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Neurological Examination in the Emergency Room


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Neurological Examination in the Emergency Room

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Neurological Examination in the Emergency Room

  1. 1. Neurological Examinationin the Emergency Room<br />急診神經學檢查<br />Tintinalli‘s Emergency Medicine: A Comprehensive Study Guide, 7E<br />Chapter e158.1 The Neurologic Examination in the Emergency Setting<br />
  2. 2. Neurological Examination急診神經學檢查<br />General Considerations<br />Always consider <br />left to right symmetry <br />比較左右對稱<br />Consider <br />central vs. peripheral deficits <br />區分中樞或週邊缺損<br />
  3. 3. Overview<br />Organize your thinking into six categories: <br />Mental Status 意識狀態<br />Cranial Nerves 顱神經檢查<br />Motor Exam 運動功能檢查<br />Reflexes 反射<br />Coordination and Gait 協調性及步態<br />Sensory Exam 感覺功能檢查<br />
  4. 4. Awareness Patient Examine for Cortical Deficits<br />Orientation: time, place, person and situation) <br />Digital span: 7 numbers foreward and 5 numbers backward<br />Confusion of right and left<br />Calculation: 100-7-7…or 20-3-3…<br />Recent memory: recall 3 objects after 5-minutes interval<br />
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  8. 8. Brainstem Anatomy<br />
  9. 9. I –Olfactory 嗅神經<br />Not Normally Tested <br />
  10. 10. II –Optic 視神經 <br />Examine the Optic Fundi<br /> Test Visual Acuity<br />Screen Visual Fields by Confrontation <br />Test Pupillary Reactions to Light <br />Test Pupillary Reactions to Accommodation <br />
  11. 11. III –Oculomotor動眼神經IV –Trochlear滑車神經VI –Abducens外展神經<br />Observe for Ptosis (CN III)<br />Test Extraocular Movements (EOM)<br />Test Pupillary Reactions to Light (CN III)<br />CN6<br />CN4<br />
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  13. 13. V –Trigeminal 三叉神經<br />Test Temporal and Masseter Muscle Strength<br />Test the Three Divisions for Pain Sensation <br />Test the Corneal Reflex <br />
  14. 14. VII – Facial 顏面神經<br />Observe for Any Facial Droop or Asymmetry Test the Corneal Reflex<br />
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  16. 16. VIII –Acoustic 聽神經<br />Screen Hearing <br />Test for Lateralization (Weber) <br />Compare Air and Bone Conduction (Rinne) <br />
  17. 17. IX –Glossopharyngeal舌咽神經X –Vagus迷走神經<br />Listen to the patient's voice, is it hoarse or nasal? <br />Ask Patient to Swallow <br />Ask Patient to Say "Ah" <br />Test Gag Reflex (Unconscious/Uncooperative Patient) <br />
  18. 18. XI – Accessory 副神經<br />From behind, look for atrophy or assymetry of the trapezius muscles. <br />Ask patient to shrug shoulders against resistance. <br />Ask patient to turn their head against resistance. Watch and palpate the sternomastoid muscle on the opposite side. <br />
  19. 19. XII – Hypoglossal 舌下神經<br />Listen to the articulation of the patient's words. <br />Observe the tongue as it lies in the mouth <br />
  20. 20. Cranial Nerves<br />Observation<br />Ptosis (III) <br />Facial Droop or Asymmetry (VII) <br />Hoarse Voice (X) <br />Articulation of Words (V, VII, X, XII) <br />Abnormal Eye Position (III, IV, VI) <br />Abnormal or Asymmetrical Pupils (II, III) <br />
  21. 21. Cerebellar Test<br />Coordination and Gait<br />Rapid Alternating Movements 快速翻轉運動 <br />Point-to-Point Movements 點對點運<br />finger-to-nose test<br />heel-to-shin test<br />Romberging test<br />Gait 步態協調<br />
  22. 22. Rapid Alternating Movements<br />
  23. 23. Point-to-Point Movements<br />
  24. 24. Motor Power<br />Pronator Drift<br />
  25. 25. Muscle System<br />Strength Muscle Groups<br />0/5: no contraction <br />1/5: flicker<br />2/5: movement when gravity eliminated<br />3/5: movement against gravity<br />4/5: movement against resistance <br />5/5: normal strength <br />
  26. 26. Reflexes 反射<br />Deep Tendon Reflexes<br /> 0: absent reflex 1+: trace, or seen only with reinforcement 2+: normal 3+: brisk 4+: nonsustainedclonus<br /> (i.e., repetitive vibratory movements) 5+: sustained clonus<br />Jendrassik's maneuver (locking the finger tips together and pulling)<br />Anal reflex: rectal sphincter tone, spinal cord injury<br />
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  28. 28. Signs of Upper Motor Neuron (UMN) & Lower Motor Neuron (LMN) Lesions<br />
  29. 29. C5, C6<br />C7, C8<br />L3, L4<br />S1, S2<br />
  30. 30. Plantar Response (Babinski) <br />
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  33. 33. Sensory 感覺<br />General 一般感覺<br />Vibration 震動<br />Subjective Light Touch 輕觸<br />Position Sense 位置感<br />
  34. 34. DermatomalTesting 皮層測驗<br />Pain 疼痛<br />Temperature 溫度<br />Light Touch 輕觸<br />Discrimination 兩點分辨<br />
  35. 35. 加油,還剩六分鐘!<br />好好學,護一生喔!<br />C7<br />C8<br />C6<br />
  36. 36. Brudzinski’s and Kernig’s SignsBoth Signs of Meningeal Irritation<br />Kernig’s sign:<br />Resistance to extension of the leg while the hip is flexed<br />Brudzinski’s sign:<br />Flexion of the hips and knees in response to neck flexion<br />
  37. 37. Lumbar Puncture (CSF Exam):Meningitis or Subarachnoid Hemorrhage (SAH)<br />
  38. 38. Neurological Examination急診神經學檢查<br />General Considerations<br />Always consider <br />left to right symmetry <br />比較左右對稱<br />Consider <br />central vs. peripheral deficits <br />區分中樞或週邊缺損<br />