Neurological Assessment March - PowerPoint Presentation

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Neurological Assessment

March

2018

v 2.1Slide2

Getting Started

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Introductions

Neurological Assessment Instructor & Staff

Neurological Assessment Provider Candidates

Neurological Assessment Provider Registration Form

Statement of UnderstandingDAN Membership FormOther Administrative ProceduresCourse LogisticsSlide3

Course Overview

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Nervous System Overview

Stroke

Decompression Illness

Conducting a NeurologicalAssessment Skill Development Final Assessment and ReviewSlide4

Nervous System

Overview

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Primary Components

Central nervous system

Brain Spinal cord Peripheral nervous system NervesFunctional unit is the neuron or nerve cellSlide5

Nervous System

Overview

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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)Slide6

Stroke

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Two Types of Stroke

Hemorrhagic Stroke

Blood vessel rupture (bleeding in the brain)

Thrombotic Stroke

Blood vessel blockage (blood clot)Slide7

Stroke

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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 Person may be unaware what is happening85% of strokes are not associated with headaches Slide8

Stroke

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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.Slide9

Stroke

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F-A-S-T

examination is an easy way to determine signs of neurological injury is presentSlide10

Stroke

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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 known causeCall 9-1-1 (emergency services) if any of these symptoms are presentSigns and Symptoms of StrokeSlide11

Decompression Illness (DCI)

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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

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Decompression Illness (DCI)

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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 goneSlide13

Decompression Illness (DCI)

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Decompression Sickness

(continued)

Onset occurs after surfacing

Factors contributing to DCS include

Excess nitrogenRapid ascentDecreasing ambient pressureDCS symptoms may differ throughout the bodyAny area of body can be affectedSlide14

Decompression Illness (DCI)

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Arterial Gas Embolism (AGE)

Results from lung overexpansion injury

greatest risk is in shallow water

breath-holdingCan allow air from lungs to enter bloodstreamGas bubbles travel to heart then the arterial systemSlide15

Decompression Illness (DCI)

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Arterial Gas Embolism (AGE)

(continued)

Presents suddenly near or at the surface

Risk factors include Breath-hold during ascent Asthma Previous lung injuriesSlide16

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. Slide17

Decompression Illness (DCI)

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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.Slide18

Conducting a

Neurological Assessment

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Note:

Performing a neurological assessment should never interfere with EMS activation, evacuation or essential first-aid measures.

Remember F-A-S-T First

Regardless of cause, if a neurological injury is suspectedCall local EMS immediatelyBe prepared to initiate CPRIf injury is dive related, provide oxygen first aid if trained to do soComplete full neurological assessmentSlide19

Conducting a

Neurological Assessment

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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 situationSlide20

Conducting a

Neurological Assessment

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Vital Signs

Part of baseline history

Includes pulse and respiration rates

Count each for 30 seconds and multiply by 2Monitor for changes - may reflect changes in the injured diver’s conditionSlide21

Conducting a

Neurological Assessment

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Note:

Performing a neurological assessment should never interfere with EMS activation, evacuation or essential first-aid measures.

The Four Functional Areas

of a Neurological Assessment Mental function Cranial nerves

Motor function Coordination and BalanceSlide22

Conducting a

Neurological Assessment

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Mental Function

Assess Level of Consciousness (A V P U)

A

lertV erbal stimulusP ainful stimulusU nresponsiveIncludes orientation to person, place, time, reason for being there Additional questions addressSpeechComprehensionComputational skills

Memory Note responsesSlide23

Conducting a

Neurological Assessment

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Cranial Nerves

Assess facial movement and hearing

Eye Control

Facial Symmetry and Control HearingSlide24

Conducting a

Neurological Assessment

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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.Slide25

Conducting a

Neurological Assessment

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Coordination and Balance

Assess coordination and balance if the injured person’s responses are normal at this point

Stroke and DCI may cause nerve-cell injury or impairment affecting coordination and balance.Slide26

SUMMARY

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Reminders

Prompt action is important

Neurological Assessment can provide valuable information for professional care

Any assessments not completed should be noted on the slate

Repeat the assessment every 60 minutes if assistance is not readily availableSooner if injured/ill person’s condition visibly changesSlide27

Neurological Assessment Skills

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F-A-S-T

History

Vital Signs

Mental Function

Cranial NervesMotor FunctionCoordination and BalanceThe skills overview for this course provides general information.There are specific technique elements that will be covered in the skill-development portion the class.Slide28

Questions?

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