physical-and-radiographic-examination-of-the-spine

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1、PhysicalandRadiographicExaminationoftheSpineKeytothespineTaskathand...HowtoexamineapatientHowtointerpretradiographicimagesSYSTEMATICAPPROACHSystematicApproachStepsComponentsCorrectDiagnosisBestTreatmentInjuryListenTouchThinkObtainImagingStudiesInterpretationandSynthesis12345Systema

2、ticApproachMissaStep?InjuryListenTouchThinkObtainImagingStudiesInterpretationandSynthesisExaminationTraumaBayE.R.InformationMechanismenergy,energyDirectionofImpactAssociatedInjuriesStartsinthe….Isthepatientawakeor“unexaminable”?What’sthedifferenceAwakeask/answerquestionpush/pain/

3、tendernessmotor/sensoryexamNotawakeyoucanask(buttheywon’tanswer)can’tassesstendernessnomotor/sensoryexamOW!------Does“unexaminable”meannoexam?NO!InspectforbruisingorecchymosisPalpateforstep-offordeformityRectalToneReflexexamBulbocavernosusClonus/BabinskiPosturingIdeal:PatientAwake

4、Step1:FrontalInspectionInspection--patientflat/frontalviewHead:RaccooneyesNeck:cock-robinpostureThorax:chestcontusions,flailchest,asymmetricchestexpansionRemoveallclothesStep1:FrontalInspectionInspection--patientflat/frontalviewAbdomen:lap-beltecchymosisPeritoneum/Pelvis:priapism,s

5、crotalswelling,bruisingExtremities:grossmovement,tone,flaccidRemoveallclothesSpecialCircumstancesMotorcyclistsandAthletesHelmet--staysinplaceinitiallyFacemaskoffCompleteinitialinspectionMulti-memberteamtoremovex-raysbefore/afterStep2:NeurologicalExaminationDetailedandSystematicMoto

6、rSensoryReflexesMotorCervical1muscletotesteachlevel/rootC5:DeltoidC6:BicepsC7:TricepsC8:FingerflexorsT1:HandIntrinsicsPickonemuscleMotorLumbar1motiontotesteachlevel/rootL1/2:HipFlexionL2/3:KneeExtensionL4:TibialisAnt.-footdorsi-flexionL5:EHLandtoedorsi-flexionS1:Ankleplantarflexion

7、PickonemotionMotorThoracicTestable?Functional?(e.g.T5intercostalsvs.T7intercostals)MotorGrade0/5none1/5trace2/5somemovement3/5anti-gravity4/5anti-resistance5/5normal+/-Testincontracted/shortenedpositionBicepsSensoryNormalDiminishedNoneLighttouchDermatomesBeware:“CervicalCape”Sensat

8、ionoverthesternumisnot“sen