Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

any numbness or tingling anywhere? Do your legs or arms feel weak?” Be direct and attentive, these are important questions and you want the patient 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.

while answering your questions is not harmful. A reliable patient will not hurt themself. If you or the patient is uncomfortable with neck movement, ask them to remain still until you have completed your exam. You can roll a supine patient onto their side to examine their back. Providing head and neck alignment 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 they 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 • Muscle weakness • Loss of bowel or bladder control

General Principles

Spinal Cord Cross Section

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Anterior (motor) Lateral (sensory)

Any symptoms related to this event?

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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.

Central (motor)

Posterior (sensory)

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

© 2018 WMA

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 - sharp/dull discrimination toes

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Signs of column or cord injury?

© 2018 WMA

Hands on stabilization of the head and neck before and during the exam is unnecessary unless the patient is having trouble maintaining position on their own. Nodding or shaking of the head