Brain Stem Reflexes – Assessment (Nursing)

00:01 Now let's look at brain stem reflexes.

00:05 We look at brainstem reflexes in a comatose patient to see if their brainstem is intact.

00:10 Now these are kind of extreme.

00:12 Okay, these are not normally done in a regular neuro assessment.

00:16 You need to be aware of them.

00:18 But don't go in every shift and do the oculocephalic or the iced water test, you just don't normally do that.

00:25 And we would never do this on an awake patient, okay? There's no need because we can assess them by how they can follow commands and push against their legs and all those types of things.

00:35 But for assessing the brainstem reflexes, this is a pretty severe case, okay so this is very serious.

00:42 Doll's eye reflex is the ocolucephalic reflex.

00:46 Now what they'll do is when you come in, or nurses can do this, we just don't often do this, you turn the patient's head briskly from side to side.

00:54 Okay, be very careful with their neck, but you're gonna turn the patient's head from side to side.

00:59 Now the eye should move to the left when the head is turned to the right.

01:03 So if you turned the head this way, the eye should go that way, okay.

01:08 And vice versa - left, right.

01:10 So you can try that again with an awake human, that's what will happen.

01:14 But if the reflex is absent, there will be no eye movement.

01:17 They'll just follow.

01:19 Okay, so you won't see the opposite movement.

01:22 Is that a positive sign? no that means that reflex is not there.

01:27 So how you would document that is, "head turned briskly from side to side", and you document that there was "no eye movement." Now the ocoluvestibular reflex.

01:38 This one is brutal, i mean the though of it, I don't even like water in my ear after the shower.

01:43 So a physician will instill at least 20 milliliters of iced water into the patient's ear.

01:51 I think that if you're awake, this would be extreme, right.

01:54 If you're comatose, they're not gonna respond.

01:57 With intact brainstem, the eyes will laterally turn towards the affected ear, like "what is going on?" So if somebody shot 20 mls of iced water in your ear when you're in a coma, if your brainstem was intact, your eyes would shoot over there like, "what in the world?" But if you have a severe brainstem injury, the gaze will just stay midline, it won't change.

02:21 So these are really ominous signs, right - this is bad news.

02:25 Nobody wants to have to deliver this news to a patient's family.

02:29 So these are two common things in an extreme situation.

02:35 You're not gonna do an oculovestibular reflex check as a nurse It's not that you would harm your patient, it's just not typically done.

02:43 You could do the doll's eye reflex, but this isn't something we usually repeat over and over and over again.

02:48 It should be only done in extreme cases.