HistoryABCsLevel of Consciousness (ask simple

questions)Determine MOI (or ask bystander)Ask about headacheAsk about nauseaAsk about paralysis/numbness/weaknessAsk about tinnitus (ringing in the ears)

ABCsC – Circulation

Pulse Adult and Child: Carotid artery Infant: Brachial Artery Begin CPR if needed

A – AirwayRemove face mask (if needed)Chin tiltJaw thrust

B – BreathingLook, Listen, and Feel2 breaths

Levels of ConsciousnessLevels

Alert and Oriented?Responsive to Verbal Stimuli?Responsive to Painful Stimuli?Lethargy: DrowsinessStupor: responsive only to vigorous stimulusComa: unresponsive to verbal or physical

stimulus

ObservationUnequal Pupils

PERRLA (Pupils equal, round, and reactive to light and accommodation)

Respiratory RateFace color (red or pale)Abnormal body positionDischarge from ears and nose

Spinal Fluid

Palpation Rate and quality of pulse

60 – 100 bpm Rapid and weak? Strong and slow? Brachycardia (bpm < 60) Tachycardia (bpm > 100)

Signs of Trauma to head and neck LOC Amnesia (retrograde and antrograde) Unable to wake sleeping victim Confusion Vomiting Dizziness Very high blood pressure Very slow pulse Numbness, tingling, pain

Cranial NervesI - Olfactory II - Optic III - Oculomotor IV - Trochlear V - Trigeminal VI - Abducens VII - Facial VIII –

Vestibulocochlear /Auditory

IX - Glossopharyngeal X - Vagus XI – Spinal Accessory XII - Hypoglassal

O - OnO - OldO - OlympusT - ToweringT - TopA - AF - FamousV - VocalG - GermanV - ViewedS - SomeH - Hops

O - OhO - OnceO - OneT - TakesT - TheA - AnatomyF - FinalV - VeryG - GoodV -

VacationsA - AreH -

Heavenly

Cranial Nerve

What? How?

1 Olfactory Smell Place a strong, identifiable odor under the nose; ammonia capsule

2 Optic Vision Read something

3 Oculomotor Mvmt of eyelid Elevate eyelid; cross eyes

4 Trochlear Mvmt of eye Elevate the eye

5 Trigeminal Touch/pain of face; muscles of mastication

Sensory: Touch the skin around the faceMotor: Elevate, depress, protrude, retract, lateral deviate mandible

6 Abducens Lateral mvmt of eye

Abduct or laterally move the eye

7 Facial Mvmt of facial muscles

Motor: close eyelid; scrunch face

8 Vestibulocochlear

Hearing/balance Stand w/eyes closed no support; snapping

9 Glossopharyngeal

Mvmt of pharynx Swallow

10

Vagus Not Tested

11

Spinal Accessory

Mvmt of Sternocleidomastoid and trapezius muscle

Shrugging of shoulders

12

Hypoglassal Mvmt of tongue Stick tongue out

Special Tests (Concussion Tests)Cranial Nerve Testing

Blurred Vision (Optic nerve)Pupillary Response (PERRLA)Tracking (Trochlear, Abducens, and

Oculomotor)Romberg Sign (Vestibulocochlear)

Finger-to-nose test Babinski Test (reflex test)Oppenheim TestOppositionAmnesia

Babinski TestTests Babinski ResponseEither Present or notHow?

Lightly rub thumb up the bottom of the sole from the heel up to the base of the toe

Normal response: Infants: Great toe extends and fanning of other toes

Disappears as infant matures (1yr or less) Adults and children (1 yr or older)

Toes curl under (flex)

Oppenheim TestTests for cranial irritationEither present or notHow?

Rub antro/medial side of tibia Noxious Stimulus

Abnormal response: Similar to Babinski Extension of great toe/toes

Finger-to-Nose TestTests Spacial awareness or proprioceptionHow?

Instruct athlete to close eyes and attempt to touch finger to nose

Positive testAthlete is unable to touch their nose without

the eyes open

Romberg TestTesting balance through the Romberg SignHow?

The essential features of the test are as follows: the subject stands with feet together, eyes open and hands by the

sides. the subject closes the eyes while the examiner observes for a full

minute. Because the examiner is trying to elicit whether the patient

falls when the eyes are closed, it is advisable to stand ready to catch the falling patient. For large subjects, a strong assistant is recommended.

Positive if, and only if, the following two conditions are both met:

The patient can stand with the eyes open; and The patient falls when the eyes are closed.

The test is not positive if either: The patient falls when the eyes are open; or The patient sways but does not fall when the eyes are closed.

OppositionThe ability to touch and hold the thumb and

another finger together.How?

Instruct athlete to touch each finger to the thumb

Then instruct the athlete to hold the two fingers together while you pull them apart.

Positive findingAthlete is unable to touch fingers together or

hold the two fingers together.

PERRLAPupils Equal, Round and Reactive to Light and

AccommodationHow to test?

If in a bright area Cover one eye and remove cover

May also use a pen light Pen lights are used starting from the lateral side and moving

medial Repeat on other eye

If in a darker area Same steps but use Pen Light

Positive if Pupils: Do not constrict Do not constrict equally Are difference sizes Are not round

Positive = Brain Injury