Clinical Practice Procedures: Assessment/Neurological ...

1 While the QAS has attempted to contact all copyright owners, this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome. Please forward to: The Digital Clinical Practice Manual is expressly intended for use by appropriately qualified QAS clinicians when performing duties and delivering ambulance services for, and on behalf of, the QAS. The QAS disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this manual, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable. State of Queensland (Queensland Ambulance Service) work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives International LicenseYou are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute the State of Queensland, Queensland Ambulance Service and comply with the licence terms.

2 If you alter the work, you may not share or distribute the modified work. To view a copy of this license, visit copyright permissions beyond the scope of this license please contact: codeCPP_AS_NA_0221 DateFebruary, 2021 PurposeTo ensure a consistent procedural approach to undertaking a patient neurological status to Queensland Ambulance Service (QAS) Clinical care settingPre-hospital assessment and to all ages unless stated of fundingInternal 100%AuthorClinical Quality & Patient Safety Unit, QASR eview dateFebruary, 2024 Information securityUNCLASSIFIED Queensland Government Information Security Classification Practice Procedures: Assessment/Neurological assessment527 QUEENSLAND AMBULANCE SERVICEN eurological assessment Indications Contraindications Nil in this setting Complications To assess the patient s neurological status The pre-existing neurological statusof a patient must be taken into accountduring assessment.

3 The application of a painful stimulus by a clinician during the assessment ofan intoxicated patient has the propensityto elicit a violent response and should be , 2021 Figure The neurological status assessment forms part of the overall patient Assessment with an impaired level of consciousness or obvious neurological dysfunction require a thorough assessment as is practicable in the bilateral muscle strengthUNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED528 QUEENSLAND AMBULANCE SERVICE Procedure Neurological assessmentThere are five critical areas to a neurological assessment: [1]1. Level of consciousness [2,3]a) The AVPU scale represents a tool easily applied during the initial patient assessment. In the AVPU assessment, three questions are asked:b) A formal assessment of the GCS is subsequently performed as soon as possible and repeated throughout patient management as is necessary to detect deterioration.

4 The need for repeated painful stimuli is rare and should not be Pupilsa) Pupil size must be determined as:- pinpoint (< 2 mm)- normal (2 6 mm)- dilated (> 6 mm)AVPU ASSESSMENTAVPU ASSESSMENTA lertIs the patient alert?VerbalDoes the patient respond to a verbal command? PainDoes the patient respond to a painful stimulus?UnconsciousWith no response to any of the above, the patient is considered ) Assess the pupillary reaction to light using a small bright light. Direct light reflex is assessed by covering one eye and shining the light directly into the open eye which should result in a rapid ) Assessment is repeated on the other eye. Both reactions should be ) Document any unusual eye movement such as deviation from midline, dilated, or non reactive pupils on one side, indicating possible raised intracranial pressure (ICP), nerve compression or traumatic mydriasis.

5 [1] 3. Motor functiona) Muscle coordination, strength and tone, including any obvious facial ) Abnormal movements such as seizures, tremors or decorticate/decerebrate posturing. The latter is an ominous sign and may occur spontaneously, or to painful sensory functiona) Hearing and ability to understand verbal ) Superficial sensation (light touch or pain).5. Vital signsa) Assess respirations for rate, rhythm and ) Assess blood pressure and pulse to ensure adequate perfusion status. Note that a widening pulse pressure and slowing pulse rate may indicate a rising ) Assess body temperature and maintain normothermia.[2]UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED529 QUEENSLAND AMBULANCE SERVICEUNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED