Navy Diver Neurological Exam

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Knowing how to do a Navy Diver Neurological Exam is good to know even if you're not a US Navy Diver.  Falls under the "Smart people do smart things" protocol. 

As a former US Navy EOD Diver and Navy Dive Instructor, we all have to study dive medicine.  Navy EOD does not travel with Dive Med Techs or 18D's...I wish we did but there's not enough room in the boat.

Here's a quick way to do a Neuro on a diver that just came up and you sense something just isn't right.

If you're in a small boat, have the stricken diver sit down.

Begin by simultaneously asking questions about the dive and looking how straight they are sitting up. Look at their eyes.  Going off in different directions?  Pupils dilated?

"How deep was your dive?"

"How long were down for?"

"How long did it take you to reach the surface?"

"What day is it?"

These are all short-term memory questions that should be easy to answer.  Miss one or two questions, you may have a problem.

"Who is the president of the United States?"  Like him or not, you should be able to answer that easily.

"What year is it?"

"How old are you?"

"What city were you born in?"

These are long-term memory questions.  Again, you're putting together pieces of a puzzle.

Spell "world" backwards" or my favorite, spell "race car" backwards.

Triple consonant words spelled backwards will be tough if the diver is experiencing a neuro deficit.

While you're asking these questions, have the diver say, "Ah" just like the MD's do.  You're looking for symmetry.  If their face is crooked, start heading to shore!

Have the diver stick his tongue out and direct him to move it left and right.  Symmetrical?

Look left and right by your direction.  Does his head move equally.  Keep in mind, he may have a previous injury that prevents him from moving his head equally.

Shoulder shrugs.  Equal?  You can press down on his shoulders to check if strength is equal.

Cross your arms with your index and middle fingers pointing at the stricken diver.  Have the diver cross his arms grab your fingers and squeeze as hard as possible.  Are they equal?

All of our nerves begin with the spinal cord so we can't leave that out!

Does the diver have Pain, Numbness or Tingling?

If you're diving in really cold water, this is a tough set to successfully complete.

You're looking for "Sharps and Dulls."  If you drug the point of a nail down your arm, you'd know it and you'd certainly know the difference between the nail and say, a baseball.

When there's injury to the nervous system radiating out from the spinal cord, you need to find the "dead spots" and mark them with a sharpie to see if they're growing or shrinking?

One of the best tools I've found is a set of medical shears called Rip Shears.  The pointy end of the blade is rounded but can still be used for "Sharps."  The handle can be used for "Dulls" and you don't have to worry about having a specialized tool, using you dive knife and puncturing a hole in your boat or patient.

They're perfect for boat ops and dive ops as they can also cut through wet suits, tubular nylon, line and cord without risk of personal injury or boat punctures.  On top of all that, there's an Oxygen valve wrench built in.  Rip Shears are available at EOD Gear

Please keep in mind, as you're conducting a Navy Diver neurological exam, you should be motoring to the nearest medical facility.

Be sure to write down times as you write down all that is happening starting when the diver left the surface, how deep the dive was and what time he hit the surface.

You can find the US Navy Dive Manual in it's entirety in an iTunes App by clicking here.

Disclaimer:  Other than being a former Navy EOD Diver and Dive School Instructor, I am not a licensed physician.  This instruction is provided for your information and general knowledge.  I assume no responsibility for accuracy, completeness and your bad diving.

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