1. Neurological Assessment

2. 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

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

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

5. 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)

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

7. 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

8. 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.

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

10. 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 (emergency services) if any of these symptoms are present

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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.

18. 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.

19. 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

20. 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

21. 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.

22. 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

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

24. 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.

25. 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.

26. 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.

27. Questions?