Neurological Assessment March 2018 v 2 1 Getting

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Neurological Assessment March 2018 v 2. 1

Neurological Assessment March 2018 v 2. 1

Getting Started • Introductions § Neurological Assessment Instructor & Staff § Neurological Assessment Provider

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 2

Course Overview • • • Nervous System Overview Stroke Decompression Illness Conducting a Neurological

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

Nervous System Overview Primary Components Central nervous system • Brain • Spinal cord •

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 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

Stroke Two Types of Stroke • Hemorrhagic Stroke – Blood vessel rupture (bleeding in

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

Stroke Manifestation of Stroke • Comes on quickly • Sudden loss of motor function

Stroke 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 happening 85% of strokes are not associated with headaches 7

Stroke is the leading cause of long term disability The sooner acute injury is

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. 8

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

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

Stroke Signs and Symptoms of Stroke • • • Sudden numbness or weakness -

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 known cause Call 9 -1 -1 (emergency services) if any of these symptoms are present 10

Decompression Illness (DCI) • Describes the signs and symptoms of an injury caused by

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 N 2 11

Decompression Illness (DCI) Decompression Sickness • Results from inert gas bubble formation in tissues

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 12

Decompression Illness (DCI) Decompression Sickness (continued) • Onset occurs after surfacing • Factors contributing

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 13

Decompression Illness (DCI) Arterial Gas Embolism (AGE) • Results from lung overexpansion injury —

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 14

Decompression Illness (DCI) Arterial Gas Embolism (AGE) (continued) • Presents suddenly near or at

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 15

Decompression Illness (DCI) Common Signs and Symptoms of DCI • • Pain – 40%

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

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. 17

Conducting a Neurological Assessment Remember F-A-S-T First Regardless of cause, if a neurological injury

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. 18

Conducting a Neurological Assessment Taking a History Assists in understanding what happened Can reveal

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 19

Conducting a Neurological Assessment Vital Signs Part of baseline history Includes pulse and respiration

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 20

Conducting a Neurological Assessment The Four Functional Areas of a Neurological Assessment • Mental

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. 21

Conducting a Neurological Assessment Mental Function Assess Level of Consciousness (A V P U)

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 22

Conducting a Neurological Assessment Cranial Nerves Assess facial movement and hearing • • •

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

Conducting a Neurological Assessment Motor Function • Assess motor strength and function. • Symptoms

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. 24

Conducting a Neurological Assessment Coordination and Balance • Assess coordination and balance if the

Conducting a Neurological Assessment 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. 25

SUMMARY Reminders • Prompt action is important • Neurological Assessment can provide valuable information

SUMMARY 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 available o Sooner if injured/ill person’s condition visibly changes 26

Neurological Assessment Skills • F-A-S-T • History • Vital Signs • Mental Function •

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 skilldevelopment portion the class. 27

Questions? 28

Questions? 28