fast, basic neurological examThis page has two fast, basic neuological exams. The first is the standard one if you suspect a stroke. The second one could be quite useful if a friend took a fall that you suspect might have caused a concussion, but they are unwilling to take their accident seriously. By having them lie still and do these tests, you might be able to prove to them that they need immediate help and need to stay still until help arrives.
If you are giving first aid to a victim who realizes they are quite injured, getting the answers to the secondary survey questions (signs and symptoms, allergies, medications, etc.) in case they pass out before the EMTs arrive could literally help save their life. Trying some of the tests in the second exam on this page and having the results for the EMTs/Paramedics, could also assist them and help make the time waiting go faster.
Note to on-line users not in my classes: this is a study sheet. It is not complete instruction in first aid. In a formal class you will learn steps for recognizing emergencies, how and when to call 911, protecting yourself, (including how to obtain consent and prevent disease transmission), how to prioritize care and much more. You would always deal with life-threatening situations before you start a simple secondary survey.
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If at some point before or during a secondary survey ( Simple secondary survey study sheet ) you had reason to suspect a head injury, you could ask levels of consciousness questions.
A person who is oriented to their surroundings and situation should be able to tell you their name, where they are, what time it is (not to the exact hour but at least is it morning or evening, what month and year it is), and what happened to them.
Sometimes as people go in and out of consciousness they tend to lose ability to answer the levels of consciousness (LOC) questions in the order person, place, time and event, with their name being the last thing they remember.
The Glasgow Trauma (or COMA) Scale, used by medical personnel, labels a person who can answer all these questions 'oriented.' If they can't give accurate responses, but they can take part in a conversation of sorts the label is 'confused.' They are given a score for these and 'inappropriate words,' 'incomprehensible sounds,' or 'no verbal response' as well. A person who is not 'oriented' or has slurred speech needs professional help and should not be allowed to leave the scene until seen by an EMT. Remember, even if they are not oriented, and may not respond to you properly, they often can understand everything you are saying so be positive without lying.
If the victim passed the 'oriented' test, but you had reason to suspect a concussion/injury, you could also do part or all of a fast, basic neurological exam, such as the following. (But you wouldn't have them move any body part you suspected was injured and if you suspect a spinal injury you would be manually protecting the spine/neck from movement and would not want them to tilt their head yes or no in the process of answering questions.)
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If you suspect a stroke, don't take the time to do all the tests further down this page. Start with the three tests recommended by Red Cross first aid. Ask the person to smile. (Watch their face to see if both sides of their face move the same or if there is drooping or weakness on one side of their face.) Have them hold up both arms, extended out straight from their body. (Someone who had a stroke would not be able to keep both arms at the same height or might have numbness in one arm.) Have the person try to repeat something you say. (Someone who had a stroke might haves slurred or distorted speech or trouble speaking.) If they fail any of these, note the time, call 911 or the local emergency number and tell the dispatcher about the symptoms and what time the symptoms started.
To care for a victim of stroke, think FAST.
Face - weakness on one side of the face
Arm - weakness or numbness in one arm
Speech - slurred speech or trouble speaking
Time - Time to summon EMS personnel (call 911) if any of the above are seen and note the time the signs and symptoms began
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These stroke tests plus holding out two hands with your index fingers pointing out, and asking the person to squeeze one of your fingers with each hand at the same time might be all you need. (Squeezing fingers can be a way to test strenght and also a fairly standard test of someone's ability to respond properly to your command.) If you have more time you can try all the tests below.
These tests are not meant for you to think you have completely ruled out problems.
eyesight Ask them if they are having any blurry vision or double vision. Hold up fingers for the victim to count. (Check each eye separately and both eyes at once. Also notice if they have any trouble fully closing either eye, are having any facial twitches/tremors.)
Check pupils -- are they equal? Cover each eye and shine shine a flashlight at the other .. do they both constrict at the same speed and the same amount?
Hold up your finger and ask them to follow its movement with their eyes.
Face muscles If you did not do so before, ask them to smile.
Ask them whistle. Watch both sides of their face to see if the smile and cheek movement is equal.
Ask them to stick out their tongue and move it from side to side.
Muscular strength If they don't have any sign of specific injuries to their hands/shoulders/arms/legs...
Hold out your hands with your index fingers pointing out, and ask them to squeeze one of your fingers with each hand at the same time.
Again, you should be describing to the person what you are going to do before you touch them and continue to get consent as you go along.
You could put your hands on their shoulders, press down slightly and ask them to shrug their shoulders.
You could also have them straighten each leg, likewise their elbow and wrist against resistance you supply.
Hand/eye control
Have them move their thumb to each finger on that hand. Try this with both hands.
Hold up your finger about a foot and a half from their face and have them move their own finger from their nose tip to your finger and back and forth.
Balance when standing, walking
If the victim fell or you have any reason to doubt their ability to perform these standing/walking tests you should have two people stand right next to them as they stand up and as they try these, ready to catch them should they faint, stumble, etc.
Have the victim stand with feet together and close their eyes. They should be able to stand and stay completely still with their arms staying at their sides.
With their eyes open, ask the victim to clap one hand into the palm of the other as quickly as possible, or, if they know how, to snap their fingers.
The next test should be easy to remember to do if you picture a police officer testing for sobriety; have the victim walk putting the heel of one foot right in front of the other foot.
and then on tiptoes.
Thinking ability
Have the victim add 2 plus 2 equals___? plus two equals---?
Then make it a little more difficult, such as counting to 30 by threes (3,6,9,12,15,18,21, etc.).
Finally do a subtraction series (subtracting seven (or eight, just be consistent) from a hundred, and seven or eight from that number, etc.). This one is the best test of abstract reasoning, because it's more difficult. (But, yes, some people may not have enough math background to pass this test.)
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If the victim 'passes' the tests and they won't wait for an EMT, you should warn them and anyone with them that should things change they need to seek professional help. Remind them that if they faint, get a headache, have any loss of function or numbness, go blind or get blurred/double vision, even for a split second, they need to get help.
Remember: you are not a doctor. 'Passing' this does not mean the victim will not need medical care. Symptoms can develop slowly. You should always advise a victim of injury to see their doctor or if at all possible, wait for an EMT to arrive and report to them what was found.
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Signs and symptoms of a concussion:
Appears dazed or stunned
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows behavior or personality changes / mood changes like feeling sad, anxious or listless or becoming easily irritated or angry for little or no reason
Can’t recall events prior to hit or fall and/or after hit or fall
Headache or 'pressure' in head
Nausea or vomiting
Balance problems or dizziness
Double or blurry vision
Sensitivity to light and/or noise
Feeling sluggish, hazy, foggy, or groggy
Concentration or memory problems
Confusion
Does not 'feel right'
Athlete who is confused about assignment or position, forgets sports plays, is unsure of game, score, or opponent
You might not witness the fall of an elderly person, but would notice some of the symptoms above and/or:
low-grade headache that won't go away
having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks or making decisions or solving problems
slowness in speaking, acting, thinking or reading
getting lost or easily confused
changes in sleep patterns, inability to wake up from sleep
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