The Paramedic Neurological Exam


This is a quick summary of the minimum physical exam that is appropriate for a non-traumatic patient complaining primarily of a neurological nature (altered mental status, or altered mobility and/or communication).  For full details of the exam items listed below, and for links to other focused physical exams, go here.

Head and Neck Exam

  1. Assess for facial and cranial lesions (DCAP-BTLS)

  2. Assess if pupils are equal and reactive to light (PEARL)

  3. Assess pupils for midline, conjugate gaze

  4. Assess pupils for nystagmus

  5. Asses for speech deficits or abnormalities

  6. Assess for oral trauma (bitten lips, cheeks or tongue)

  7. Assess for ptosis and other facial asymmetry

  8. Assess for tracheal deviation

  9. Assess for cervical vertebral body deviation & tenderness

  10. Assess for cervical muscle spasm & tenderness

Respiratory Exam

  1. A   Assess for Accessory muscle use

  2. B   Assess Breath sounds

  3. C   Assess Colour and condition of skin

  4. D   Assess word Dyspnea

  5. E   Assess for Extending position

  6. F   Assess SpO2 using Finger probe

  7. G   Assess end tidal CO2 Gas values and waveforms

  8. H   Heart Rate

  9. I   Assess the inspiratory/expiratory ratio (“i/e ratio”)

Abdominal Exam

  1. Assess for shape

  2. Assess for softness / guarding

Pelvic Exam

  1. Assess for priaprism

  2. Assess for urinary and fecal incontinence

Extremity Exam

  1. Assess for PMS (pulse, motor, sensory) 

  2. Assess for ROM (range of motion)

  3. Assess for ambulation if appropriate (ability, posture and gate)

  4. Assess for strength (grip strength and pronator drift)

  5. Assess for tremors or ataxia

  6. Assess for Plantar- Babinski reflex

Comments?  Suggestions? Anything to add?  E-mail me.