Rapid Neuro Exam

Outlaw

hey Mike,

this is very interesting. can you post what you did in the neuro exam? in other words, intepret neuro exam...

Thanks.

Spyros

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sadave

Spyros, I've found this link Neurological Exam to be very helpful.

In my deco course, we were taught a basic "Rapid Neurological Exam" which involved most of the above, but probably not quite so thorough, the other thing we did was a Rombergs Test, which involved the diver standing in bare feet, one foot in front of the other (heel to toe, touching), with arms crossed, hand on opposite shoulders, and eyes closed. Its apparently (I'm about the furthest thing you could possibly find from a doctor!) a good test of neurological function...

I'm sure the docs can expand more on this one!

(btw, I've split this post from the IWR thread, as I believe its important information, and deserves its own thread).

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Mdemon

(Although I think this sub-thread should have been left with the IWR thread - you need to know what to check for before thinking about IWR...)

Part of/a variation of Rombergs, IIRC, is continuing the "one foot in front of the other" by trying to walk (eyes closed!) heel to toe, feet touching. You should be able to do more than a couple of steps before falling over. HOWEVER!!!!! One of the problems we have as divers is WE HAVE NO BASELINE!!!!! So, those reading this would be helping themselves greatly by getting out of their armchairs NOW and trying it a couple of times. (Keep the light low/no bright bulbs or you use the light to help balance).

So, how many steps could you manage? Remember that number. Because if you ever have to do it again in anger and the number is lower, that'll help with the other major symptom, denial. Now you know something might be wrong.

It's a useful test a) if you're not on a pitching ship and b) you've damaged that part of your brain. But every little helps...

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Gilles

OK you caught me couch patato'ing.

3-4 steps not very gracefully, but I do have damaged Lumbar nerves (due to other reasons).

I'll be sending ya a blob for the above advise.

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Dave Sutton

As was written, make sure you capture your baseline on a 42 foot boat rolling in a 5-8 foot sea 100 miles offshore.
Stand heel to toe? Good luck.

This is why the open ocean divers that I've PM'd with on the IWR thread are mostly rolling their eyes.... we need to be able to distinguish the difference between the benign environment of the land and the reality of offshore diving in the North Atlantic or Channel. It's all nice to know stuff, but if it cannot be done...???

What exam would anyone suggest we give to a diver we have put into his bunk on 02 offshore? That's where the rubber meets the road.


Dave

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Drmike

Dave the balance test is only one part of the test , theres more parts to the neuro test that can be done on a boat in rough weather and have been done on a boat in rough weather


Am I not an 'open ocean diver' now? damn These tests or something more basic will be one of the first thing DAN will ask you to do on a patient and I think every operator should be aware of them and how to give them. I cant fathom why the 'open ocean divers' you PMd would roll their eyes at the concept of a neuro exam - unless of course they think doing a neuro is just not macho enough? Ahh the good old days when real men didnt do IWR or take neuros

But seriously, taking the exam in the link as an example:-

All the below in blue can and have been done on board in a bunk, and require no baseline, the stuff in red I see as the only part of the test that could be a problem on a rocking boat (or would benefit from a baseline)


Mental Status:

• Alertness - Does patient seem to be aware of what is going on and able to communicate appropriately
• Orientation - Does patient know who they are, how old are they, where they are, what date/day it is, what have they been doing
• Memory* - Ask patient to remember an three objects then later in the exam ask the patient to recall the objects
• Calculation* - Have patient count backwards from 100 by sevens

Cranial Nerves:

• Eyes - Can patient see, is vision normal, is eye movement normal
• Hearing - Can patient hear equally in both ears, is hearing normal
• Smell - Can patient smell (coffee, peppermint, etc.)
• Facial Muscles - Is the face equal in muscle tone and control, have patient smile
• Tongue - Can patient control tongue movement, it should stick straight out
• Gag Reflex - Does the "Adam's Apple" move when patient swallows
• Facial Sensation - Can patient feel light touch equally on both sides of their face
• Shoulders - Can patient raise their shoulders equally against resistance

Muscle Strength against resistance (using 0-5 scale):

• Arms:
  • Lift arms away from side
  • Push arms towards side
  • Pull forearm towards upper arm
  • Push forearm away from upper arm
  • Lift wrist up
  • Push wrist down
  • Squeeze examiners finger
  • Pull fingers apart*
  • Squeeze fingers together*
• Legs:
  • Lift legs up
  • Push legs down
  • Pull legs apart*
  • Push legs together*
  • Pull lower leg towards upper leg
  • Push lower leg away from upper leg
  • Push feet away from legs
  • Pull feet towards legs

Sensory (have patient close eyes while checking sensory perception):

• Light Touch* - Can patient feel light touch equally on both sides of the body
• Sharp/Dull - Can patient distinguish between a sharp or dull object on both sides of the body
• Hot/Cold* - Can patient distinguish between a hot or cold object on both sides of the body

Coordination* (on any test requiring a patient to stand make sure someone is there to support them):

• Have the patient touch their nose with their index finger of each hand with eyes shut
• Have the patient rapidly slap one hand on the palm of the other, alternating palm up and then palm down - test both sides
• Have the patient walk heel to toe in a straight line - forwards and backwards
• While standing, have the patient touches the heel of one foot to the knee of the opposite leg, and while maintaining this contact, have them run the heel down the shin to the ankle - test each leg
• With eyes closed, have the patient stand with feet together and arms extended to the front, palms up

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Dave Sutton

I have a published Exam Protocol form that I carry aboard EXPLORER, and am trying to find the document file for it to share (different laptop). It's not too much different than what you clipped and attached, it's just in a checklist format that can be filled in during the exam and is designed to be attached to the diver so after evacuation the MD's have it for reference. In any event, what I was trying to say is that there is a huge difference between the clinical setting of dry land and the reality of a rolling small boat. Only a fraction of the tests can be done reliabily offshore on a rolling boat. It pretty much comes down to "Can you talk?", "Can you walk?", "Can you see?", and "Can you feel this?" as I run a Wartenberg Wheel down your legs and on your feet (and yes, I carry one in our medical kit and I know how to use it). "Push against my hands with both of yours and now go back on 02" and we're about finished. It's not going to get much more complex than that. All we are doing is to see if we are looking at Type 1 or Type 2, if if Type 2 setting up a record of symptoms for the next level of treatment personnel to look at.



Dave (looking to find if I have our checklist in electronic format).

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Dave Sutton

Found it:

What I carry is a prototype of this that Mike Emmerman gave me years ago when they were developing this for Lifeguard Syetems:

Catalog

There's an electrinc version somewhere too.... just can not find it. It's on another laptop (not on the boat).


Snap it to the diver when you evacuate him. Ought to be a standard item of emergency kit.


Dave

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Drmike

with respect, I have to disagree with you here.

Perhaps you can highlight from the blue list below what you feel cant be done on a rolling boat or needs a baseline. You can do the arms and leg tests on a diver laying on their back on a bunk if need be.

Mental Status:

• Alertness - Does patient seem to be aware of what is going on and able to communicate appropriately
• Orientation - Does patient know who they are, how old are they, where they are, what date/day it is, what have they been doing
• Memory* - Ask patient to remember an three objects then later in the exam ask the patient to recall the objects
• Calculation* - Have patient count backwards from 100 by sevens

Cranial Nerves:

• Eyes - Can patient see, is vision normal, is eye movement normal
• Hearing - Can patient hear equally in both ears, is hearing normal
• Smell - Can patient smell (coffee, peppermint, etc.)
• Facial Muscles - Is the face equal in muscle tone and control, have patient smile
• Tongue - Can patient control tongue movement, it should stick straight out
• Gag Reflex - Does the "Adam's Apple" move when patient swallows
• Facial Sensation - Can patient feel light touch equally on both sides of their face
• Shoulders - Can patient raise their shoulders equally against resistance

Muscle Strength against resistance (using 0-5 scale):

• Arms:
  • Lift arms away from side
  • Push arms towards side
  • Pull forearm towards upper arm
  • Push forearm away from upper arm
  • Lift wrist up
  • Push wrist down
  • Squeeze examiners finger
  • Pull fingers apart*
  • Squeeze fingers together*
• Legs:
  • Lift legs up
  • Push legs down
  • Pull legs apart*
  • Push legs together*
  • Pull lower leg towards upper leg
  • Push lower leg away from upper leg
  • Push feet away from legs
  • Pull feet towards legs

Sensory (have patient close eyes while checking sensory perception):

• Light Touch* - Can patient feel light touch equally on both sides of the body
• Sharp/Dull - Can patient distinguish between a sharp or dull object on both sides of the body
• Hot/Cold* - Can patient distinguish between a hot or cold object on both sides of the body

Coordination* (on any test requiring a patient to stand make sure someone is there to support them):

• Have the patient touch their nose with their index finger of each hand with eyes shut
• Have the patient rapidly slap one hand on the palm of the other, alternating palm up and then palm down - test both sides
• Have the patient walk heel to toe in a straight line - forwards and backwards
• While standing, have the patient touches the heel of one foot to the knee of the opposite leg, and while maintaining this contact, have them run the heel down the shin to the ankle - test each leg
• With eyes closed, have the patient stand with feet together and arms extended to the front, palms up

__________________

__________________
Cave diving is a sport
Wreck diving is a sport
Diving in general is a sport

'Rebreather diving' is not a sport
its the delusional obsession with a highly dangerous and often inappropriate piece of equipment

sadave

Dave, not every incidence of the bends happens in 5-8foot seas, 100miles offshore.

Previous examples and ideas work well with certain types of diving, and not with others.

Just because they don't work where you dive, is no reason to discount them or rubbish them entirely.

Dave, you need to consider that the diving done by members of this board is about as varied as can possibly be. Wrecks, to Caves, boat dives and shore dives, open ocean and protected lakes. Rebreatherworld covers the whole planet, lots of divers in lots of differing situations. I believe that what has been posted so far in this thread has been good information, and applicable to anyone that dives. OK, so a Romberg test might not work "on a 42 foot boat rolling in a 5-8 foot sea 100 miles offshore" but there are plenty of circumstances where it will work, and as has been stated by Mdemon, every diver should have already done the test to establish a baseline.

Cheers, CD

And btw, Dave, green on your way for the neuro slate, that looks like the goods.

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