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

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Wilderness and Rescue Medicine

every time, so you may need to perform repeated tests in different places to confirm your results. No Spine Injury If the spine assessment is normal (negative) the spine is clear, and you can remove spine injury from the problem list. Be aware that it is com- mon for trauma patients to develop various minor aches and pains as swelling and inflammation increases over several hours. A stiff neck or back is one of these common late occurring symptoms. If you were able to clear the spine initially, this does not indicate a significant injury.

General Principles

Spine Exam

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Motor exam for the upper extremities: Distal motor and sensory exam:

• Finger abduction or • Finger or wrist extension against resistance

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Sensory exam for the upper extremities: • Intact sensory perception (No tingling or numbness) • Differentiation between pain/sharp and light/dull stimulation on the hand and wrist

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©2018WMA

General Principles

Spine Exam

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General Principles

Spine is Clear WILDERNESS PROTOCOL

Distal motor and sensory exam: Motor exam for the lower extremities: • Dorsiflexion and plantar flexion of foot. or • Extension of big toe.

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• Normal mental status; reliable patient • No new pain, tingling, numbness or muscle weakness • No spine tenderness • Normal motor and sensory exam

Sensory exam for the lower extremities: • Intact sensory perception (No tingling or numbness) • Distinction between pain/sharp and light/dull stimulation on top of foot or lateral aspect of lower leg or ankle

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©2018WMA

©2018WMA

General Principles

Pick One: • No Spine Injury (clear) • Low Risk Spine Injury • High Risk Spine Injury • Non-emergent • Emergent Field Assessment Results

Low Risk Spine Injury Any positive findings during the assessment such as persistent pain, tenderness, unequal muscle strength or asymmetrical sharp vs dull discrimi- nation mean that you should assume that the spine is injured. Later examination during evacu- ation or in the hospital may clear the spine, but for now you should protect the spine from further injury as best you can under the circumstances. Now the question becomes; is this spine injury serious or not serious, high risk or low risk? This will determine the urgency of evacuation and how much risk is acceptable in executing it. Fortunately, most spine injuries are at low risk for complica- tions from normal activity and can be evacuated on a non-emergent basis, often by walk-out. The few high-risk injures that do occur in the field should, ideally, be stabilized and carried out.

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The patient is asked to distinguish, without look- ing, one end from the other when pressed against the skin. The upper extremities are tested on the ulnar and dorsal aspect of the hand. The lower extremities are tested on the lateral aspect of the foot or lower leg. An asymmetrical response where one side is very different than the other would be considered abnormal. Calluses or cold extremities may prevent a precise response