Neurological Assessment

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Paramedics are frequently presented with neurological emergencies in the pre-hospital environment. Neurological emergencies include conditions such as, strokes, head or spinal injuries. To ensure the effective management of neurological emergencies an appropriate and timely neurological assessment is essential. Several factors are associated with the effectiveness and appropriateness of neurological assessments within the pre-hospital setting. Some examples include, variable clinical presentations, difficulty undertaking investigations, and the requirement for rapid management and transportation decisions (Lima & Maranhão-Filho, 2012; Middleton et al., 2012; Minardi & Crocco, 2009; Stocchetti et al., 2004; Yanagawa & Miyawaki, 2012). Through a review of current literature, the applicability and transferability of a neurological assessment within the pre-hospital clinical environment is critiqued. Blumenfeld (2010) describes the neurological assessment as an important analytical tool that evaluates the functionality of an individual’s nervous system. Blumenfeld (2010) dissected and evaluated the neurological assessment into six functional components, mental status, cranial nerves, motor exam, reflexes, co-ordination and gait, and a sensory examination.

The mental status exam investigates global and limbic brain functions, left and right parietal functionality and language. This is achieved through tests such as, level of consciousness, memory, and language assessment (Blumenfeld, 2010). Yanagawa and Miyawaki (2012) highlight the importance of obtaining reports from witnesses to assist with a mental status examination. They state that pre-hospital patients can deteriorate quickly into unconsciousness, limiting the ability for para...

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Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131
Sullivan, S. J., Hammond-Tooke, G. D., Schneiders, A. G., Gray, A. R., & McCrory, P. (2012). The diagnostic accuracy of selected neurological tests. Journal of Clinical Neuroscience, 19. 423-427. doi:10.1016/j.jocn.2011.09.011
Yanagawa, Y., & Miyawaki, H. (2012). Importance of checking prehospital neurological findings to reveal incidence of spinal cord concussion. Spinal Cord, 50, 278-280. doi:10.1038/sc.2011.151
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