EMS World

AUG 2016

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 46 of 61

46 AUGUST 2016 | EMSWORLD.com calm. Intoxication can mask injuries so sobriet y is required. Finally, a reliable patient is free from distracting injuries. Distracting injuries are ones that keep the patient's attention and focus when you are trying to engage the patient in the spine assessment. This can be somewhat subjec - tive; however, if the patient keeps return- ing the conversation to an injury, or can- not carry on a conversation because they another injury's pain is so great, then that injury is distracting their attention and prevents the patient from being reliable. Distracting injuries may include: dislo- cated ankles, impaled objects, open frac- tures, severe abdominal pain and respi- ratory distress. Restrict spinal movement and manage all of the patient's distracting injuries before attempting a spine assess- ment; often proper injury management can increase a patient's comfort to the point where the patient may become reliable. This is especially true for musculoskel- etal injuries, which are often very painful prior to management. Repositioning mus- culoskeletal injuries into their anatomical position, providing padding, and a qual- ity splint often substantially decrease the patient's pain level. Completing an accurate spine history requires the patient's focus and undivided attention. Ask them two questions: "Do you have any numbness, tingling or sensa- tions of electrical activity anywhere in your body?" and "Do you have any pain on your spine?" Try to differentiate discomfort along the ribs and muscles of the back from the spine. Many patients have chronic lower back discomfort in their muscles though they do not have bone pain. When assessing for spine pain, it may be helpful to ask the patient to close their eyes and visualize their spine. Having the patient mentally walk their mind down each vertebra and asking if it hurts may help the patient separate spine from muscle pain. Pain in any verte- bra suggests a spinal column injury. Suspect a spinal cord injury whenever the patient identifies numbness, tingling or electrical sensations shooting through their body. Any evidence of column or cord injury here indicates full spine immobilization is required. Even when evidence in their history suggests a spine injury continue the spine assessment so you can fully identify the injury's severity. The final component to the complete spine assessment is the physical spine exam. A potential spinal injury indicates the need to have several responders assist in log-roll- ing the patient to potentially limit spinal movement. To evaluate the spine itself, roll the patient onto their side, exposing the entire back and neck (the entire spine), and slowly palpate each vertebra from C-1 to L-5 in an attempt to elicit tenderness. To assess for tenderness press firmly on the posterior spinus process for each vertebra; tenderness on any bone suggests that there may be a fracture. Although it may be rea- sonable to assess the spinal column first, it can be done at any point throughout the exam. For example, should a patient have paresthesis, it is reasonable to assess the column last and move the patient only once. Please note that the motor and sensory exam completed during a spine assessment TABLE 2: MOTOR STRENGTH IN SPINAL CORD INJURY 8 Strength Score Motor Activity 0 No contractions or movement 1 Minimal movement noted 2 Limited movement with no resistance, no movement against resistance or gravity 3 Active movement against gravity but not resistance 4 Active movement against some resistance 5 Active movement against full resistance Source: Gondim, Francisco de A ssis Agunio, Spinal Cord Trauma and Related Diseases, ht tp://emedicine.medscape. com/ar ticle/1149070-over view. • Undergraduate concentrations are available in health services management or in science (pre-med) • Accredited by Committee on Accreditation of Educational Programs for EMS Professions (CoAEMSP) • EMS management and EMS education concentrations available in the Master of Health Sciences program emc.wcu.edu 828-227-3516 / mhubble@wcu.edu For more information: ON-LINE O R ON-CAMPUS: Earn your bachelor's or master's degree through WCU! Established in 1977, WCU's Emergency Medical Care Program was the first paramedic program leading to the Bachelor of science degree in the nation. For More Information Circle 36 on Reader Service Card

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