Appendix 5a Dive Manual

Question 1

What is the purpose of Appendix 5A?

Answer 1

To provide guidance on evaluating diving accidents prior to treatment

This appendix includes a form for recording essential details and conducting a neurological examination.

Question 2

What should be included in the history of the case when a diver reports a medical complaint?

Answer 2

Facts ranging from the dive profile to progression of the medical problem

Review of the diver’s Health Record and Diving Chart or Diving Log is also recommended.

Question 3

What are key questions to ask during the initial assessment of a diver?

Answer 3

1. What is the problem/symptom?
2. Has the patient made a dive recently?
3. What was the dive profile?

Question 4

What should be assessed if the only symptom reported is pain?

Answer 4

a. Describe the pain:
* Sharp
* Dull
* Throbbing
b. Is the pain localized, or hard to pinpoint?

Question 5

What specific information about the dive profile should be gathered?

Answer 5

• Depth of the dive
• Bottom time
• Dive rig used
• Type of work performed
• Any unusual occurrences during the dive

Question 6

What components should be included in a complete neurological examination?

Answer 6

Mental status, coordination, cranial nerves, sensory, strength, deep tendon reflexes

A comprehensive examination provides a thorough assessment of neurological function.

Question 7

What are the key components of Mental Status evaluation?

Answer 7

Alertness, orientation, thought process, mood, and memory

It is important to determine if the patient knows the time and place, recognizes familiar people, and understands what is happening.

Question 8

What types of questions can help assess a patient’s memory?

Answer 8

Questions such as:
* What is your commanding officer’s name?
* What did you have for lunch?

These questions should be reasonable and the examiner must know the answers.

Question 9

What is cognitive function?

Answer 9

An intellectual process that involves awareness, perception, comprehension, thinking, reasoning, and remembering

It encompasses all aspects of perception and thought.

Question 10

How is cognitive function assessed during a neurological examination?

Answer 10

Question 11

What signs should be observed during the Heel-to-Toe Test?

Answer 11

Look for:
* Limping
* Staggering or falling to one side

These signs indicate potential deficits in coordination.

Question 12

How can a patient’s gait provide information about their neurological status?

Answer 12

A normal gait indicates that many muscle groups and general brain functions are normal

Observing how a patient walks is a good indicator of muscle strength and coordination.

Question 13

What is an example of a cognitive function test involving spelling?

Answer 13

Asking the patient to spell a word, such as ‘world,’ backwards

This tests both memory and cognitive processing.

Question 14

What is an example of a cognitive function test involving counting?

Answer 14

Asking the patient to count backwards from 100 by sevens

This assesses cognitive ability and numerical processing.

Question 15

What should be done if a problem arises during the mental status evaluation?

Answer 15

The examiner may choose to assess the patient’s cognitive function more fully

Question 16

What is the Romberg Test used for?

Answer 16

Assessing balance by having the patient stand with eyes closed and feet together

Examiners may also give a gentle shove to test balance further.

Question 17

Describe the Finger-to-Nose Test.

Answer 17

The patient touches their nose with an extended forefinger while standing with eyes closed, alternating arms

An extension includes touching the examiner’s fingertip with eyes open.

Question 18

What does the Heel-Shin Slide Test assess?

Answer 18

Coordination by having the patient slide their heel down the opposite shin while standing

Each leg should be tested.

Question 19

What is the purpose of the Rapid Alternating Movement Test?

Answer 19

To assess coordination by having the patient slap one hand on the palm of the other, alternating positions

Any exercise requiring rapid changes in movement is acceptable.

Question 20

How many pairs of cranial nerves are there?

Answer 20

12 pairs

Cranial nerves emerge from the brain and are involved in various sensory and motor functions.

Question 21

What is the function of the Olfactory nerve?

Answer 21

Provides the sense of smell

This nerve is usually not tested in standard examinations.

Question 22

What does the Optic nerve test assess?

Answer 22

Vision, including light perception and object recognition

Tests should be done one eye at a time.

Question 23

What conditions should be checked during the Optic nerve assessment?

Answer 23

Blurring of vision, loss of vision, spots in the visual field, peripheral vision loss

Tunnel vision is a specific form of peripheral vision loss.

Question 24

How can the Oculomotor, Trochlear, and Abducens nerves be tested?

Answer 24

By having the patient’s eyes follow the examiner’s finger in all four quadrants and towards the nose

This tests eye movement control.

Question 25

True or False: The Oculomotor nerve is responsible for controlling eye movements.

Answer 25

True ## Footnote It works alongside the Trochlear and Abducens nerves.

Question 26

What is the normal response when shining a light into one eye?

Answer 26

The pupils of both eyes will constrict

Question 27

What does the Trigeminal Nerve govern?

Answer 27

Sensation of the forehead and face, clenching of the jaw, and supplies the tensor tympani muscle

Question 28

How is sensation tested for the Trigeminal Nerve?

Answer 28

By lightly stroking the forehead, face, and jaw on each side with a finger or wisp of cotton wool

Question 29

What muscles does the Facial Nerve control?

Answer 29

Scalp, forehead, eyelids, muscles of facial expression, cheeks, and jaw

Question 30

How is the Facial Nerve tested?

Answer 30

By having the patient smile, show teeth, whistle, wrinkle forehead, and close eyes tightly

Question 31

What should be observed when testing the Facial Nerve?

Answer 31

Symmetry of the nasolabial folds

Question 32

What functions does the Acoustic Nerve control?

Answer 32

Hearing and balance

Question 33

How is the Acoustic Nerve tested?

Answer 33

By whispering, rubbing fingers together next to ears, or using a tuning fork

Question 34

What does the Glossopharyngeal Nerve transmit sensation from?

Answer 34

The upper mouth and throat area

Question 35

How is the Glossopharyngeal Nerve tested?

Answer 35

By touching the back of the throat with a tongue depressor to elicit a gagging response

Question 36

What is one of the functions of the Vagus Nerve?

Answer 36

Control of the roof of the mouth and vocal cords

Question 37

How is the Vagus Nerve tested?

Answer 37

By having the patient say 'aah' while watching for the palate to rise

Question 38

What does the Spinal Accessory Nerve control?

Answer 38

Turning the head from side to side and shoulder shrug against resistance

Question 39

How is the Spinal Accessory Nerve tested?

Answer 39

By having the patient turn head from side to side with resistance applied

Question 40

What happens if there is an injury to the Spinal Accessory Nerve?

Answer 40

Inability to turn head to the opposite side or weakness/absence of shoulder shrug on the affected side

Question 41

What does the Hypoglossal Nerve govern?

Answer 41

Muscle activity of the tongue

Question 42

What occurs with an injury to one of the hypoglossal nerves?

Answer 42

The tongue twists to that side when stuck out of the mouth

Question 43

What symptoms may a diver with decompression sickness experience?

Answer 43

Disturbances in the muscle system, ranging from mild twitching to weakness and paralysis

Question 44

True or False: Symptoms involving the motor system should not be treated if they are slight.

Answer 44

False

Question 46

What is the primary symptom of decompression illness related to muscle function?

Answer 46

Muscle weakness ## Footnote Divers often experience muscle weakness due to decompression illness.

Question 47

How is extremity strength testing divided?

Answer 47

Upper body and lower body ## Footnote Extremity strength testing includes assessments for both upper and lower body muscles.

Question 48

What are the grades for muscle strength testing?

Answer 48

0-5 ## Footnote Muscle strength is graded from 0 (paralysis) to 5 (normal strength).

Question 49

What does a grade of 0 indicate in muscle strength testing?

Answer 49

Paralysis. No motion possible. ## Footnote This indicates complete lack of muscle movement.

Question 50

What does a grade of 5 indicate in muscle strength testing?

Answer 50

Normal. Equal strength bilaterally and able to resist examiner. ## Footnote Indicates fully normal muscle strength.

Question 51

List the six muscle groups tested in the upper extremity.

Answer 51

* Deltoids * Latissimus * Biceps * Triceps * Forearm muscles * Hand muscles ## Footnote These muscle groups are tested with resistance from the examiner.

Question 52

How is lower extremity strength assessed?

Answer 52

Walking on heels, walking on toes, and duck walk ## Footnote These tests evaluate both strength and coordination.

Question 53

What is inspected during the assessment of muscle size?

Answer 53

Visual inspection and palpation for size and consistency ## Footnote Symmetry and muscle contours are also examined.

Question 54

What abnormalities in muscle tone should be looked for?

Answer 54

* Spasticity * Rigidity * No tone ## Footnote Abnormal tone can indicate underlying neurological issues.

Question 55

What types of involuntary movements may be observed?

Answer 55

* Slow, irregular movements * Jerky movements * Rapid contractions * Tics * Tremors ## Footnote These movements can indicate neurological dysfunction.

Question 56

What common presentations may indicate spinal cord dysfunction in divers?

Answer 56

Symptoms of decompression sickness ## Footnote These symptoms can vary and may require careful examination.

Question 57

What is the term for the sensation often described as 'pins-and-needles'?

Answer 57

Paresthesia ## Footnote Paresthesia can also refer to sensations of tingling or numbness.

Question 58

What should be performed to evaluate a patient's sensory faculties?

Answer 58

Sensory Examination ## Footnote This examination checks for loss of sensation across spinal segments.

Question 59

How do dermatomal areas of the trunk run?

Answer 59

In a circular pattern ## Footnote This contrasts with the lengthwise pattern in the arms and legs.

Question 60

What are the easily recognized sensations tested in a sensory examination?

Answer 60

* Sharp/dull discrimination * Light touch ## Footnote Testing may also include pressure, temperature, and vibration in special cases.

Question 61

What are ideal instruments for testing changes in sensation?

Answer 61

* Wartenberg pinwheel * Common safety pin ## Footnote These instruments should be applied carefully to avoid pain.

Question 62

Describe the method for testing the trunk.

Answer 62

Move the pinwheel or sharp object from the top of the shoulder down the torso to the groin area ## Footnote Testing should be done on both sides of the body.

Question 63

What pattern is best for testing the limbs?

Answer 63

A circular pattern ## Footnote Test each limb in at least three locations and note any differences.

Question 64

How is the hand tested for sensation?

Answer 64

Run the sharp object across the back and palm of the hand and across the fingertips ## Footnote This helps to evaluate sensory response in the hands.

Question 65

What should be done if an area of abnormality is found during testing?

Answer 65

Mark the area as a reference point ## Footnote This allows for rechecking during treatment to assess improvement.

Question 66

How is the deep tendon reflex examination documented?

Answer 66

* Normal response * Nonexistent response * Hypoactive response * Hyperactive response ## Footnote Responses should be compared to previous observations.

Question 67

What is important to note about reflex responses during examination?

Answer 67

Whether responses are equal bilaterally and if upper and lower reflexes are similar ## Footnote Differences in reflexes may indicate underlying issues.