1. Neurological Assessment
August 2017 v 2.1

2. Overview of Neurological Assessment
Nervous System Overview
Decompression Illness
Conducting a Neurological Assessment
Skills Development
Final Assessment and Review

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

4. 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)

5. 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

6. 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

7. 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

8. 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 to enter bloodstream
Gas bubbles travel to heart then the arterial system

9. 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

10. 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.

11. Decompression Illness (DCI)
First aid for DCS and AGE is the same
Most important initial action is early recognition and use of supplemental oxygen
Additional information on treating dive emergencies and how to treat injured divers utilizing emergency oxygen for scuba diving injuries is provided next in this course.

12. 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.

13. 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

14. 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

15. 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.

16. 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

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

18. 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.

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

20. Skills F-A-S-T History Vital Signs Mental Function Cranial Nerves
Motor Function
Coordination and Balance

21. Questions?