Critical Matters The Neuro Exam
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Jun 27, 2024 In this engaging discussion, Dr. Adam Rizvi, a neurologist specializing in critical care and tele-neurology, shares insights on performing neurological assessments in the ICU. He emphasizes key factors for non-neurologists to recognize signs of strokes and other conditions in sedated patients. The conversation highlights innovative exam techniques, including assessing brainstem reflexes and alternative methods for increased safety. Dr. Rizvi also discusses the profound impact of kindness and empathy in critical care settings, reflecting on the teachings of Marcus Aurelius.
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Use HAND To Spot Cortical Signs
- Use the mnemonic HAND to spot cortical signs: Homonymous hemianopsia, Aphasia, Neglect, Deviation.
- Recognize cortical signs quickly to suspect large vessel occlusion and possible seizures.
Assess Brainstem With Three Reflex Arcs
- Test brainstem via three reflex arcs: midbrain (pupils), pons (corneal), medulla (gag/cough).
- Use gentle methods (lash brush or saline drop) to avoid corneal abrasions when testing corneal reflex.
Avoid Direct Corneal Trauma
- Avoid touching the cornea directly repeatedly; brush eyelashes or drop saline to elicit blink safely.
- Prevent corneal abrasions from frequent corneal reflex checks in ICU patients.