Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section IV: Trauma

to really think about the answer. You may have to focus the patient’s attention on the neck and back and away from other concerns or injuries to get a reliable answer.

ask him to remain still until you have completed your exam. You can roll a supine patient onto her side to examine her back. Providing head and neck align- ment and support to the patient while doing this is more comfortable and generally safe. It is also safe for the patient to help with the roll if she can do so without pain. While palpating, don’t forget to examine the skin surface for bruising or abrasions.

General Principles

Field Assessment

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New Symptoms : • Neck or back pain

• Numbness or tingling

General Principles

Spinal Cord Cross Section

• Muscle weakness

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• Loss of bowel or bladder control

Anterior (motor)

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Lateral (sensory)

Any symptoms related to this event?

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Central (motor)

The physical examination of the spinal column involves firm palpation or gentle percussion of the midline spine from the base of the skull to the tailbone. You are looking for tenderness that may indicate column injury. If the patient has already complained of back or neck pain, be gentle but continue with the exam to determine location, severity, and the presence of any deformity. It may be useful and necessary to distinguish mid- line spine tenderness from paravertebral muscle tenderness.

Posterior (sensory)

“Different parts of the spinal cord carry different types of messages.”

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The physical examination of the spinal cord uses motor and sensory function to detect injury or ischemia. The motor examination tests the strength of specific muscle groups. In the upper extremities we test finger abduction (spreading fingers apart) or wrist extension against resistance. In the lower extremities we test plantar flexion and dorsiflexion of the feet or extension of the big toe against resistance. Strong and symmetrical muscle strength is a normal response. Sensory pathways in the spinal cord are tested by assessing the patient’s ability to distinguish between sharp and dull touch on all four extremi- ties. An ideal tool for this exam is a cotton swab where the cotton end is used to apply the dull stimulus and the cut shaft is used as the sharp stimulus.

General Principles

Spine Exam

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Physical Exam : • Firm spine palpation for tenderness and deformity • Motor/sensory exam for spinal cord function: - finger abduction, wrist extension - plantar and dorsi-flexion of feet or toes - sharp/dull discrimination

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Signs of column or cord injury?

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Hands on stabilization of the head and neck before and during the exam is unnecessary unless the patient is having trouble maintaining posi- tion on his own. Nodding or shaking of the head while answering your questions is not harmful. A reliable patient will not hurt himself. If you or the patient is uncomfortable with neck movement,