Other things Flashcards
How is a neurovascular assessment performed? (9)
- Clean hands
- Check pulses
- Note colour (pale/white)
- Swelling/oedema
- Temperature (cool)
- Capillary refill (normal = 1-3s)
- Pain with passive movement
- Sensation
- Motor = AROM/PROM/RISOM (aware of restrictions)
How do you assess the circumflex/axillary nerve?
Supplies the deltoid.
Sensory = touch deltoid
Motor = shoulder abduction
How do you assess the musculocutaneous nerve?
Supplies biceps and brachioradialis.
Sensory = touch radial forearm
Motor = elbow flexion
How do you assess the ulna nerve?
Supplies the ulna side flexors and hand intrinsics.
Sensory = touch pad of 5th finger
Motor = abduct (spread fingers)
How do you assess the radial nerve?
Supplies the extensors of the arm.
Sensory = touch back of the hand between thumb/index finger
Motor = dorsiflex hand/wrist (hyperextend thumb/fingers if in POP)
What is POP?
Plaster of Paris
How do you assess the median nerve?
Supplies forearm flexors, especially the thumb.
Sensory = touch index finger
Motor = opposition (thumb to 5th)
Why should the brachial plexus always be checked, and what for?
Can cause neurological deficits in the upper limb anywhere along the path.
Check for external pressure.
What constitutes an abnormal motor response and what should the next test be?
Unable to perform movements due to pain/numbness.
Check if PROM causes severe pain.
What does the sciatic nerve supply?
Supplies the hamstrings and their divisions below the knee.
How do you assess sensation of the sciatic nerve?
Injury type
- Buttock +/or thigh = all surfaces of foot
- Tibial = lateral calf, heel and foot
How do you assess motor function of the sciatic nerve?
Injury type
- Buttock = move toes and foot
- Thigh = knee flexion + move toes and foot
- Tibial = ankle PF/DF and eversion
How do you assess the femoral nerve?
Supplies quadriceps femoris.
Sensory = medial aspect of foot
Motor = knee extn
How do you assess the peroneal nerve?
Supplies peroneal and anterior tibial mm.
Sensory = first webbed space between 1+2 toes.
Motor = ankle DF (if in POP, toe extn at MT and phalangeal jts)
How do you assess the tibial nerve?
Supplies gastrocnemius/soleus.
Sensory = medial/lateral sole of foot
Motor = PF ankles/toes (if in POP, just toes)
How should the lumbosacral plexus pathway be checked? (5)
- regional block (when/where/how)
- swelling/oedema in limb
- plaster/dressings/traction/splints (not causing impairment?)
- hip is not dislocated (limb shorter, ext rot of leg)
- supports at knee to prevent ext rot.
When testing temperature, what do the results mean?
Cold = inadequate arterial.
Hot = inadequate venous.
When testing colour, what do the results mean?
White/pale = inadequate arterial
Blue = inadequate venous
Is a pulse still present with Compartment Syndrome?
Sometimes.
How should swelling be documented?
- Slight
- Moderate
- Gross
What should be considered if vascular deficit is detected?
- Plaster/dressing/traction/splintage (PDTS) impingement
- Environmental factors
- Room temp
- Limb exposure
- Hot/cold pack use
- If cap refil > 3s
- MHx =
- PVD
- Raynard’s disease
- MHx =
- Remember ~10% of the population don’t have a palpable dorsal pedal pulse
- Palp post tib pulse if exposed.
What are potential consequences of neurovascular compromise?
- Nerve damage
- Loss of sensation/ROM
- Muscle tissue damage
- Loss of sensation/ROM
4-12 hrs ischaemia may = permanent dysfunction/deformity (mm necrosis)
- This may = loss of motor fn or amputation
Before neurovascular obs, you should:
- Read notes
- Restriction on movement
- Relevant conditions (e.g. Reynaud’s)
- Nerve block?
- Explanation to pt
- Why Ax necessary
- IC
- Understands S/S to be reported
- Ensure nothing occludes skin before Ax (e.g. nail polish)
