On-site Neurological Examinations Scott Evans DMT, ADC Mixed Gas Diver, NAUI Course Director www.scubajax.com

How do you determine a diving malady?

On-site Neurological Examinations Designed for non-medical personnel to recognize a potential diving injury Information is useful to medical personnel in determining treatment and effectiveness of treatment Provides valuable information to doctor responsible for treatment

Designed for non-medical personnel to recognize a potential diving injury

Information is useful to medical personnel in determining treatment and effectiveness of treatment

Provides valuable information to doctor responsible for treatment

On-site Neurological Examinations The assessment is divided into two parts: Initial Assessment of diving injury Neurological Assessment

The assessment is divided into two parts:

Initial Assessment of diving injury

Neurological Assessment

Initial Assessment Gathering necessary information for proper evaluation Begins the history of the case Made up of FACTS including: Profile Progression History

Gathering necessary information for proper evaluation

Begins the history of the case

Made up of FACTS including:

Profile

Progression

History

Initial Assessment Can help determine preliminary diagnosis and need for immediate treatment If it is determined treatment begin recompression then complete exam once patient is stabilized at depth

Can help determine preliminary diagnosis and need for immediate treatment

If it is determined treatment begin recompression then complete exam once patient is stabilized at depth

Initial Assessment What is the problem? Describe pain (if any) Sharp Dull Throbbing

What is the problem?

Describe pain (if any)

Sharp

Dull

Throbbing

Initial Assessment When was last dive? May not be diving related *Less than 1% occurrence after 6 hours What was profile? Depth Bottom time Equipment used Work preformed Anything occur on dive?

When was last dive?

May not be diving related

*Less than 1% occurrence after 6 hours

What was profile?

Depth

Bottom time

Equipment used

Work preformed

Anything occur on dive?

Initial Assessment How many repetitive dives? Were symptoms noted: Before dive During Dive After dive If during the dive: Descending on bottom Ascending

How many repetitive dives?

Were symptoms noted:

Before dive

During Dive

After dive

If during the dive:

Descending

on bottom

Ascending

Initial Assessment Have symptoms changed since first noticed? Any additional symptoms? History of similar symptoms? History of D.C.S. or AGS? Current medical problems? Ascending

Have symptoms changed since first noticed?

Any additional symptoms?

History of similar symptoms?

History of D.C.S. or AGS?

Current medical problems? Ascending

Neurological Assessment Provides a quick way to determine disorder or/and injury The following six areas of focus provide the best information

Provides a quick way to determine disorder or/and injury

The following six areas of focus provide the best information

Neurological Assessment Mental Status: Orientation Name Location Time and Date Coordination: Muscle groups & brain in-sync Heel toe test Romberg test Finger-to-nose test Heel-shin slide Rapid alternative

Mental Status:

Orientation

Name

Location

Time and Date

Coordination:

Muscle groups & brain in-sync

Heel toe test

Romberg test

Finger-to-nose test

Heel-shin slide

Rapid alternative

Neurological Assessment 3. Motor DCS commonly effects the muscle system in a wide range: Twitching to paralysis Treatment required if signs determine Strength test (looking for bilateral symmetry) Scale: 0 - paralysis 1 - profound weakness 2 - severe 3 - moderate 4 - mild 5 - normal

3. Motor

DCS commonly effects the muscle system in a wide range:

Twitching to paralysis

Treatment required if signs determine

Strength test (looking for bilateral symmetry)

Scale:

0 - paralysis 1 - profound weakness 2 - severe

3 - moderate 4 - mild 5 - normal

Neurological Assessment 3. Motor ’ continued Muscle size Muscle tone Involuntary movement Sensory function (common and may indicate spinal cord dysfunction) Pain Numbness Tingling Deep tendon Reflexes3.

3. Motor ’ continued

Muscle size

Muscle tone

Involuntary movement

Sensory function (common and may indicate spinal cord dysfunction)

Pain Numbness Tingling

Deep tendon Reflexes3.

Quick Neurological Assessment Simple nine step Neuro Exam: Orientation Name & age Location Date & time

Simple nine step Neuro Exam:

Orientation

Name & age

Location

Date & time

Quick Neurological Assessment Simple nine step Neurological Exam: 2.Eyes Have diver count fingers displayed, using 2 to 3 different numbers. Check each eye separately and then together Have diver ID distant object Stabilize head and have diver follow fingers Check pupils equal in size

Simple nine step Neurological Exam:

2.Eyes

Have diver count fingers displayed, using 2 to 3 different numbers.

Check each eye separately and then together

Have diver ID distant object

Stabilize head and have diver follow fingers

Check pupils equal in size

Quick Neurological Assessment Simple nine step Neurological Exam: Face Purse lips (whistle) look for both sides same Grit teeth - exam jaws muscles Have diver close eyes and lightly touch fingertips across the forehead and face to be sure sensation is present and same

Simple nine step Neurological Exam:

Face

Purse lips (whistle) look for both sides same

Grit teeth - exam jaws muscles

Have diver close eyes and lightly touch fingertips across the forehead and face to be sure sensation is present and same

Quick Neurological Assessment Simple nine step Neurological Exam: Hearing 2 feet away from divers ear, rub fingers together Move fingers closer until diver hears Compare to your own hearing

Simple nine step Neurological Exam:

Hearing

2 feet away from divers ear, rub fingers together

Move fingers closer until diver hears

Compare to your own hearing

Quick Neurological Assessment Simple nine step Neurological Exam: Tongue Have diver stick out tongue - should be straight and in middle of mouth

Simple nine step Neurological Exam:

Tongue

Have diver stick out tongue - should be straight and in middle of mouth

Quick Neurological Assessment Simple nine step Neurological Exam: Muscle Strength Shoulder shrug - equal on both sides Check arms - hand push Leg strength - leg lifts

Simple nine step Neurological Exam:

Muscle Strength

Shoulder shrug - equal on both sides

Check arms - hand push

Leg strength - leg lifts

Quick Neurological Assessment Simple nine step Neurological Exam: Sensory Perception Check both sides of body from head to toe, similar to facial exam

Simple nine step Neurological Exam:

Sensory Perception

Check both sides of body from head to toe, similar to facial exam

Quick Neurological Assessment Simple nine step Neurological Exam: Balance and Coordination Heel - toe walk Walk forward and backwards 10 feet Stand up with feet together close eyes with palms up - check for balance Rapid movements Shin rub

Simple nine step Neurological Exam:

Balance and Coordination

Heel - toe walk

Walk forward and backwards 10 feet

Stand up with feet together close eyes with palms up - check for balance

Rapid movements

Shin rub

Quick Neurological Assessment Simple nine step Neurological Exam: Tests 1,7,9 are most important and should be given priority If you omit a test, note reasons why Repeat test every 30 minutes

Simple nine step Neurological Exam:

Tests 1,7,9 are most important and should be given priority

If you omit a test, note reasons why

Repeat test every 30 minutes