# Some tidbits I learned recently- pt assessment



## Guardian (Jul 26, 2006)

Just got a chance to read over last months EMS mag and saw some neat pt assessment tidbits yall might enjoy.  If you have any of your own, please include them here.

Some are old favorites that I constantly forget such as positive Babinski Reflex is when toes spread out and up or toward the pt's face and indicates cerebral lesion (maybe normal in child up to 2 y/o).  Negative Babinski Reflex is when big toe curls downward.  If anyone has a memory aid or trick for learning this, please tell me.

Others you may or may not be aware of such as:

Hypoglycemia is most commonly misdiagnosed as stroke because of similar s/s especially in older population so check BGL early and whatever you do, don't give D50 to a CVA pt!.....(unless they need it due to low BGL)

Not sure whether the fluid is blood,CSF, or H2O, along with the halo test you can also check the BGL with your glucometer on this clear fluid.  If it's CSF, it will contain a low amount of glucose.

Unequal pupils that are reactive to light in ALOC is most likely hypoxia, drug overdose, electrolyte problem, hypoglycemia, etc. plus 8% of the population has baseline unequal pupils anyway.  Unequal pupils that don't react with ALOC is likely structural lesion, subarachnoid hemorrhage, tumor, stroke, or epidural hematoma.

Todd's Paralysis is transient focal weakness or paralysis to leg or arm following seizure.  It may indicate focal lesion but important to know that it will go away after a while, hence transient.

Heart rate and fever go hand in hand.  For every 1 degree increase in temperature, the heart increases 10 bpm.  Some diseases such as typhoid and malaria will produce bradycardia however.  A early indicator of sepsis is tachycardia.


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## Guardian (Aug 4, 2006)

Another neat trick I learned the other day is to put someones inhaler into a glass of water.  If it sinks, it has medication in it but if it floats, it is empty.


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## doc5242 (Aug 6, 2006)

If you have a Pt that is complaining of back pain, push down the top of there head, and ask them if it makes the pain worse, if they say yes, there full of crap, this is called the WADDELS Test.


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## ffemt8978 (Aug 6, 2006)

doc5242 said:
			
		

> If you have a Pt that is complaining of back pain, push down the top of there head, and ask them if it makes the pain worse, if they say yes, there full of crap, this is called the WADDELS Test.


It's not an all inclusive test if you read here

But this site also has some good tests for that


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## doc5242 (Aug 6, 2006)

ffemt8978 said:
			
		

> It's not an all inclusive test if you read here




that articles refers to pt's needing SX,  and the spinal pathology, I was referring to the term WADDELLS in general, the specific test IS a clear indication of the Crap of meter, especially when you get the frequent flyers at 2am who are drug seekers, AS it is physiologiclly impossible to pass energy from the top of the head to the spinal process and cause pain with only 25th of a pound of pressure from your hand.


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## ffemt8978 (Aug 6, 2006)

Oh, I agree with you especially after reading the information on the second site I listed.


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## randyb (Aug 24, 2006)

Nice referances.  Thanks!


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## Jon (Aug 24, 2006)

Wow... I missed this.

Great post.


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## eggshen (Sep 6, 2006)

AAHHHH not the D-50/ CVA thing again!!!!!!!!!!

Egg


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## Firechic (Sep 6, 2006)

Why do you say that?


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## Guardian (Sep 7, 2006)

eggshen said:


> AAHHHH not the D-50/ CVA thing again!!!!!!!!!!
> 
> Egg




there must be some big debate i missed


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## Jon (Sep 7, 2006)

eggshen said:


> AAHHHH not the D-50/ CVA thing again!!!!!!!!!!
> 
> Egg


 


Firechic said:


> Why do you say that?


 


Guardian said:


> there must be some big debate i missed


 
I think this point has been made before here, but I don't think it was really a heated debate, at least not here.

Our medical director has posted articals at my part-time job about this... He is against ALS administering D50 in elderly patients to "rule out" hypoglycemia, because it supposedy can worsen the effects of the CVA.


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## Firechic (Sep 8, 2006)

My protocols address the possible CVA patient and administering D50. Hypertonic medications/ fluids are not a good thing for a possible hemorrhagic CVA patient.
I thought there was a previous great and heated debate!!


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## eggshen (Sep 8, 2006)

If you shot someone in the brain w/ d-50 I think that would be a bad thing. Between the metabolism and dilution you tend to get w/ IV admin of anything I think maybe not so much a problem. Now that we finally have a method of checking blood sugar it tends to be a non-issue. I feel one should know what the BGL is before you check anyhow, a good way to get around tehnical imparative problems you tend to see w/ new medics and non thinkers

Egg


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## Guardian (Sep 9, 2006)

you know i'm going to throw my 2 cents into this...I think glucometer is a vital sign in many cases.  If you don't have a cheap little glucometer, you need a new medical director. this shouldn't even be an issue and looking back on it, i'm not sure why I even included it in the initial post.  I guess unfortunately, in some archaic systems it is an issue though...


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