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 47 of 61

EMSWORLD.com | AUGUST 2016 47 EMS1608S For More Information Circle 37 on Reader Service Card is dynamically different from an evaluation of circulation, sensation and movement (CSM). A CSM check evaluates the integrity of the neurovascular bundle in an extremity and the motor and sensory exam evaluates the body's ability to send and receive signals between the distal aspect of an extremity and the spinal cord itself. Do not confuse these two assessments. A distal motor and sensory exam evalu- ates the patient's extremities for bilateral equality of strength and sensory skills. Per- form full spine immobilization whenever a patient demonstrates inequality between strength or sensory function. Motor strength in the upper extremities can be evaluated with either wrist exten- sion or finger abduction against moderate resistance. Both the wrist and fingers are innervated by the upper extremity's most distal dermatome. To test wrist extension, stabilize the lower arm firmly (usually against the ground), and apply moderate pressure with one hand against the poste- rior aspect of the patient's hand. Then, ask the patient to extend their hand upward against your pressure. Repeat this on the other side. Alternatively, test the patient's finger abduction strength when the patient cannot extend their wrist for a non-spine injury-related reason (e.g. splinted extremi- ty). Have them spread their fingers apart and ask them to resist your attempt to squeeze their index and ring finger together. The resistance should be identical in each hand. Test lower extremity motor strength with the extension and f lexion of either the patient's ankle or great toe. Bear in mind that this is different from the upper extremity motor test, which only evaluates extension. Apply pressure against both feet simultaneously and ask the patient to pull their feet toward their head. Immediately place your hands on the inferior aspect of the feet and ask the patient to push down as if pressing the gas pedal. Both legs normally have equal strength. Abnormal weakness on one side suggests spinal cord injury. Use the same f lexion and extension process with only the great toe whenever an injury or illness prevents the patient from moving their ankle normally. The final portion of the spine assessment is a sensory skill examination. Successful completion requires the patient distinguish between light/soft touch and sharp (pain) touch at the distal end of each extremity. Evaluating pain sensation tests the free nerve endings in the skin, and light touch evaluates the Meissner corpuscle. Good tools must be used to accurately test these nerve endings cotton balls or Kling are great objects capable of triggering a light touch sensation, and a safety needle or pointed tweezers effectively trigger pain sensors. Pressure sensors are not being tested, only pain and light touch nerve endings. To be sure the patient can effectively distinguish the two objects selected test them on the patient's forehead; the skin of the forehead is nearly always unaffected by a spine injury. While testing an extremity, keep it out of sight of the patient, but do not hold it with your hand or arm as this will trigger other nerves in the patient's extremity. In the

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