Page 222 - PJ MED OPS Handbook 8th Ed

19. Pararescue Neurological Exam

Components and Format

• Mental Status
• Cranial Nerves
• Motor
• Sensory
• Coordination

NOTE: Be familiar with this exam before administering it in the field. Do not rush the exam
but go at a reasonable pace to avoid error. The goal is to identify obvious abnormalities, trust
your instincts, and be as descriptive in the deficits identified as possible (i.e., instead of saying
left 3rd nerve palsy, say droopy left eyelid).

Performing the Exam
• Begin with patient seated if appropriate.
• Mental Status:
○ A/O: What is your name, where are you, when – day/date/year, what happened – this
also answers speech and comprehension
○ 3 words (immediate recall): Give the patient three unrelated words to remember. (e.g.,
car, watch, pen). Tell them to repeat back immediately and remember them.
○ Logic: “count backwards from 100 by 7s”
• Cranial Nerves:
○ Visual acuity (2): Read something (printed text on a uniform or print on paper, count fin-
gers, detect hand motion, detect light, no light perception)
○ Pupillary response (2): check one eye at a time for response to light
○ Follow my finger (3, 4, 6): Instruct patient to look up, down, right, left; looking for twitch-
ing for lack of movement.
○ Facial sensation (5): close your eyes, tell me when I touch you – touch with finger side of
face at 3 levels – above eye, cheek, jaw. One side then the other. Clench jaw. Blink.
○ Smile, then look up and wrinkle your forehead (7): have patient perform
○ Hearing (8): have patient close eyes, rub your fingers together next to ear and have pa-
tient identify which ear it is. Repeat for other ear. If they cannot hear rubbing fingers, snap
your fingers.
○ Say “aaahhh” (9, 10, 12): open your mouth, stick out your tongue and say “ah”. Tongue
should protrude midline, normal voice (vs hoarse), both sides of palate go up symmetri-
cally and uvula is midline.
○ Shrug (11): using your hands for resistance have patient turn their head left and right then
shrug their shoulders.
• Motor:
○ While providing resistance, have patient move each extremity (push and pull). Perform
each area on both sides (L/R) before moving to next area to provide comparison.

220 n Pararescue Medical Operations Handbook / 8th Edition