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Trauma Resuscitation - part 6

Dù lý do, nếu cuộc khảo sát thứ hai là không được hoàn thành tại Khoa Cấp cứu, điều này phải được rõ ràng tài liệu trong các ghi chú của bệnh nhân và lãnh đạo nhóm cần phải nhắc nhở các bác sĩ lâm sàng chịu trách nhiệm về việc chăm sóc bệnh nhân nội trú trên bàn giao. | SPINAL INJURIES 161 surgery in order to stop the bleeding or transfer to the ICU. Whatever the reason if the secondary survey is not completed in the Emergency Department this must be clearly documented in the patient s notes and the team leader should remind the clinicians responsible for the inpatient care on handover. All too commonly for the lack of a detailed secondary survey injuries that are eminently treatable are missed and go on to produce problems long after the immediate life-threatening conditions have been forgotten. The remainder of this section will concentrate on those aspects of the secondary survey that relate to the management of patients with spinal injuries. The conscious patient A number of symptoms are associated with spinal injury pain in the spine at the level of the injury worsened with movement in the absence of pain ask the patient to cough or tap their heels this may reveal a painful area abnormal or absent sensation ignorance of other injuries particularly fractures presence of weakness or inability to move a limb or limbs. A full neurological examination must be performed on both sides to detect any abnormalities cranial nerves sensation in all dermatomes light touch and pain Figure 7.7 muscle power using the MRC scale Box 7.4 reflexes rectal examination if not already performed during the log roll. BOX 7.4 THE MRC SCALE FOR ASSESSING MUSCLE POWER 0 total paralysis 1 A flicker of contraction but no movement 2 Movement with gravity eliminated 3 Movement against gravity 4 Movement against resistance but reduced power 5 Normal power Myotomes Although strictly speaking most muscles are innervated by more than one nerve root the following actions can be regarded as being performed predominantly by muscles as having one spinal root value C5 shoulder abduction C6 wrist extension 162 TRAUMA RESUSCITATION Figure 7.7 Diagram of the dermatomes C7 elbow extension C8 finger flexion T1 finger abduction L2 hip flexion L3 knee extension L4 ankle .