# Cranial Nerves and Reflexes-assessment



## NYBLS (Oct 7, 2010)

Hello all! I have been in a little debate with a co worker, and I wanted to get the opinion of some other providers. I have recently been studying cranial nerves and reflexes. My co workers debate is that these do not make a difference pre hospitaly and we should not be doing them. His belief is that we should stick only to the cincinnati stroke scale, and use no other neurological examination.

So, do you perform cranial nerve testing on applicable patients? Reflexes? Should it be limited to just ALS?


----------



## zmedic (Oct 7, 2010)

If you are doing it to gather more information for the hospital I don't really see a problem, but since your protocols assume that you don't do cranial nerves you have to be careful that the results aren't changing your treatments or decisions. You don't want to say "we bypassed our normal destination for the neurotrauma center because cranial nerve III was off." 

Now I would only communicate or document a cranial nerve exam if you've been actually trained how to do it. You don't want to start telling the nurse that a cranial nerve exam is off, and then have the doctor tell you that that you didn't do the exam right. It makes you look bad and that's when people get all fired up. 

Your partner is right, it isn't going to change much prehospital, but you might pick up something that wouldn't have been noticed in the ED for hours. You can consider doing it after you've finished everything else (all your history, obtaining demographic info, 2 sets of vital signs etc.) 

Depending on where you work it might be a nice thing to do to kill some time during the transport. I used to have hour long transports, and often would have a lot of time after I was done with what I had to do.


----------



## medicRob (Oct 7, 2010)

NYBLS said:


> Hello all! I have been in a little debate with a co worker, and I wanted to get the opinion of some other providers. I have recently been studying cranial nerves and reflexes. My co workers debate is that these do not make a difference pre hospitaly and we should not be doing them. His belief is that we should stick only to the cincinnati stroke scale, and use no other neurological examination.
> 
> So, do you perform cranial nerve testing on applicable patients? Reflexes? Should it be limited to just ALS?



Doing a proper neuro exam is great. Just don't let it delay transport. Get your SAMPLE history, etc first then worry about all the detailed assessments. 

If you get a chance, try to get a copy of, "Bate's Guide to Physical Examination". You will find some awesome tips and tricks to patient assessment.


----------



## usalsfyre (Oct 7, 2010)

Cranial nerve assesments are great. They can indeed change your treatment and transport descions, just make sure you try to see normal vs abnormal. 

Keep in mind the Cincinnati scale is for hemispheric stroke, and may not catch intracerebral hemorrhage, strokes in areas of the lower brain, ect.


----------



## medic417 (Oct 7, 2010)

An ex co worker posted a topic on another site this week and it shocks me how many people use the don't do ( fill in the blank ) because it does not change your method of care in the field.  With that logic a basic should not take a blood pressure because it will not change how they treat the patient as they have no way to raise or lower the pressure.  

So as to cranial nerves if done during transport w/o delay on scene I am all for it as it allows you to provide a more accurate picture to the doctor that gets your report.  But are you do a true assessment of them?  Do you carry items to test smell, etc?  Be careful though some medical directors will say you over stepped protocol.


----------



## zmedic (Oct 9, 2010)

No one tests smell, not the ED docs, and not neurologists on 95% of their patients unless the patient is complaining of problems with smell/taste. You should be able to test the rest of the cranial nerves without anything more than a penlight and some gauze.


----------



## JPINFV (Oct 9, 2010)

zmedic said:


> No one tests smell, not the ED docs, and not neurologists on 95% of their patients unless the patient is complaining of problems with smell/taste. You should be able to test the rest of the cranial nerves without anything more than a penlight and some gauze.



Basically this, and if you want to get technical, CN I-deferred, CN II-XII grossly intact"


----------



## CAO (Oct 9, 2010)

I'm for it.

It takes, what?  Just a moment?  At the very least, it lets your patient know you're doing something.  I hate seeing somebody sitting in the captain's chair with their feet propped up, doing essentially nothing because it's not been five minutes since the last set of vitals.

Of course it depends on the patient.  You're not exactly going to want to examine CN: XI too thoroughly with somebody needing immobilization.


----------



## zmedic (Oct 9, 2010)

JPINFV; said:
			
		

> Basically this, and if you want to get technical, CN I-deferred, CN II-XII grossly intact"



I write CN II-XII intact. If you write grossly intact you are saying that you didn't actually check cranial nerves and just didn't notice any deficits while you were sitting there are talking to the patient. If you actually do a formal assessment of cranial nerves you should document as such.


----------



## mikie (Oct 9, 2010)

our program makes us learn each CN, its function and how to assess it (individually).  

and i have a test over it Monday!


...there's some pretty great mnemonics out there for them, btw :lol:


----------

