August 2017 v 21 Overview of Neurological Assessment Nervous System Overview Decompression Illness Conducting a Neurological Assessment Skills Development Final Assessment and Review ID: 734437
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Neurological Assessment
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August 2017 v 2.1Slide2
Overview of Neurological Assessment
Nervous System Overview Decompression Illness Conducting a Neurological Assessment
Skills Development Final Assessment and Review
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Nervous System Overview
Primary Components
Central nervous system
Brain
Spinal cord Peripheral nervous system Nerves
Functional unit is the neuron or nerve cell
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Spinal cord
Provides interface between central nervous system and peripheral nervous systemContains nerve tracts or columns that conduct impulses either to or from the brain
Possible causes of nerve pathway interruptions Trauma
Stroke Decompression Illness (DCI)
Nervous System Overview
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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 functionEffects 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 goneSlide7
Decompression Illness (DCI)
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Decompression Sickness
(continued)Onset occurs after surfacing
Factors contributing to DCS includeExcess nitrogenRapid ascent
Decreasing ambient pressure
DCS symptoms may differ throughout the body
Any area of body can be affectedSlide8
Decompression Illness (DCI)
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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 systemSlide9
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 injuriesSlide10
Decompression Illness (DCI)
Common Signs and Symptoms of DCI
Pain – 40% of casesNumbness 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.
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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
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.Slide12
Conducting a Neurological Assessment
Note:
Performing a neurological assessment should never interfere with EMS activation, evacuation or essential first-aid measures.
Remember F-A-S-T FirstRegardless of cause, if a neurological injury is suspected
Call local EMS immediatelyBe prepared to initiate CPR
If injury is dive related, provide oxygen first aid if trained to do so
Complete full neurological assessment
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Conducting a Neurological Assessment
Taking a History
Assists in understanding what happenedCan reveal underlying medical issues.Utilize mnemonic SAMPLE
Signs/symptoms A
llergies Medications
Pertinent medical history
L
ast oral intake
E
vents leading to the current situation
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Conducting a Neurological Assessment
Vital Signs
Part of baseline historyIncludes pulse and respiration ratesCount each for 30 seconds and multiply by 2Monitor for changes - may reflect changes in the injured diver’s condition
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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 Balance
Conducting a Neurological Assessment
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Mental Function
Assess Level of Consciousness (A V P U)A lert
V erbal stimulusP
ainful stimulusU nresponsive
Includes orientation to person, place, time, reason for being there Additional questions address
SpeechComprehension
Computational skills
Memory
Note responses
Conducting a Neurological Assessment
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Cranial Nerves
Assess facial movement and hearing
Eye Control
Facial Symmetry and Control
Hearing
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.
Conducting a Neurological Assessment
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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.
Conducting a Neurological Assessment
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Skills
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F-A-S-T
History
Vital SignsMental Function
Cranial NervesMotor Function
Coordination and BalanceSlide21
Questions?
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