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MEND

MEND. Miami Emergency Neurologic Deficit Exam. MEND. The MEND exam is an integral part of a comprehensive head to toe assessment: Enhances communication among EMS personnel, nurses, and physicians

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MEND

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  1. MEND Miami Emergency Neurologic Deficit Exam

  2. MEND The MEND exam is an integral part of a comprehensive head to toe assessment: • Enhances communication among EMS personnel, nurses, and physicians • Incorporates NIH Stroke Scale (NIHSS), and the Cincinnati Prehospital Stroke Scale (CPSS) for effective outcomes • Able to be performed in less than 3 minutes

  3. MEND EXAM The MEND exam should be considered an initial or acute exam: • Completed on all patients every shift as a part of the head to toe assessment • except for ICU & Maternal/Child • In ED if a suspected Stroke patient or AMS • Repeated with any decrease in neurological status

  4. MEND The MEND exam is performed by: • EMS • Nurses • Physicians • Other Trained Personnel

  5. THE MEND

  6. MENTAL STATUS • Level of Consciousness - Alert-Verbal-Pain-Unresponsive (AVPU) • Speech – Ask the patient to repeat this sentence exactly “You can’t teach an old dog new tricks” • Questions – Ask the patient to tell you his/her age and current month • Commands –Ask the patient to close and open eyes

  7. CRANIAL NERVES • Facial Droop – ask patient to show teeth or smile. (look for droop or difference in labial folds.) • Visual Fields – Ask patient to look at your nose . While wiggling your finger in all 4 quadrants have pt identify which quadrant . • Horizontal Gaze – Ask patient to hold head still and follow finger (with eyes only) side to side. You may need to steady the head by placing your thumb on the chin.

  8. LIMBS • Motor - arm and leg drift • Arm drift - Eyes closed, extend arms, palms down (10 seconds) • leg drift -Eyes open, lift legs one at a time (5 seconds) • Sensory - touch to arms and legs • With eyes closed touch or pinch arms and legs one at a time having the patient tell where the touch was and if all touches felt the same • Coordination – arm (finger to nose) & leg (heel to shin) • Make sure patient’s arm fully extends & is not braced against body or bed.

  9. MEND Advantages The MEND exam allows staff to have an objective assessment of the patient’s neurological status Identifies patients in-house who may have Stroke S/S during admission Removes variation in Neurologic assessments completed by staff

  10. What to do when a Stroke patient presents: • Patient presents with signs and symptoms • MEND preformed with abnormal findings • Stroke Team Alerted (by dialing 3000) • Stroke Team arrives and confirms abnormal finding with repeat MEND or NIHSS • Stroke Team will rule out any History that has a stroke mimic

  11. What to do when a Stroke patient presents: 6. NIH Stroke Scale done by Stroke Team 7. Patient to CT Scan (will be done and read within 45 minutes of arrival to ED) and labs drawn 8. Primary Physician notified, if no response in 10 minutes - Neurologist notified 9. If patient meets criteria Stroke will initiate tPA protocol per Primary Physician or Neurologist

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