Physical Examination Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when

en not stimulated Obtunded- sleeps most times, difficult to arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for arousal; responds to stimuli Coma- no response (Jarvis CH 2) . A reflex 0 A reflex is defined as an immediate and involuntary response to a stimulus. Superficial reflexes. Stroke the skin with a hard object such as an applicator stick. What is felt is a superficial reflex 5 Ps Pain Pallor Pulses Paresthesia Paralysis There are five reflexes to check which include: Biceps: With the patient sitting, flex his arm at the elbow and rest his forearm on his thigh with the palm up. Place your thumb firmly on the biceps tendon in the antecubital fossa. Strike your thumb with the hammer. The elbow and forearm should flex, and the biceps muscle should contract. Triceps: The triceps tendon is tested with the patients arm flexed at a 90

angle. Supporting the arm with your hand, strike the triceps tendon on the posterior arm just above the elbow. The tendon should contract and the elbow extend. Brachioradialis: Have the patient rest his slightly flexed arm on his lap with the palm facing downward. Strike the posterior arm about two inches above the wrist on the thumb side. The forearm should rotate laterally and the palm turn upward. Patellar: Dangle the patients legs over the side of the bed. Place your hand on the patients thigh and strike the distal patellar tendon just below the kneecap. (If the patient must remain supine, flex each leg to a 45 angle and place your dominant hand behind his knee to support it.) The normal response is contraction of the quadriceps muscle with extension of the knee. Achilles: Have the patient dorsiflex (point downward) his foot slightly and lightly tap the Achilless tendon on the posterior ankle area. A slight jerking of the foot should be seen.