Neuro Obs in ICU

[Hardcastle, Tim, Dr <tch at sun.ac.za>]

Brenton

A) Supra-orbital nerve unless spinal cord injury reliably excluded, then we use sternal stimulus
B) If the patient feels the sternal stimulus and reacts we consider it equivalent - you are testing BEST MOTOR response.
C) We do it, and sedation without paralysis, which is our ICU standard practise here in South Africa, should not detract significantly from response.

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Brenton Hughes
Sent: Wednesday, September 13, 2006 11:41 AM
To: trauma-list at trauma.org
Subject: Neuro Obs in ICU


I am a General ICU nurse with just over six years experience in 
predominately Trauma/neuro intensive care both in Australia and the UK. I am 
after opinion, current practice/guidelines, or relevant references/evidence 
for assessment using the Glasgow Coma Score in order to facilitate best 
practice at my current workplace.

Most specifically,

A) What is the best site for giving central pain stimulus?

B) Is there any true relevance to assessing using peripheral stimulus? Or is 
it impossible distinguish it from purely a spinal reflex?

C) Is it necessary to assess using the GCS (ie give painful stimulus etc, 
hourly/4th hourly etc), to a sedated patient? Or is pupil assessment the 
only guide to deterioration once sedation is commenced?

Any information is greatly appreciated

Brenton

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