrate posturing

Signs and symptoms of skull fractures and brain injuries

Paralysis or disability on one side of the body

Signs and symptoms of skull fractures and brain injuries

Seizures

Signs and symptoms of skull fractures and brain injuries

Deteriorating vital signs

Treatment for Head injuries

Take appropriate Standard Precautions.

Treatment for Head injuries

Consider the possibility of a spine injury. If indicated, provide manual stabilization of the head.

Treatment for Head injuries

Open and maintain the airway.

Treatment for Head injuries

Monitor the unconscious patient for changes in breathing. avoid hyperventilation

Treatment for Head injuries

Talk to the conscious patient, providing emotional support.

Military Acute Concussion Evaluation 2 (MACE 2)

A screening tool for assessing concussion in the deployed setting. This assessment takes approximately 10 minutes to administer by a skilled medic/corpsman or a provider

Concussion Pathophysiology

A blow causes acceleration-deceleration and rotational forces that may stretch, compress, or shear nerve fibers as the brain moves within the skull, and disrupts the brain chemicals responsible for brain functioning; often caused by sports injuries.

Seizures Pathophysiology

The brain's electrical activity can become irregular; irregularities can bring about a sudden change in sensation, behavior, or movement.

Meningitis Pathophysiology

Bacterial, viral, or fungal organism colonizes in the upper respiratory tract, invades the bloodstream, and then crosses the blood-brain barrier to infect the cerebrospinal fluid and meninges.

Ischemic strokes

Occur when a thrombus or embolism interrupts the blood supply, oxygen, and nutrients to the brain, and brain cells die.

Bell's Palsy Pathophysiology

May be caused by an acute inflammation of the facial nerve (cranial nerve VII), such as a viral infection with herpes simplex, which leads to ischemia and demyelination.

Unstable Patient Recognition

Aggressive or disruptive behavior may be caused by trauma to the brain and nervous system, metabolic disorders, stress, alcohol, other drugs, or psychological disorders.

Reasonable force

Force necessary to keep a patient from himself or others.

Diabetes Mellitus (DM)

The condition brought about by decreased insulin production or the inability of the body cells to use insulin properly.

Type 1 DM

Occurs when pancreatic cells fail to function properly and insulin is not secreted normally.

Type 2 DM

Occurs when the body's cells fail to use insulin properly.

Glucagon

A hormone that causes a temporary rise in blood sugar levels.

Blood Glucose Meter

An instrument used to test the level of glucose in blood; also called a glucometer.

Gestational Diabetes

Diabetes that occurs for the first time when a woman is pregnant.

Glucose

A simple sugar obtained from the foods we eat, is the basic nutrient of the cell.

Hormone

Chemical substance, formed in one organ or part of the body and carried in the blood to another organ or part where they exert functional effects.

Hyperglycemia

High blood sugar.

Hypoglycemia

Low blood sugar.

Insulin

A hormone produced by the pancreas that is critical to the body's use of glucose.

Ketone

An organic compound (as acetone) with a carbonyl group attached to two carbon atoms.

Ketone body

One of a group of ketones; high levels are found in tissues and body fluids in ketosis.

Ketonuria

An enhanced urinary excretion of ketone bodies.

Ketosis

A condition characterized by the enhanced production of ketone bodies, as in diabetes mellitus or starvation.

Pancreas

A gland located behind the stomach that produces insulin and juices that assist in the digestion of food in the duodenum of the small intestine.

Polydipsia

Excessive thirst that is relatively prolonged.

Polyphagia

Excessive eating; gluttony.

Polyuria

Increased urination.

Exocrine glands

Glands that secrete their products into ducts, and the ducts carry the secretions to the target site.

Endocrine glands

Glands that secrete their products (hormones) into the interstitial fluid surrounding the secretory cells from which they diffuse into capillaries to be carried away by blood.

Hypothalamus

A small region of the brain is a major link between the nervous and endocrine systems.

Adrenal Glands

Secretes epinephrine (also known as adrenaline) and norepinephrine.

Glucagon

Increases blood glucose levels.

Insulin

Decreases blood glucose levels.

Hyperglycemia

High blood sugar caused by a decrease in insulin, which leaves sugar in the bloodstream rather than helping it to enter cells.

Ketones

A waste product of DKA (Diabetic Ketoacidosis).

Blood-Brain Barrier

A naturally occurring barrier created by the modification of brain capillaries that prevents many substances from leaving the blood and crossing into the brain tissue.

Cerebrospinal Fluid (CSF)

Clear, colorless liquid that protects the brain and spinal cord against chemical and physical injuries.

Functions of CSF

Mechanical protection, chemical protection, and circulation.

Neurologic Equipment

Includes penlight, tongue blades, sterile needles, tuning forks, familiar objects, cotton wisp, monofilament, reflex hammer, aromatic substances, solutions for taste testing, and test tubes for temperature sensation testing.

Optic Nerve (CN II) Test

Tests distant and near vision.

Oculomotor (CN III), Trochlear (CN IV), & Abducens Nerve (CN VI) Assessment

Inspect eyelids for drooping, pupils' size and their response to light and accommodation and tests extraocular eye movements.

Trigeminal Nerve (CN V) Assessment

Inspect face for muscle atrophy and tremors, palpate jaw muscles when patient clenches teeth, and test facial sensation.

Facial Nerve (CN VII) Assessment

Inspect symmetry of facial features with various expressions and test ability to identify sweet and salty tastes on each side of the tongue.

Acoustic Nerve (CN VIII) Assessment

Test sense of hearing with whisper screening test and compare bone and air conduction of sound using a tuning fork.

Glossopharyngeal (CN IX) & Vagus Nerve (CN X) Assessment

Test ability to identify sour and bitter tastes, gag reflex, ability to swallow, and observe for swallowing difficulty.

Spinal Accessory Nerve (CN XI) Assessment

Test trapezius and sternocleidomastoid muscle strength against resistance.

Hypoglossal Nerve (CN XII) Assessment

Inspect tongue for symmetry, tremors, and atrophy; test tongue movement and strength, and evaluate lingual speech sounds.

Proprioception and Cerebellar Function Tests

Includes rapid rhythmic alternating movements, accuracy of movements, balance (Romberg test), and gait and heel-toe walking.

Cortical Sensory Functions

Tests cognitive ability to interpret sensations; inability to perform these tests may indicate a lesion in the sensory cortex or posterior columns of the spinal cord.

Stereognosis (Tactile Recognition)

Ability to recognize objects by touch.

Tactile agnosia

Inability to recognize objects by touch, suggests a parietal lobe lesion.

Two-Point Discrimination

Test using two sterile needles or ends of a paper clip, alternating touching the patient’s skin with one point or both points at various locations over the body.

Extinction Phenomenon

Simultaneously touch two areas on each side of the body and ask the patient to tell you how many stimuli there are and where they are.

Graphesthesia

Drawing a letter, number, or shape on the palm of the patient’s hand and asking them to identify the figure.

Point Location

Touching an area on the patient’s skin and asking the patient to point to the area touched.

Plantar Reflex

Use the end of a reflex hammer to stroke the lateral side of the foot; expect plantar flexion of all toes.

Babinski Sign

Dorsiflexion of the big toe with or without fanning of the other toes, which is an abnormal finding in adults.

Deep Tendon Reflex Score 0

Deep tendon reflex score indicating no response.

Deep Tendon Reflex Score 1+

Deep tendon reflex score indicating sluggish or diminished response.

Deep Tendon Reflex Score 2+

Deep tendon reflex score indicating active or expected response.

Deep Tendon Reflex Score 3+

Deep tendon reflex score indicating more brisk than expected, slightly hyperactive response.

Deep Tendon Reflex Score 4+

Deep tendon reflex score indicating brisk, hyperactive response with intermittent or transient clonus.

Biceps Reflex Test

Flex the patient’s arm to 45 degrees at the elbow, palpate the biceps tendon, and strike your thumb over the tendon with the reflex hammer.

Brachioradial Reflex Test

Flex the patient’s arm to 45 degrees and rest his or her forearm on your arm with the hand slightly pronated; strike the brachioradial tendon with the reflex hammer.

Triceps Reflex Test

Flex the patient’s arm at the elbow up to 90 degrees, support the arm proximal to the antecubital fossa, palpate the triceps tendon, and strike it directly with the reflex hammer.

Patellar Reflex Test

Flex the patient’s knee to 90 degrees, support the upper leg, and strike the patellar tendon just below the patella.