Head injury - Serial assessment/neuro obs stupid question

[Michelle123]

I'm just curious about the serial assessment and the neuro obs that you would do on a pt that was brought in with a head injury.

Here is what I we have been told in class:

The basics

Airway, C spine stabilisation (is suspested spinal injury)

Breathing, ventilation

Circulation, heamerrhage control

Disability - neuro obs, GCS, pupils

It is then suggested a full serial assessment be undertaken as well, but I am not all that sure what exactly that entails?

Also, I understand GCS and the pupil assessment, as well as vital signs, but what else is part of the "neuro obs"?

And is there anything else in the serial assessment that I may have missed?

Then we do things like MRI, CT etc when resus is happening and pt is stable.

We also add

Enviromnent/Exposure

Fharenheit (temp - preventing hypothermia)

Have I missed anything in the initial assessment??

[CritterLover, BSN, RN]

your terminology is a little different than i am used to.

i'm assuming that "serial assessment" is a head-to-toe assessment?

in that case, you would proceed with a typical head-to-toe assessment, including breath sounds, heart tones, pulses, cap refill, abd exam.....etc.

while doing that, pay particular attention to the motor exam -- following commands, quality/strength of movement.

i'm not sure about the "neuro obs," but i'm guessing other signs of head injury, like a depressed skull fracture, raccoon eyes, battle sign, csf leak from the nose or ears. at any rate, those are "neuro specific" things i would look for.

[Daytonite, BSN, RN]

a thorough neurological assessment should include not only the mental status, but also assessment of speech, cranial nerve function, sensory function, motor function and reflexes (see http://meded.ucsd.edu/clinicalmed/neuro2.htm). the glasgow coma scale (gcs) is a quick assessment of mental status and motor response and should be done at regular intervals (serial) so that results can be compared to determine the patient's improvement, stabilization or deterioration. most facilities have policies on how frequently these serial assessments are made. they can be as frequently as every 15 minutes during admission to every 4 hours after the patient is recovering and more stable.

[Michelle123]

Thanks for that. I just had a lightbulb moment with the serial assessment! Sometimes I just feel so silly!

[leelee283]

I think what you mean is the limb movement section. its not the same as motor response. You ask the patient to raise both arms or legs and give you a thumbs up, for example. It lets you see if they have a weakness or normal power. It lets you see if the power is equal and could be indicitive of a CVA or something similar. However remember to consider PMH they might already have a weakness. Do you have MEWS charts? They have a section included for documenting the neuro obs and are quite useful. :)