Better late than never...
Several days ago I promised an overview of a simple but effective technique for examining a diver quickly but thoroughly for signs of c.n.s.compromise. Alas, life got in the way of my prompt submission of this information & I do apologize to anyone waiting in sleepless anticipation of my posting...
Ahem.
This procedure is, in essence, a secondary survey specific to neuro-muscular assessment. It goes without saying that a primary survey has proven normal & there are no more immediate medical concerns to be dealt with.
This rapid neuro. assessment combines casualty questioning, sensory, motor, coordination & reflex analysis. It is a useful tool to assist in the quick determination of c.n.s. involvement in the diving casualty.
With the casualty supine & starting at the head, assess mental status beginning with...
Orientation:
> "What is the time of day"?
Memory:
> "Repeat this sequence of numbers back to me" (5 digits)
Capacity:
> Starting at 100, subtract 7 until 72 is reached.
If all checks out, continue on with...
Sight:
> Have the casualty follow with their eyes as you move your finger up & down, left & right
(Smell: if you have a source of distinct odour on hand, such as mentholatum, test one nostril at a time)
Trigeminal nerves...
> ask the casualty to clench their teeth
> smile? (facial nerves)
Hearing:
> with one ear closed, snap your fingers. Test both ears.
Talking:
>listen for gagging & proper enunciation
> language foul-ups (misplaced words, wrong word order)
Tongue:
> ask them to stick it straight out (does it droop to one side?)
Moving on down...
Shoulder muscles:
>have them shrug their shoulders while you press down on them ( is the force equal on both sides?)
Sensory Nerves...
"Sharp vs. Dull" ( check one hand against the other):
> using sharp & dull objects, see if the casualty can tell the difference by testing the back of the hand, the base of the thumb & the base of the little finger.
Motor Nerves...
Strength:
>Have the casualty grip two of your fingers in each hand. Is the strength the same in each hand?
>Press down lightly on the legs just above the ankles & ask the person to lift his legs. Is the strength equal?
Range of Motion:
>Check for normal movement in the arms & legs
Babinsky Reflex:
> run a blunt object up the sole of the foot. If the toes curl foreward, a normal Babinsky is indicated. If the toes flex backward & spread, it is a reliable sign of impairment. If nothing happens, no conclusion can be drawn.
Priapism:
> In the male patient, a consistent penile erection can be indicative of c.n.s. compromise.
With the person standing, check...
Coordination:
>Stand about 2' away, hold up one finger & ask the person to touch your raised finger with their index finger.
>ask them to alternately touch their nose & then your finger several times reasonably quickly.
>Have the patient walk heel-to-toe for several steps
It may seem like alot, but with practice, you should complete this exam in about :5. Be sure to include the accessories needed for the test in your 1st Aid kit.
Regards,
D.S.D.
Several days ago I promised an overview of a simple but effective technique for examining a diver quickly but thoroughly for signs of c.n.s.compromise. Alas, life got in the way of my prompt submission of this information & I do apologize to anyone waiting in sleepless anticipation of my posting...
Ahem.
This procedure is, in essence, a secondary survey specific to neuro-muscular assessment. It goes without saying that a primary survey has proven normal & there are no more immediate medical concerns to be dealt with.
This rapid neuro. assessment combines casualty questioning, sensory, motor, coordination & reflex analysis. It is a useful tool to assist in the quick determination of c.n.s. involvement in the diving casualty.
With the casualty supine & starting at the head, assess mental status beginning with...
Orientation:
> "What is the time of day"?
Memory:
> "Repeat this sequence of numbers back to me" (5 digits)
Capacity:
> Starting at 100, subtract 7 until 72 is reached.
If all checks out, continue on with...
Sight:
> Have the casualty follow with their eyes as you move your finger up & down, left & right
(Smell: if you have a source of distinct odour on hand, such as mentholatum, test one nostril at a time)
Trigeminal nerves...
> ask the casualty to clench their teeth
> smile? (facial nerves)
Hearing:
> with one ear closed, snap your fingers. Test both ears.
Talking:
>listen for gagging & proper enunciation
> language foul-ups (misplaced words, wrong word order)
Tongue:
> ask them to stick it straight out (does it droop to one side?)
Moving on down...
Shoulder muscles:
>have them shrug their shoulders while you press down on them ( is the force equal on both sides?)
Sensory Nerves...
"Sharp vs. Dull" ( check one hand against the other):
> using sharp & dull objects, see if the casualty can tell the difference by testing the back of the hand, the base of the thumb & the base of the little finger.
Motor Nerves...
Strength:
>Have the casualty grip two of your fingers in each hand. Is the strength the same in each hand?
>Press down lightly on the legs just above the ankles & ask the person to lift his legs. Is the strength equal?
Range of Motion:
>Check for normal movement in the arms & legs
Babinsky Reflex:
> run a blunt object up the sole of the foot. If the toes curl foreward, a normal Babinsky is indicated. If the toes flex backward & spread, it is a reliable sign of impairment. If nothing happens, no conclusion can be drawn.
Priapism:
> In the male patient, a consistent penile erection can be indicative of c.n.s. compromise.
With the person standing, check...
Coordination:
>Stand about 2' away, hold up one finger & ask the person to touch your raised finger with their index finger.
>ask them to alternately touch their nose & then your finger several times reasonably quickly.
>Have the patient walk heel-to-toe for several steps
It may seem like alot, but with practice, you should complete this exam in about :5. Be sure to include the accessories needed for the test in your 1st Aid kit.
Regards,
D.S.D.
