Neurological assessments are important for monitoring patients' neurological status. Key reflexes include pupillary reaction, motor function, and vital signs. The Glasgow Coma Scale assesses eye opening, verbal response, and motor response on a scale of 3 to 15. The AVPU scale rapidly measures consciousness. Pupillary reaction provides information about intracranial pressure and should be round and reactive to light. Motor response examines limb strength. Brainstem reflexes like the pupillary, corneal, gag, cough, doll's eye, and caloric testing help assess brainstem function. The doll's eye reflex checks if eyes remain stationary with head movement while caloric testing assesses eye movement in response to cold water in the ear. Neurological
Nursing management of the client with increased intracranial pressureANILKUMAR BR
The rigid cranial vault contains brain tissue (1,400 g), blood (75 mL), and CSF (75 mL)
The volume and pressure of these three components are usually in a state of equilibrium and produce the ICP.
ICP is usually measured in the lateral ventricles; normal ICP is 10 to 20 mm Hg. Increased ICP is a syndrome that affects many patients with acute neurologic conditions.
This is because pathologic conditions alter the relationship between intracranial volume and pressure. Although an elevated ICP is most commonly associated with head injury, it also may be seen as a secondary effect in other conditions, such as brain tumours, subarachnoid haemorrhage, and toxic and viral encephalopathies
Nursing management of the client with increased intracranial pressureANILKUMAR BR
The rigid cranial vault contains brain tissue (1,400 g), blood (75 mL), and CSF (75 mL)
The volume and pressure of these three components are usually in a state of equilibrium and produce the ICP.
ICP is usually measured in the lateral ventricles; normal ICP is 10 to 20 mm Hg. Increased ICP is a syndrome that affects many patients with acute neurologic conditions.
This is because pathologic conditions alter the relationship between intracranial volume and pressure. Although an elevated ICP is most commonly associated with head injury, it also may be seen as a secondary effect in other conditions, such as brain tumours, subarachnoid haemorrhage, and toxic and viral encephalopathies
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone, or from internal bleeding and damage to the brain.
intracranial pressure is a medical condition encountered in clinical setting resulting from traumatic injury of brain, RTA, ischemia, stroke & similar brain pathology. understanding of this condition is necessary for prompt identification & management at early stage.
Neuroassessment important neuro reflex’s in icu for nurses +rass score+tbiMURUGESHHJ
its an small guide to assess the neuorological status with various pictures , it explains clearly about GCS, MUSCULAR POWER ASSESSMENT , PUPILLARY REACTION & IMPORTANT REFLEXES specially for nurses ....it has brief information about TBI PROTOCAL & RASS SCORE
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone, or from internal bleeding and damage to the brain.
intracranial pressure is a medical condition encountered in clinical setting resulting from traumatic injury of brain, RTA, ischemia, stroke & similar brain pathology. understanding of this condition is necessary for prompt identification & management at early stage.
Neuroassessment important neuro reflex’s in icu for nurses +rass score+tbiMURUGESHHJ
its an small guide to assess the neuorological status with various pictures , it explains clearly about GCS, MUSCULAR POWER ASSESSMENT , PUPILLARY REACTION & IMPORTANT REFLEXES specially for nurses ....it has brief information about TBI PROTOCAL & RASS SCORE
Approach to coma
1-Definition
2-Pathophysiology, Causes, and similar condition
3-History and general physical examination
4-Neurological examination
5-Investigation
6-Management
EXTERNAL VENTRICULAR CARE FOR NURSES.pptxMURUGESHHJ
EVD---EVD CARE ESPECAILLY IN ICU SETTINGS MORE ESSENTIAL , THIS PPT EXPLAINS YOU ABOUT EVD IN BRIEF, INDICATIONS, COMPLICATIONS , , EVD CARE PROCEDURE, NURSING DIAGNOSIS & MANGEMENT ASSOCIETED WITH EVD RELATED INFECTIONS ...
HOSPTAL ACQUIRED PNEUMONIAE , PREVENTION AND MANAGEMENT PROTOCALS MURUGESH.pptxMURUGESHHJ
this is an brief explanation for one of most common infection in hospital i.e , HAI, meaning, causes, prevention & management stragies , VAP OR VAE & NVHAP bundles, especially usefull for nurses ...
IMPORTANCE OF ORAL CARE IN ICU MURUGESH HJ.pptxMURUGESHHJ
THIS PPT EXPLAINS ABOUT IMPORTANCE OF ORAL HYGIENE ESPECIALLY FOR UNCONSIOUS PATIENTS, SEVERLY ILL PATIENTS , IT EXPLAINS YOU ABOUT PROCEDURE, IMPORTANT ARTICLES , MOST BENEFICIAL FOR NURSES
HEART SOUNDS ASSESSMENT FOR NURSES MURUGESH.pptxMURUGESHHJ
IT IS AN BRIEF DESCRIPTION ABOUT SIMPLE ASSESMENT OF HEART , ANATOMY & PHYSIOLOGY OF HEART ,HEART SOUNDS, NORMAL & ABNORMAL SOUNDS..ESPECIALLY MOST USEFULL TO NURSES...
Chest auscultation & lung sounds assessment for nursesMURUGESHHJ
its an brief explanation regarding respiratory system & most common sites to assess lung sounds &lobe associated lung infections...visuals explains briefly & clearly about abnormal lung conditions
Artereal blood gas meaning,brief guide for nurses murugeshMURUGESHHJ
ABG-It is an vital &fastest test to assess the patient haemodynamics , this ppt explains you briefly about ABG meaning, components,sampling, allens test & nurses roles....
Mechanical ventilator, common modes, indications,nursing responsibilities MURUGESHHJ
it is an brief summary with diagrammatic presentation for NURSES regarding Mechanical ventilator, uses, complications, types, important terms,common modes, NIV, uses, NURING ROLES & RESPONSIBILITIES for handling INTUBATED patients...
it is an brief description and slides about the CYANOSIS,ISCHEMIA, ISCHEMIC MANAGEMENT MEANING , HEPARIN , HEPARIN USES , IV INFUSION, SIMPLE HEPARIN IV INFSUION CALUCULATION FORMULAE , ANTIDOTE AND NURSING MANAGEMENT,expalins in diagrammatic manner for nurses, ICU nursing educators,primarily its most benificial for INTENSIVE NURSES works in critical area units like ICUs , CT ICUS etc...
Diabetic ketoacidosis meaning,types &management for nurses murugeshMURUGESHHJ
its an brief information about the Diabetic ketoacidosis, causes, signs & symptoms ,hospital management protocals in simple english......provides more information with diagrammatic way ...thank you all
THIS IS AN BRIEF INFORMATION ABOUT AN ONE OF MY FAVOURITE SUBJECT ARDS & & ITS MANAGEMENT ,ROLES OF INTENSIVE NURSES , IT WILL EXPLAINS ABOUT CATEGORIES, PF RATIO, PRONE POSITIONING & NURSING CARE .....FOR THIS I REFFERED OLD SLIDE SHARE PPTS & IN HOSPITAL ROUTINELY PRACTICING POLICIES
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. INTRODUCTION..
► Neurological observations collect data on a patient’s neurological status and can be
used for many reasons, including in order to help with diagnosis, as a baseline
observation, following a neurosurgical procedure, and following trauma (Mooney &
Comerford 2003)….
► Therefore, it is important that all healthcare professionals are efficient and accurate in
assessing the neurological status of their patients.
► It is also important to remember that these changes may occur rapidly over a short period
of time or more gradually, taking place over days or weeks. This is why accurate
neurological assessments and observations are vital in ensuring the early recognition of
neurological deterioration in patients (Koutoukidis et al. 2017; Mooney & Comerford
2003).
4. BREIF INFORMATION…..
► A neurological assessment involves checking the patient
in the main areas in which changes are most likely to occur:
► Level of consciousness
► Pupillary reaction
► Motor function
► Sensory function
► Vital signs.
5. Glassgow Coma Scale…….
There are many different assessment tools for neurological function, however,
the most widely known and used tool is the Glasgow Coma Scale (GCS).
The patient is assessed and scored in three areas:
1.Eye opening
2.Verbal response
3.Motor response.
The highest possible score is 15, which reflects an individual who is fully alert,
aware and orientated, whereas the lowest possible score is 3 and reflects an unconscious individual.
Although pupil reaction is not included as part of the GCS, but is the vital element to assess the abnormality
6. Components of GCS …..
Behaviour Rating Score
Eye Opening Response
Opens eyes spontaneously Spontaneous 4
Opens eyes in response to speech and sound Sound 3
Opens eyes in response to painful stimuli Pain 2
Does not open eyes None 1
Verbal Response
Oriented to time, person and place Oriented 5
Confused and disoriented Confused 4
Utters incoherent words Words 3
Incomprehensible sounds Sounds 2
Makes no sounds None 1
Motor Response
Obeys two-part requests Obeys commands 6
Localises to painful stimuli Localising 5
Flexion / withdrawal from painful stimuli Normal flexion 4
Abnormal flexion from painful stimuli Abnormal flexion 3
Extension to painful stimuli Extension 2
Makes no movement
7. CONSIOUSNESS ASSESSMENT ;AVPU
scale…
► A rapid assessment tool that is utilised in the healthcare field to measure conscious state is the AVPU scale.
► A stands for Alert
► The patient is aware of the environment and the examiner and is opening their eyes spontaneously. They can also follow
commands and track objects.
► V stands for Verbal
► The patient’s eyes do not open spontaneously, rather, their eyes only open in response to a verbal stimuli directed towards
them. The patient can respond to this verbal stimuli directly and in a meaningful way.
► P stands for Pain
► The patient's eyes do not open spontaneously or in response to verbal stimuli. The patient will respond to painful stimuli
directed towards them by moving, moaning or crying out.
► U stands for Unresponsive
► The client is not responding spontaneously, or to verbal or painful stimuli.
8. PUPILLARY REACTION…..
► Assessing Pupillary Reaction
► When we are assessing the patient’s pupils, we are gaining information regarding the brain and determining
whether there has been an increase in intracranial pressure.
► The pupils are assessed for their size and shape, as well as how they react to the presence of light. They should be
round and equal in size.
► The size of the pupils can vary, however, the normal range is 2 to 6 mm in diameter. Upon shining a bright light
into each eye, the pupils should constrict briskly to a smaller size (QAS 2021a).
► The reactions to light can be described as brisk, sluggish or non-reactive/fixed.
► Both eyes should be checked and compared against each other. Generally, any change that occurs during an
assessment of the pupils indicates a change in the individual’s intracranial pressure and may signify a
neurological emergency.
► Acute pupillary dilation in patients who have suffered a head injury is thought to be caused by compression of the
third cranial nerve from brain oedema and herniation, or alternatively, from a decrease of blood flow to the
brain stem, resulting in brain stem ischaemia (Koutoukidis et al. 2017; Majdan 2015…….
9. MOTOR RESPONSE –LIMBS
STRENGTH
► Limb strength can be described as either:
► Normal power
► Mild weakness
► Severe weakness
► Spastic flexion
► Extension
► No response.
► Generally, this assessment focuses on the arms and legs and will look for any improvement
or deterioration in function. However, it must be noted that lower limb function may impact
spinal function in some patients and this can disrupt the assessment findings …..
10. INTRA CRANIAL PRESSURE ….
► Elevated intracranial pressure (ICP) is seen in ;
► head trauma, [1]
hydrocephalus, intracranial hemorrhage, sub-arachnoid hemorrhage from ruptured brain
aneurysm, intracranial tumors, [3]
hepatic encephalopathy, [4]
and cerebral edema. Intractable elevated ICP can
lead to death or devastating neurological damage
► either by reducing cerebral perfusion pressure (CPP) [6]
and causing cerebral ischemia or by compressing and causing
herniation of the brainstem or other vital structures. Prompt recognition is crucial in order to intervene appropriately
► CUSHINGS TRIAD…
► refers to a set of signs that are indicative of increased
► intracranial pressure (ICP), or increased pressure in the brain.
► Cushing's triad consists of
► bradycardia (also known as a low heart rate), HR < 50B/MIN
► irregular respirations, some times TACHYPNOEA OR BRADYPNOEA
a widened pulse pressure BP > 150/80MMHG
12. PUPILLARY REFLEX……
► PUPILLARY REFLEX
► Eyes allow for visualization of the world by receiving and processing light stimuli. The
pupillary light reflex constricts the pupil in response to light, and pupillary
constriction is achieved through the innervation of the iris sphincter muscle……..
► Pupillary light reflex is used to assess the brain stem function. Abnormal pupillary light
reflex can be found in optic nerve injury, oculomotor nerve damage, brain stem
lesions, such as tumors, and medications like barbiturates.
13. CORNEAL REFLEX….
► CORNEAL REFLEX
► A reflex closing of the eyelids when the cornea is touched or a puff of air is blown on
to it, mediated by the fifth cranial trigeminal nerve (sensory) and the seventh cranial facial
nerve (motor), often diminished or absent in people who wear contact lenses..
► The corneal reflex, also known as the blink reflex or eyelid reflex, is an involuntary
blinking of the eyelids elicited by stimulation of the cornea, though could result from any
peripheral stimulus.
14. GAG REFLEX…..
► GAG REFLEX….
► The gag reflex, also called the pharyngeal reflex, is a contraction of the throat that
happens when something touches the roof of your mouth, the back of your tongue or
throat, or the area around your tonsils. This reflexive action helps to prevent choking and
keeps us from swallowing potentially harmful substances
15. COUGH REFLEX…..
► COUGH REFLEX
► Coughing is an important defensive reflex that enhances clearance of secretions and
particulates from the airways and protects from aspiration of foreign materials
occurring as a consequence of aspiration or inhalation of particulate matter, pathogens,
accumulated secretions, postnasal drip, inflammation, and mediators ……
16. OCULO CEPHALIC REFLEX ( DALLS
EYE) ….
► OCULO CEPHALIC REFLEX (DALLS EYE )…..
► The doll's eyes reflex, or oculocephalic reflex, is produced by moving the patient's head left to right or up and down. When the reflex is present,
the eyes of the patient remain stationary while the head is moved, thus moving in relation to the head.
► OVERVIEW
► Oculocephalic and oculovestibular reflexes are primarily used to determine whether a patient’s brainstem is intact (e.g. coma or brain
death assessment)
► ensure the C-spine is cleared.
► the patient’s eyes are held open.
► the head is briskly turned from side to side with the head held briefly at the end of each turn.
► a positive response occurs when the eyes rotate to the opposite side to the direction of head rotation, thus indicating that the brainstem (CN3,6,8) is intact.
► a similar result is seen when the head is flexed and extended — a positive result is downward deviation of the eyes during extension, and upward deviation
during flexion (the eyelids, if closed, may also open as part of the ‘doll’s head phenomenon’). These vertical responses indicates that the brainstem (CN3,4,8)
is intact.
► The eyes should gradually return to the mid-position in a smooth, conjugate movement if the brainstem is intact.
► Patients with metabolic coma (e.g. hepatic failure) may have exaggerated, brisk oculocephalic reflexes.
17. OCULOVESTIBULAR
REFLEX(CALORIC TEST
► OCULOVESTIBULAR REFLEX ( COLD CALORIC TEST)
► Oculovestibular reflex (caloric stimulation):
► the head is elevated to 30 degrees above horizontal so that the lateral semicircular canal is vertical, and so that stimulation with generate a maximal response.
► check that the tympanum is intact and that the external ear canal is clear — C-spine clearance is not necessary.
► introduce iced water into the external ear canal through a small catheter until one of the following occurs:
► nystagmus (in the intact brainstem the slow phase is towards the irrigated ear)
► ocular deviation
► 200mL of iced water has been instilled.
► allow 5 minutes between testing ears to allow re-equilibration of the oculovestibular system.
► as consciousness is lost, the fast component (towards the non-irrigated ear) is lost and the slow component deviates the eye in the direction of the irrigated ear.
► Vertical oculovestibular eye responses can be assessed by irrigating both ears simultaneously.
► If the brainstem is intact, cold water causes the eyes to deviate downwards and warm water causes the eyes to deviate upwards.
► The positive brainstem responses described above are those seen in a comatose patient with an intact brainstem.