So I'm doing my yearly renewal of the NIHSS certification, and I have to say - for practical, ER usage...it's kind of bullshit. I do my best to score patients appropriately, but when I'm watching the educational videos it's impressive how far off the test situations are from the reality of the ER.
For example: on the item where we're supposed to show patients a card and ask them to name certain objects. According to the video, "for the intubated patients, have them write down their answers on a notecard and then score them appropriately."
Riiiiiiiight. I can't even get patients to do the simplest of tasks correctly. Like put a thermometer under their tongue. Or take their shirt off before putting a gown on. Or not try and rip off all their cardiac leads because "they're itchy." Or even provide me a list of what surgeries they've had, because why should someone know what internal organ has been ripped from their insides? So with that in mind, do you realllly think I'm gonna have my newly stroked out intubated patient brought out from sedation long enough to try and draw me a pretty picture on a notecard? I think not.
It's more likely they'd bypass my NIHSS attempt, rip the ETT out with their one good arm, and then arrest a minute later because they're too gorked to maintain an airway. I guess they score a 3 on the aphasia part if they're dead?