Severe facial trauma may make CN testing difficult
Pupils (CN 2 sensory, CN 3 constriction)
No response to light (fixed and mid-dilated)
Ocular movement (CN 8 sensory, CN 6 lateral rectus)
Oculocephalic reflex (positive Doll's Eyes)
Eyes should move to maintain forward fixation as head is turned
Do not perform if cervical spine injury is suspected
Oculovestibular reflex (aka "Cold Calorics")
(Irrigation with 60cc cold water to ears on intact tympanic membrane and observe for deviation of eyes/fast beat nystagmus. Allow 5 minutes between either side.
if<unk> stem reflex is intact, fast beating nystagmus to the opposite side
if<unk> stem reflex is not intact, eye deviation towards the side of irrigation
Clotted blood or cerumen in auditory canal may influence response to cold calorics
Cortex injured but<unk> stem intact = eyes deviate toward cold ear<unk> stem injured = no eye deviation at all
Corneal reflex (CN 5 sensory, CN 7 motor/blinking)
Drip saline flush into eye
Progress to direct stimulation on sclera with gauze if no response above (DO NOT scrape cornea)
Pharyngeal (CN 9/10)
Gag (tongue blade) or suction.
Tracheal (CN 10)
Endotracheal suction (In intubated patients only)
Spontaneous body movements observed at any point during the<unk>  exam may represent spinal reflexes, up to ~20%
May be difficult to discern from respiratory effort
Findings may include pronation-extension reflex, abdominal reflex, flexion reflex, the Lazarus sign, periodic leg movements
Should not be misinterpreted as<unk>  stem function
Evidence of<unk>  comes from consistent clinical exam and imaging
No response to light (fixed and mid-dilated)
Oculocephalic reflex (positive Doll's Eyes)
Eyes should move to maintain forward fixation as head is turned
Do not perform if cervical spine injury is suspected
Oculovestibular reflex (aka "Cold Calorics")
(Irrigation with 60cc cold water to ears on intact tympanic membrane and observe for deviation of eyes/fast beat nystagmus. Allow 5 minutes between either side.
if<unk> stem reflex is intact, fast beating nystagmus to the opposite side
if<unk> stem reflex is not intact, eye deviation towards the side of irrigation
Clotted blood or cerumen in auditory canal may influence response to cold calorics
Cortex injured but<unk> stem intact = eyes deviate toward cold ear<unk> stem injured = no eye deviation at all
Eyes should move to maintain forward fixation as head is turned
Do not perform if cervical spine injury is suspected
(Irrigation with 60cc cold water to ears on intact tympanic membrane and observe for deviation of eyes/fast beat nystagmus. Allow 5 minutes between either side.
if<unk> stem reflex is intact, fast beating nystagmus to the opposite side
if<unk> stem reflex is not intact, eye deviation towards the side of irrigation
Clotted blood or cerumen in auditory canal may influence response to cold calorics
Cortex injured but<unk> stem intact = eyes deviate toward cold ear<unk> stem injured = no eye deviation at all
if<unk> stem reflex is intact, fast beating nystagmus to the opposite side
if<unk> stem reflex is not intact, eye deviation towards the side of irrigation
Drip saline flush into eye
Progress to direct stimulation on sclera with gauze if no response above (DO NOT scrape cornea)
Gag (tongue blade) or suction.
Endotracheal suction (In intubated patients only)
May be difficult to discern from respiratory effort
Findings may include pronation-extension reflex, abdominal reflex, flexion reflex, the Lazarus sign, periodic leg movements
Should not be misinterpreted as<unk>  stem function
Evidence of<unk>  comes from consistent clinical exam and imaging
Brain death
Spinal shock
Hemorrhagic shock
Neurogenic shock
Heat exhaustion
Heat stroke
Stroke 
Tumor lysis syndrome