Hospitalized patient Flashcards
Most common hospital consults (Top 4)
Pneumonia
COPD
Asthma
Bronchitis
C6 nerve emerges between which 2 vertebrae?
C5 and C6 vertebrae
Thus C5-C6 disc herniation can impinge upon C6 nerve root.
C6: motor, reflex
Biceps (C5-C6)
Wrist extensors
Reflex: brachioradialis
L4 - motor, reflex, sensation
Foot inversion (tibialis anterior)
Patellar reflex
Medial aspect of foot sensation
L5 - motor, reflex, sensation
Great toe extension (EHL)
NO REFLEX* trick :)
Dorsum of foot sensation
S1 - motor, reflex, sensation
Foot eversion (peroneus longus, brevis) Achilles tendon Lateral foot
Spurling’s test tests for
Narrowing of neural foramina
Sidebend and backward bend head –add compression
Positive if pain radiates to ipsilateral arm
Underburg test tests for
Vertebral artery insufficiency
Supine, backward bend, rotate, WAIT 30 seconds
+ with dizziness, nausea, lightheadedness
3 primary goals and guidelines as written by Kenneth Graham
Prevention and tx of many common problems/complications of hospitalization
Return to function
Guidelines are not designed to address a lifetime of somatic dysfunction
Situations to avoid or be cautious in when doing OMT on hospitalized patient
CVA/TIA/DVT/PE/MI Uncooperative Osteomyelitis Unresponsive/lethargic Cancer/Mets/Spinal fxs
Sympathetics to bladder
T11-L2
Sympathetics to prostate
T12-L2
Sympathetics to LE
T11-L2
Sympathetics to UE
T2-8
Sympathetics to upper ureters
T10-11
Sympathetics to lower ureters
T12-L1
Sympathetics to uterus and cervix
T10-L2
Sympathetics to erectile tissue
T11-L2
Sympathetics to adrenals
T10
Somatic dysfuncton of OA (vagus and cranial base) may result in what effects on CN X and the head
Direct muscular pressure and myofascial tension on CN X.
Compression of jugular v. causing venous back pressure on CN X
Inhibit venous and lymphatic drainage and return from head
Somatic dysfunction in superior cervical ganglia –unopposed SANS stimulation (vasoconstriction/mucosa drying), increased SANS tone (beneficial vasoconstriction and decongestant), inhibited SANS tone
11 beneficial effects of rib raising
(1) Enhance and encourage the “toilet” expectorant function of the lungs
(2) Facilitate and encourage venous and lymphatic circulation and drainage in the lungs and abdomen
(3) Encourage mucous drainage from the lungs
(4) Increase rib cage mobility, which encourages chest and diaphragm excursion
(5) Decrease pulmonary inflammation and congestion
(6) 1-5 plus gentle ballottement of lung tissue, secondary to rib raising motion, can decrease the incidence of atelectasis and pneumonia
(7) Directly stimulate increased ANS tone, thru a pumping action on the SANS chain ganglia, resulting in bronchodilation
8) Rib raising on lower 6 ribs can encourage diaphragm motion
(stimulates diaphragm to wake up)
(9) Improved SANS function, chest cage mobility, diaphragm motion, and venous and lymphatic drainage can all combine to imporve arterial and venous/lymphatic circulation within the lungs and other areas, which can decrease pulmonary congestion and inflammation, maximize tissue levels of oxygen and adaptive immunity (macrophages, IG’s, T-cells etc), improving delivery of antibiotics and other meds to lungs and body tissues
(10) Gentle rocking motion produced by rib raising can stimulate and encourage return to normal peristaltic activity( ileus, nausea).
(11) Rib raising motion can also stimulated other internal organs to recover from organ stasis and return to normal functioning
12) Encourage increase SANS tone to the heart (benefit in CHF) - enhancing HR, Cardiac output, and Conduction of Heart
(13) Balance excessive SANS tone to the GI Tract, and GenitourinarynSystems
(14) Balance SNS tone to ENT and sinuses
(15) Enhance venous and lymphatic return from ENT and sinuses-decreasing swelling, edema, congestion, and inflammation
SD of OA/cranial base may result in what effect on cranial venous sinuses and vertebral vv.?
back pressure extending into lower brainstem where vegetative centers for heart, GI, respiratory centers are located. Thus may result in decreased arterial circulation to the brainstem and put direct venous compression to the brainstem.
SD of OA/cranial base may result in what kinds of effects in GI system?
Can facilitate excessive sensory input to vomiting center – > N/V
Excessive PANS to small intestine, right colon, and transverse colon causing increased motility, spasticity, and diarrhea.
Excessive PANS to esophagus causing excessive/inappropriate spasticity of esophagus or relaxation of LES, promoting GERD.
Inhibition of PANS to entire GI tract causing constriction of LES and decreased motility from esophagus to splenic flexure causing distention, constipation, gas retention, and N/V.
Why is H/A associated with OA and cranial disturbances?
Vagal stim of occipital nn C1 and C2 may also facilitate increased sensitivity to pain in occipital area of head inreasing possibility of headache often found in association with GI tract disturbances.
