3.1 Patient History, Assessment & Safety

Why Patient History and Safety Matter on the R.EEG.T. Exam

The Pre-Study/Patient Preparation domain is 25% of the ABRET (American Board of Registration of Electroencephalographic and Evoked Potential Technologists) R.EEG.T. content outline. Before a single electrode is applied, a registered EEG technologist must collect a focused clinical history, confirm the indication for the study, screen for medications that change the tracing, and apply infection-control practices. A weak history limits the interpreting neurologist; a missed precaution risks patient and staff safety. Exam items in this area test judgment, not just recall.

Clinical History Intake

A useful electroencephalogram (EEG) history is structured and recorded directly in the technical worksheet so the reader can correlate the tracing with the patient's state. Capture the clinical question first: what is the ordering physician trying to answer? Then document the items below.

Always note the last seizure, last meal, and last dose of relevant medication, plus any clinical event seen during the recording with the exact time and channel context.

Common Indications for EEG

The technologist should recognize why an EEG is ordered, because the indication shapes setup choices (montage, activations, recording length):

• Evaluation of suspected seizures or epilepsy and classification of seizure type
• Assessment of altered mental status, encephalopathy, or coma
• Spells of uncertain cause (syncope vs. seizure vs. nonepileptic events)
• Suspected CNS infection, metabolic, or toxic disturbance
• Evaluation in stroke, head trauma, or neurodegenerative disease
• Support for brain death/electrocerebral inactivity (ECI) determination using a specific protocol
• Effect of, or response to, antiseizure medication

Medications That Affect the EEG

Medication effects are heavily tested. The technologist must record drug names, doses, and last-dose times so the reader does not misinterpret drug effect as pathology.

A frequent pitfall: drug-induced beta or slowing being read as a primary abnormality because the medication history was incomplete. Documentation prevents this.

Infection Control and Standard Precautions

Standard precautions treat blood and body fluids from every patient as potentially infectious. For EEG, the core practices are:

• Hand hygiene before and after every patient and after glove removal
• Gloves for scalp preparation, electrode application, and any contact with broken skin or fluids
• Disinfection of reusable electrodes per facility protocol; use single-use electrodes when skin is not intact or for patients with transmissible disease concerns
• Cleaning and low-level disinfection of the patient bed, headbox, and shared equipment between patients
• Transmission-based precautions (contact, droplet, airborne) added to standard precautions when indicated; appropriate PPE for isolation rooms
• Safe sharps and waste handling; never reuse adhesive/abrasive supplies between patients

For any patient with suspected prion disease (e.g., Creutzfeldt-Jakob disease), follow facility prion protocols, which typically require single-use electrodes and special instrument handling because routine disinfection does not inactivate prions.

Skin Integrity and Allergy Screening

The content outline lists skin integrity and allergies/sensitivities as pre-study knowledge areas. Before prepping, inspect the scalp for wounds, lesions, rashes, or fragile skin, and screen for sensitivities to collodion, acetone, adhesives, latex, and conductive pastes. Abrade the skin only enough to lower impedance without breaking it; over-abrasion causes pain, bleeding, and infection risk. For patients with fragile or non-intact skin, choose single-use electrodes and gentler application methods, and document the skin condition before and after.

In long-term recordings, anticipate pressure injury under stationary electrodes and rotate/inspect sites.

Related Diagnostic Procedures and Terminology

The outline expects familiarity with medical/EEG terminology and related diagnostic procedures - MRI, CT, SPECT, and fMRI - because the order and chart frequently reference them and they provide localization context the EEG can be correlated against. The technologist should understand, for example, that a CT or MRI lesion may predict where focal slowing will appear, and that prior imaging helps the reader interpret an asymmetry. You are not interpreting imaging, but you should recognize the terminology so you can extract relevant findings from the record when planning the recording strategy.

Patient and Special-Population Considerations

• Neonates: Identify conceptional age (gestational plus chronologic age) and behavioral state (active vs. quiet sleep, wakefulness), since normal patterns are age-dependent. Use gentle handling, maintain thermoregulation, and coordinate with bedside staff.
• Pediatric patients: Explain the procedure at the child's level, allow a caregiver to remain, and minimize fear of paste/electrodes. Natural or sleep-deprived sleep improves diagnostic yield.
• Uncooperative or confused patients: Prioritize safety, reduce stimulation, document the limited cooperation and any movement, and avoid forcing activation procedures that cannot be performed safely.
• Critically ill / ICU patients: Confirm line and ventilator safety, coordinate with nursing, and document sedation and the clinical picture.

The technologist always communicates clearly, obtains cooperation appropriate to the patient's age and condition, and documents level of consciousness and any events during the study.