Hey, everybody. This is Steve Carroll from the Em Basic podcast. So I just posted the episode on dizziness,

and as always, with any neurological topic, I referenced the neuro exam that I talked about in the

headache episode. So what I have today is just a clip from the headache episode of how to do a

neuro exam. So if you want to refer back to it about how to do a complete

neuro exam, it's now its own episode. It's about seven minutes long, and I hope this helps you guys out.

All right, that's it for now. I'll talk to you later. Now let's talk about the physical exam.

In these patients, it is very important to do a complete but brief neuro exam. I'm going to go through

what I call my five-minute ER neuro exam. While it may not be as complete as an exam done

by a neurologist, it will cover all the important neuro findings that we need to know to rule out

serious conditions. Once again, describing this exam over a podcast is not ideal, but if you follow along in your head with the exam movements, then you can start to get an idea of what needs to be done on every neuro exam.

Just like any exam, it's helpful to start head to toe so you don't miss anything.

Start by testing the cranial nerves in a systematic fashion.

Check pupil response with a pen light or an ophthalmoscope. You also want to check for papal edema. It's kind of difficult to do in the ED without a dilated pupil, but if you can visualize the optic disc, check for papal edema. Next, check extraocular movements with your finger, paying attention for anastagnus. Next, check the facial sensation by touching both sides of the patient's

face and asking if it feels the same. Next, have the patient puff out their cheeks like a fish. I usually

have to demonstrate this for them. Make sure that they puff out both sides equally. Next, ask the patient

to smile. Then have the patient shrug of their shoulders. Finally, have the patient turn their head to the left

and right, as well as flex and extend their head all the way. The head flexion and extension is not a part

of a traditional cranial nerve exam, but it's a good screen for meningismus. Next, you'll want to test

motor strength and find motor movements. Ask the patient to grab your two fingers and

squeeze. Examine for any weakness or asymmetry and grip strength. While the patient still has

your fingers in their hand, ask them to push you away. Next, ask them to pull you back towards

them. This tests their bicep and tricep strength. Just make sure to brace yourself if the patient

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