# May seem like an odd question



## LdSb (Apr 3, 2008)

But I cant seem to find the answer Im looking for.  If you have an unresponsive patient and you are trying to complete your PMS checks on all the extremities, since they are unresponsive they cant tell you which toe you are touching or they cant squeeze your hands.  Are there any other quick/efficient ways of doing so?

Thanks in advance.


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## CFRBryan347768 (Apr 3, 2008)

*Are*

they unresponsive to painful stimuli? and their still breathing right? hah


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## LucidResq (Apr 3, 2008)

You can check for a pulse. You can't check for movement. You can't check for sensation (unless they responsive to touch or pain, which is a good think to check). 

Do what you can. I would just check for a pulse and watch their skin.


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## LdSb (Apr 3, 2008)

Would rubbing your finger across the bottom of their foot or palm of the hand to see if their fingers/toes curl count as motor/sensory?


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## LucidResq (Apr 3, 2008)

LdSb said:


> Would rubbing your finger across the bottom of their foot or palm of the hand to see if their fingers/toes curl count as motor/sensory?




I don't know about sensory... I believe you're referring to the plantar reflex test (I don't think this reflex occurs in the hands). I don't think it would really be comparable to the whole "which toe am I grabbing?" game because it's just testing for a reflex, so you don't have to consciously feel the stimulus for the reflex to happen. If anything it would be more of a motor test. 

The plantar reflex tests the integrity of the spinal cord from L4 to S2 and the corticospinal tract (essentially the bundle of nerve fibers that connect the brain and spinal cord). Normally if you draw an object down the side of the sole of the foot, a person's toes will curl downwards in plantar flexion. If there is disease or damage to the spinal cord at L4-S2 or in the corticospinal tract the big toe dorsiflexes (curls back towards the top of the foot) and the other toes fan out. This is called Babinski's sign, and it also appears in normal healthy infants because their neurons are not fully developed. 

As for a sign of motor, perhaps. However, I believe that (and more experienced folks correct me if I'm wrong) if you have someone who's totally unresponsive, it's not really necessary to check for motor and sensation since it's basically impossible.


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## LdSb (Apr 3, 2008)

Cool.  Thanks for all your input, it is much appreciated.


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## Onceamedic (Apr 3, 2008)

If your patient is unresponsive to pain, they are unconscious.  Sensation and movement in this patient is an oxymoron...  that is why they anethesize people for surgery...
There is no point and no reason to check for sensation and movement in the extremities of an unresponsive patient.
If you are doing a neurological assessment, then yes - you MAY check for reflexes but even these are relatively unneccessary in the age of CT scans.  
Wierd question man..   or maybe I am missing something


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## emtwacker710 (Apr 4, 2008)

If I were in that situation I would 1st try a sternal rub after ABC's of course, if the pt. still remains unresponsive I would then check all 4 distal pulses and skin color to make sure they are hopefully normal, then procede with my rapid assessment...etc...


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## MSDeltaFlt (Apr 4, 2008)

When it comes to assessing PMS (or SMC's) in an unresponsive pt (a true GCS of 3), if they are unresponsive you will only be able to assess pulses.  That's it.  If the GCS is that low, you've got other things pressing than if their ext is numb or not.

Depending on where their GCS is, if it's above 3 and less than 15, you might be able to adequately assess PMS, then again you might not.  If their motor is at 2 or 3, you MIGHT be able to assess sensation.  Probably won't, but you you might.  If they're posturing before the stimulation, then you won't.  If their motor is 4 or 5, then you can watch the reaction.  A motor of 6 is self explanatory.

Now if their verbal is less than 5, take what they say 9 (or what they don't) with a grain of salt.

Hope this explains it well enough for you.


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## daedalus (Apr 4, 2008)

LucidResq said:


> I don't know about sensory... I believe you're referring to the plantar reflex test (I don't think this reflex occurs in the hands). I don't think it would really be comparable to the whole "which toe am I grabbing?" game because it's just testing for a reflex, so you don't have to consciously feel the stimulus for the reflex to happen. If anything it would be more of a motor test.
> 
> The plantar reflex tests the integrity of the spinal cord from L4 to S2 and the corticospinal tract (essentially the bundle of nerve fibers that connect the brain and spinal cord). Normally if you draw an object down the side of the sole of the foot, a person's toes will curl downwards in plantar flexion. If there is disease or damage to the spinal cord at L4-S2 or in the corticospinal tract the big toe dorsiflexes (curls back towards the top of the foot) and the other toes fan out. This is called Babinski's sign, and it also appears in normal healthy infants because their neurons are not fully developed.
> 
> As for a sign of motor, perhaps. However, I believe that (and more experienced folks correct me if I'm wrong) if you have someone who's totally unresponsive, it's not really necessary to check for motor and sensation since it's basically impossible.


Brilliant! You are correct to my knowledge. 

I have a question, is this reflex important in the field? Rid? or anyone??


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## LucidResq (Apr 4, 2008)

I can't see any use for it in the field. If you had a positive result it shouldn't affect your treatment, except perhaps if you hadn't already taken spinal precautions it may encourage you to do so. In the prehospital setting I don't think there's any need to localize where the lesion/injury may be. 

I can imagine that ED physicians may use it if they suspect spinal injury, but it actually seems like a test that is used more when they're checking someone out with non-traumatic neuro deficits in a non-acute setting. I'm not really sure though. 

My A&P professor was a spankin' new neurosurgeon and he referred to checking that reflex on non-trauma patients.

Thank you by the way. I probably wouldn't know anything about this stuff if it weren't for that aforementioned instructor. He went way overboard on the neurology unit for obvious reasons.


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## el Murpharino (Apr 4, 2008)

The babinski reflex is rare in people over the age of 2.


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## Onceamedic (Apr 4, 2008)

Babinski in people over 2 is a sign of serious brain injury...


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## triemal04 (Apr 4, 2008)

Actually, every paramedic and any EMT who wants to be even considered decent at what they do should know what this is, how to assess it, and what it means.

Early ER notification...potential for alternate destination...alternate means of transportation...the fact that your pt is having fairly serious problems and may detiriorate on you...getting a positive babinksi sign should be making you consider all these things and more.  

Just because having an extra piece of information doesn't mean that we automatically start "doing" more things to a pt doesn't mean that it's not important to know about it, or that it won't potentially alter the pt's outcome.  

Forgetting that is a mistake that far to many people (at all levels) make.


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