Transcript Slide 1

PICU Quick Reference Pediatric
Neurological Assessment
Infant or Severe
Developmental Delay
Child
In addition to infant
assessment:
LOC
Level of arousal ,
emotional state, social
orientation
CN 1- Smell
OLFACTORY I
Assess changes in
baseline:
• easy/ difficult/ unable to
arouse
• response to parents
• degree of irritability/
consolability
•difficult to assess in ICU
setting
–attention span,
Adolescent
In addition to infant
and child assessment:
•orientation in terms of memory:
(name of favorite stuffed animal
,pet, best friend ,school routine,
holidays.)
•degree of agitation/
restlessness,
• discerns night-time from
daytime
•assess orientation to
person, place time,
•increase in confusion,
anxiety or
combativeness
•difficult to assess in ICU setting
•difficult to assess in
ICU setting
CN 2/3- muscles of
eyes and optic nerve
OPTIC II
OCULOMOTOR III
•grimaces to light
• “blinks to threat”
•tracts or follows objects
across visual fields
•Assess visual acuity
“how many fingers?
Same as child
CN 3/4/6 -muscles of
eyes
OCULMOTOR III
TROCHLEAR IV
ABDUCENS VI
PERRL, Visually follows
object, no abnormal eye
movements
Intact Extra ocular movements
difficult to assess
Clenches teeth
Symmetrical facial movements
when smiling or crying
In addition : Makes faces ,
smiles, wrinkles forehead, looks
at ceiling, blows out cheeks
ACOUSTIC VIII
Awakens to verbal stimuli
Same as infant assessment
CN 9/10-
•.Cry/Voice does not become
hoarse or high pitch, intact gag
reflex
Same as infant assessment
CN 5 –nerves of the jaw
In addition Can identify
objects in peripheral
visual field, no
complaints of double
vision
In addition Can move
jaw side to side against
resistance
TRIGEMINAL V
CN 7- muscles of facial
expression
FACIAL VII
Same as child
assessment
CN 8- nerves of
acoustic and equilibrium
Mouth and throat muscles
VAGUS X
CN 11
Shoulder muscles
ACCESSORY XI
HYPOGLOSSAL XII
In addition; When
saying “aahhh” uvula
mid line
Symmetrical shoulder shrug
In addition -Shoulder
shrug against resistance
No deviations when sticking out
tongue
In addition Punches
tongue inside cheek
against resistance
Difficult to assess
CN 12- Muscles of
Tongue
In addition no
complaints of dizziness
•Sucking
•swallowing gag
Goal : Recognize/Report subtle changes in baseline neurological status before
deterioration.
Most Important: Be systematic! Repeat assessment same order each time:
1.
2.
3.
4.
5.
6.
Appearance and Observation
Level of consciousness
Cranial Nerve Assessment
Motor Sensory Function
Vital Signs
External Monitoring Devices
Exam -
Infant/Toddler- determine eye opening, arousability, level or irritability/consolability, symmetry of
facial expressions and movement of upper and lower extremities, listen for increase weakness
or pitch in cry/vocalizations, assess anterior fontanel, check each pupil separately for size , shape,
equality of reaction to light, check ability to track object, note muscle tone for rigid extension or
flexion of extremities, flaccidity and/or unusual posturing.
Child- (In addition )- note c/o headache, assess social orientation attention span, orientation in
terms of memory (name of favorite stuffed animal etc.) degree of agitation/ restlessness, clarity
of speech, EOMs, visual acuity, blow fish cheeks, tongue deviation, symmetrical shoulder shrug,
high five, drift assessment*, grip strength, ability to lift legs against resistance.
Adolescent- (In addition)-note complaints of double vision, dizziness, anxiety, fearfulness
Score patient using Glascow Coma scale:
Activity
Score
Infant/Non verbal
child <2years
Verbal child/
adolescent
>2years
Eye Opening
4
3
2
1
Spontaneous
To Speech
To Pain Only
No Response
Spontaneous
To verbal stimuli
To Pain Only
No Response
Motor
Response
6
5
4
3
2
1
Normal/Spontaneous
Withdraws to touch
Withdraws to pain
Abnormal flexion-decorticate
Extension- decerebrate
No response
Obeys commands
Localizes Pain
Flexion withdrawal
Abnormal flexion
Abnormal extension
No response
Verbal
Response
5
4
3
2
1
Cries appropriately, coos
Irritable crying
Inappropriate screaming/cry
Grunts
No response
Appropriate words
Inappropriate words
Screams
Grunts
No response
>5year
Oriented
Confused
Inappropriate
Incomprehensible
No response