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When assessing a patient for spinal cord injuries, use this technique developed by Laura M. Criddle, MS, RN, CS, CEN, CCRN, CNRN, emergency, trauma, and neurological clinical nurse specialist at Oregon Health and Sciences University in Portland. "This is a quick little assessment I think of as the SCI Dance,’" she says. "It begins, C one through four, breathe no more; five, six, seven, eight.’ What this means is: If your patient is still breathing spontaneously, the injury is below C-4."
Have the supine patient abduct his or her arms from his or her torso (tests C-5), then flex the arms and bend them at the elbow (C-6). Next, extend the arms back down on the bed (C-7), and finally, move the fingers (C-8). "Try doing this yourself a few times, and it becomes stuck in your brain," says Criddle. "This is an easy way to get a gross determination of level of injury without looking at a neurological assessment chart."
Sensory assessment of the SCI patient also is crucial, but standard dermatome charts often are very confusing, notes Criddle. "If you have a chart that shows the patient in the quadruped position vs. the usual upright/biped stance, dermatome distribution makes a lot more sense," she says. However, the two key levels to remember are T-4 at the nipple line and T-10 at the umbilicus, she adds. "With those two sites in mind, you can guesstimate’ whatever falls in between," she says.
[Editor’s Note: For more information about assessment of spinal cord injuries, contact Laura M. Criddle, MS, RN, CS, CEN, CCRN, CNRN, Oregon Health and Sciences University, Mail Code UHS 8Q, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201. Telephone: (503) 494-1350. Fax: (503) 494-7441. E-mail: firstname.lastname@example.org.]