You want to look for changes that develop in the process of motion as the pa- tient lifts their head up, as they tuck their chin down, rotate side to side, etc. any type of changes. What are you going to look for? You want to look for the 5D's, the 3N's and the A. Dizziness, diplopia, dysphagia, dysarthria, drop at- tacks, nausea, numbness, nystagmus and ataxia. Now let's be honest. If we take very person that sees a chiropractor because they have a degree of dizzi- ness, that's a 30-year practice itself would be filling every MRI facility in the country 10 times over. That's not what I want to talk to you about. When you think about things like dizziness or you're thinking about things like nausea or numbness, they are less of a concern but we want to think about how they cluster. When patients do present with double vision, difficulty swallowing or difficulty speaking, those are major stroke signs. We want to pay very close attention to that. Also, nystagmus is one that we want to move up the scales of index of suspicion that when a patient presents with nystagmus and they had it before, we want to be alert to that. I'd ask you to be aware of all 9 of these symptom categories. Some are relatively urgent. Others not so but think about the con- stellation and the development of the pattern that these symptoms represent. You might also think about these symptoms in relationship to the typical whip- lash injury that you see. It's not uncommon for that patient to be dizzy, for them to have double vision, for them to have nausea, for them to have numb- ness. Keep in mind that there's always the potential that that whiplash injury read could have caused a dissection in progress as well. It may be some clinical but we want to keep that possibility in mind and evaluate for that along the way. Next slide, please. Now if you have any concern about any of the findings from your history or physical, take the time to do a quick cranial nerve assessment. Take the time to do the deep tendon reflexes and the dermatome check. It's very good baseline information from a neurological perspective for you to have in your record. If you think there's a possibility of concern for a dissection, in particular dissection in progress, then you want to evaluate how serious you think this is. Is this something that can wait to see a neurologist or is this something based on the presentation of the patient, they need to see an emergency room. That's a call you have to make on each individual situation and hopefully, they're very rare situations. Have them at the back of your mind. Be prepared to make that decision. I've never seen a patient that was referred out that was angry because somebody double checked before moving on with their care. The opposite can be a problem. Next slide, please. Another suggestion in terms of things to do differently in your office. Review your office procedures. Do you have procedures established in your office written down and reviewed it to your staff for handling emergencies? Now emergencies don't have to be a stroke.
Made with FlippingBook HTML5