Okay so at this point I think we should do a focused spine assessment.
Should we look at the field guide so that we make sure we follow all the steps?
That sounds great.
Page 19: Five steps.
So the first thing Charlie, I want to make sure that I ask you some questions.
I may have already asked you some of these questions
and then I'm going to do some physical exam tests and, again, I've already done these
so I realize I'm repeating them so bear with me if you will.
Okay.
What's your full name?
Charles Romeo Manganiello.
Roughly what time of day is it?
About one o'clock.
Where are you?
At the Sinks Canyon Center in Lander, Wyoming.
And one more time what happened to you?
I was climbing the tree and there was some snow up there and I slipped and fell.
Okay, so he is oriented to person, place, time, and event.
Have you had any alcohol today?
No.
Any drugs?
No.
Prescriptions? Pain medications? Anything that might cloud your thinking?
Not at all.
Okay great. So he's sober.
And we didn't find any injuries on head to toe.
Is there anything that's starting to hurt you at this point?
No.
So he doesn't appear to be distracted by pain.
And he's calm and engaging in conversation so he's a reliable patient.
Okay next thing Charlie. I want to check your hands and your feet again.
Let's start with your hands.
Can you wiggle all your fingers for me?
Great. Which finger am I touching?
The left pinky.
Okay how about over here?
The right pinky.
Okay, great.
Go ahead and give me a squeeze.
Hands feel warm to me with a strong radial pulse.
That hand feels warm. Also a strong radial pulse.
Are your hands warm to you?
Yes.
Do you have any funny sensations? Hot and cold flashes, numbness, tingling?
Anything that's not normal for you?
No.
Lets do the same on your feet.
Can you go ahead and just bend your knees for me so I can see your feet.
Okay, go ahead and push down on the gas.
Pull up.
Okay, wiggle all your toes.
Which toe am I pinching?
The left pinky toe.
Now?
The right big toe.
Okay.
Your feet feel nice and warm to me. Do they feel warm to you?
Yes.
Okay, same question. Hot and cold sensations, numbness tingling?
Anything out of the ordinary?
No.
Okay, so I've got good circulation, sensation, and motion in all four extremities.
You agree?
I agree.
Okay, you can tuck your legs back into the bag.
I'm gonna take this bag out from under your legs so we can roll you on your side one more time.
Just like we did before we are going to roll you up on your side
and I'm going to walk my fingers down your spine and I want you to tell me if I cause you any discomfort.
On my three. One. Two. Three.
Starting right back up here.
Any pain Charlie?
No.
Okay, I'm going to reach under these clothes again.
Okay.
Still your spine?
Yup.
Any pain?
No.
Okay, we'll go back down on your count Travis.
One. Two. Three.
So Travis and Charlie, what we found on our assessment is that Charlie is awake and oriented
to person, place, time, and event.
He's sober
and he's not distracted so he's a reliable patient.
Charlie, what I found on my assessment is that you had good circulation, sensation, and motion
in both hands and both feet
and when we pressed on your spine from top to bottom
you had no complaints of pain when I did that.
So those are all the steps of the focus spine assessment.
At this point it is my recommendation that Travis can let go of your head
and we'll release spinal stabilization.
Travis, are you okay with that?
I'm okay with that.
Charlie, does that feel okay to you, that we let go of spine stabilization?
Yes.
Okay Travis, so go ahead and let go of his head.
Charlie we can get you into a position that's more comfortable for you.