Neurological Assessment

Getting Started Introductions Neurological Assessment Instructor & Staff Neurological Assessment Provider Candidates Neurological Assessment Provider Registration Form Statement of Understanding DAN Membership Form Other Administrative Procedures Course Logistics

Course Overview Nervous System Overview Stroke Decompression Illness Conducting a Neurological Assessment Skill Development Final Assessment and Review

Nervous System Overview Primary Components Central nervous system Brain Spinal cord Peripheral nervous system Nerves Functional unit is the neuron or nerve cell

Nervous System Overview Spinal cord Provides interface between central nervous system and peripheral nervous system Contains nerve tracts or columns that conduct impulses either to or from the brain Possible causes of nerve pathway interruptions Trauma Stroke Decompression Illness (DCI)

Stroke Two Types of Stroke Hemorrhagic Stroke Blood vessel rupture (bleeding in the brain) Thrombotic Stroke Blood vessel blockage (blood clot)

85% of strokes are not associated with headaches Manifestation of Stroke Comes on quickly Sudden loss of motor function Typically on one side of the body Inability to understand or formulate words Loss of visual field Victim may be unaware what is happening 85% of strokes are not associated with headaches

Stroke is the leading cause of long term disability The sooner acute injury is detected and emergency services alerted, the greater the chances that medical treatment will reduce injury and disability.

Stroke F-A-S-T examination is an easy way to determine signs of neurological injury is present

Call 9-1-1 (emergency services) if any of these symptoms are present Stroke Signs and Symptoms of Stroke Sudden numbness or weakness - face, arm, leg Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, balance, coordination Sudden severe headache with no know cause Call 9-1-1 (emergency services) if any of these symptoms are present

N2 Decompression Illness (DCI) Describes the signs and symptoms of an injury caused by breathing gas at depth Includes arterial gas embolism (AGE) and decompression sickness (DCS) First aid treatment for AGE and DCS is the same N2

Decompression Illness (DCI) Decompression Sickness Results from inert gas bubble formation in tissues or blood Size, quantity and location determine impact on normal physiologic function Effects can include distortion or tearing of tissue blood flow interruption activation of blood clotting mechanisms systemic inflammation circulatory system fluid leakage vasoconstriction Effects may persist long after bubbles are gone

Decompression Illness (DCI) Decompression Sickness (continued) Onset occurs after surfacing Factors contributing to DCS include Excess nitrogen Rapid ascent Decreasing ambient pressure DCS symptoms may differ throughout the body Any area of body can be affected

Decompression Illness (DCI) Arterial Gas Embolism (AGE) Results from lung overexpansion injury greatest risk is in shallow water breath-holding Can allow air from lungs enter to enter bloodstream Gas bubbles travel to heart then the arterial system

Decompression Illness (DCI) Arterial Gas Embolism (AGE) (continued) Presents suddenly near or at the surface Risk factors include Breath-hold during ascent Asthma Previous lung injuries

Common Signs and Symptoms of DCI Decompression Illness (DCI) Common Signs and Symptoms of DCI Pain – 40% of cases Numbness and Paresthesia – 27% Extreme Fatigue – 14% Balance and Equilibrium – 6% Muscular Weakness – 4% Cutaneous (Skin) Symptoms – 3% Altered Mental State – 1.2% Bowel and Bladder issues – 0.04% Note: Any suspicion of neurological symptoms should prompt immediate transportation to a medical facility.

Decompression Illness (DCI) First aid for DCS and AGE is the same Most important initial action is early recognition and use of supplemental oxygen For additional information on treating dive emergencies and how to treat injured divers consider taking DAN Emergency Oxygen for Scuba Diving Injuries course.

Remember F-A-S-T First Conducting a Neurological Assessment Remember F-A-S-T First Regardless of cause, if a neurological injury is suspected Call local EMS immediately Be prepared to initiate CPR If injury is dive related, provide oxygen first aid if trained to do so Complete full neurological assessment Note: Performing a neurological assessment should never interfere with EMS activation, evacuation or essential first aid measures.

Neurological Assessment Conducting a Neurological Assessment Taking a History Assists in understanding what happened Can reveal underlying medical issues. Utilize mnemonic SAMPLE Signs/symptoms Allergies Medications Pertinent medical history Last oral intake Events leading to the current situation

Neurological Assessment Conducting a Neurological Assessment Vital Signs Part of baseline history Includes pulse and respiration rates Count each for 30 seconds and multiply by 2 Monitor for changes - may reflect changes in the injured diver’s condition

Neurological Assessment Conducting a Neurological Assessment The Four Functional Areas of a Neurological Assessment Mental function Cranial nerves Motor function Coordination and Balance Note: Performing a neurological assessment should never interfere with EMS activation, evacuation or essential first aid measures.

Neurological Assessment Conducting a Neurological Assessment Mental Function Assess Level of Consciousness (A V P U) A lert V erbal stimulus P ainful stimulus U nresponsive Includes orientation to person, place, time, reason for being there Additional questions address Speech Comprehension Computational skills Memory Note responses

Neurological Assessment Conducting a Neurological Assessment Cranial Nerves Assess facial movement and hearing Eye Control Facial Symmetry and Control Hearing

Neurological Assessment Conducting a Neurological Assessment Motor Function Assess motor strength and function. Symptoms may range from weakness to paralysis. Proper examination entails comparison with the other side of the body. Subtle abnormalities are often detected or confirmed by this process.

Neurological Assessment Conducting a Neurological Assessment Coordination and Balance Assess coordination and balance if the injured person’s responses normal at this point Stroke and DCI may cause nerve-cell injury or impairment affecting coordination and balance.

Neurological Assessment Skills F-A-S-T History Vital Signs Mental Function Cranial Nerves Motor Function Coordination and Balance The skills overview for this course provides general information. There are specific technique elements that will be covered in the skill-development portion the class.

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