Neuro field testing for DCI

[RumBum]

<Mandatory Disclaimer: only a medical professional can diagnose DCI. Passing or failure of a field test is not a diagnosis of or contraindication to clinical DCI.>

I was reading an article that endorsed the wisdom of field testing but never got around to saying what to do. I think that it would help a lot of divers who are very stubborn who may otherwise delay seeking medical treatment.

1. If a fellow diver has symptoms that may be suspect for DCI, what are some simple field testing methods one could use to gather more information?

2. Please explain what would your professional reaction be to someone who failed one component of testing but passed all others with flying colors? Two components? Where is the line that indicates "EMERGENCY"?

I guess tandem gait testing would be a good idea (hard to do on a boat though), finger-to-nose test, oriented in 4 spheres...

Thank you!

 

[H2Andy]

here's one of many, many 5-minute neurological test guides:

http://www.wkpp.org/neuroexam.htm

as to what constitutes a problem, any kind of indication that there may be
a problem would be good enough for me. if in doubt, at least put them
on O2. can't hurt while the pros show up.

 

[TSandM]

The examination on the WKPP site is a pretty thorough one, but you can screen faster.

Observe the person's face while they are talking to you. Look for asymmetric movement. Have them show you their teeth -- again, look for asymmetry.

Have the person hold their arms out in front of them, palms up, with eyes closed. Look for a tendency for one arm to start to turn over (pronator drift). This is a subtle weakness test.

Have the person walk a few steps on their toes and on their heels. (If they can't stand or walk, you don't need a screening test!) This tests strength and balance at the same time, although it's not a specific cerebellar test.

With regards to the question about how much you have to "fail" to be worrisome -- I'd say any of it; and even subjective complaints of numbness or paresthesias (tingling) would be enough to get somebody on O2 and headed for a doctor. From what I've read, a lot of serious neurologic hits start with relatively minor or subtle symptoms and progress.

 

[Dive-aholic]

Like Lynne said, any failure is enough to warrant emergent action. The "failure" might be baseline for the person, but unless you already know this, treat it as a hit. People show up in the ER all the time complaining of "chest pain" that we know is either heart burn or musculoskeletal...because it was the last dozen times they were in this month. We generally still treat it as a cardiac condition because the one time you don't it will be the real thing. Better safe than sorry!

 

[made for it]

As said in the last 4 messages, if any symptoms arise treat seriously especially if they occur within the first or second hour after a dive (Which DAN states can be the start of a serious DCI case)
For a Joe Blogs diver checking them selves or a fellow diver on a dive trip as a first step to recognise a potential DCI hit, I suggest either having a look at SSI's rescue slate as the 1st step or either do the new DAN neuro course which I believe has just come out. However this does not exclude you seeking advise from a DMO/Dive medic who specialise in this area.
My moto has always been "When in doult give them oxygen" keep it that simple, seek proffesional assistance A.S.A.P even if the out come was not DCI, then you know you did the right thing.

made for it
(Diver Medical Technician)

 

[Dr Deco]

Hello readers:

Many thanks for the medical replies to this query. Yes, subtle neurological findings are very important.

As Dr. Chris Lambertsen (of University of Pennsylvania) would say, “If you see a little, then you have found a lot.”

Dr Deco :doctor:

 

[MikeM878]

There is a video providing info on a field neuro "exam" on the Catalina Hyperbaric Chamber web site at http://wrigley.usc.edu/hyperbaric/neuro/neuro.htm