There are various forms of neurological examinations with all the major training organisations and medical organisations having their specific recommendations some of which are shown below.
PUFFIN DIVE CENTRE FIVE-MINUTE NEURO EXAM
2. Eyes - Have the diver hold head still. Ask the diver to follow your hand (18 inches from diver's face) while you move it up and down and side to side. The diver's eyes should track smoothly in all direction and should not jerk from side to side (nystagmus). Check peripheral vision. See if pupils are equal in size and respond to light.
3. Forehead - Have diver close eyes while you lightly touch diver's forehead and face. Check that sensation is present and not if there is a difference. With eyes shut tight, check for muscle strength by trying to open eyes above brow. Have the diver furrow brow. Note if there is a difference. Check for skin sensation.
4. Face - Tell diver to purse the lips (as if to whistle). Check to see if diver can pucker lips. Have diver smile. Note if there is a difference in facial muscles. Ask the diver to clench teeth. Feel jaw. Muscles should be of equal strength. Note if there is a difference. Check for skin sensation.
5. Ears - Have diver close eyes. Ask if hearing is abnormal. Check hearing by holding your hand approximately 2 fee from the diver's ear and rubbing your thumb and finger together. Move hands closer until the diver hears sound.
6. Swallow - Instruct diver to swallow while watching his/her Adam's apple move up and down.
7. Tongue - Instruct the diver to stick out his/her tongue. It should come out straight in the middle of the mouth without deviating to either side.
8. Shoulders - Place hands firmly on diver's shoulders. Tell diver to shrug shoulders. Note if there is a difference in strength. Check for skin sensation.
9. Arms - Have diver squeeze your fingers. Note if there is a difference in strength. Have diver grasp hands at chest level, elbows high. Gently push, then pull, elbows while diver resists motion. Note if there is a difference in strength. Check for skin sensation.
10. Chest - Have diver close eyes. Check for skin sensation.
11. Legs - Have diver lie flat. Raise and lower legs while diver resists motion. Note if there is a difference in strength. Have diver stand. Check balance and coordination by having diver walk heel-toe. Ensure that the head does not fall. Check for skin sensation.
If any abnormalities are present, assume that you have a diving accident. Provide appropriate first aid, transport to the nearest medical facility and call EMS. The diver's condition may prevent the performance of one or more of these tests. Record the omitted test and the reason. The neurological exam should be repeated frequently, at least every hour. Record the results and report to medical personnel. Practice the neurological examination frequently to become proficient. Note: Using this cue-card does not replace the necessary training to perform an effective neurological exam.
DO NOT DELAY FIRST AID AND EVACUATION IN ORDER TO PERFORM THIS NEUROLOGICAL EXAM
DDRC NEURO EXAM
Supplied with kind permission from:
The Hyperbaric Medical Centre
PROFFESIONAL ASSOCIATION OF DIVING ACCIDENT MANAGEMENT FLOWCHART
© PADI 2008. ALl rights reserved. These materials are owned by PADI Americas, Inc. and their use herein is with permission from PADI Worldwide Corp.
DIVERS ALERT NETWORK (DAN) ON-SITE NEUROLOGICAL EXAMINATION
DAN Medical Center
On-Site Neurological Examination
Information regarding the injured diver's neurological status will be useful to medical personnel in not only deciding the initial course of treatment but also in the effectiveness of treatment. Examination of an injured diver's central nervous system soon after an accident may provide valuable information to the physician responsible for treatment. The On-Site Neuro Exam is easy to learn and can be done by individuals with no medical experience. Perform as much of the examination as possible, but do not let it interfere with evacuation to a medical treatment facility.
Perform the following steps in order, and record the time and results.
Note: Even though a diver appears alert, the answers to these questions may reveal confusion. Do not omit them.
Note: Have the diver count the number of fingers you display, using two or three different numbers.
Note: If the surroundings are noisy, the test is difficult to evaluate. Ask bystanders to be quiet and to turn off unneeded machinery.
5. Swallowing Reflex
7. Muscle Strength
8. Sensory Perception
Note: The diver's eyes should be closed during this procedure. The diver should confirm the sensation in each area before you move to another area.
9. Balance and Coordination
Note: Be prepared to protect the diver from injury when performing this test.
Puffin Dive Centre Shows these variants as a guide only. Should be used in conjunction with suitable training
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