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an untreated septal hematoma and its infection causing necrosis of the nasal cartilage can result in deformity of the nose

extension of the extremeties and the retraction of the head

(lesion of the brain stem, also possibly secondary to heat stroke)

flexion of the elbows and wrists, clenched fists, and extension of lower extremities

(lesion above the brain stem)

arms flexed across the chest

(spinal cord lesion at the C5-C6 level)

1. Place tongue blade in the patient's mouth

2. As the patient attempts to hold the tongue blade in place, the examiner twists the blade

+ = The patient is unable to maintain a firm bite or pain is elicited

Indicates: Possible mandibular fracture

1. Patient shuts the eyes and abducts the arms to 90 degrees with elbows extended

2. the patient tilts the head backward and lifts one foot off the ground while atttempting to maintain balance

3. If this is adequately completed, patient is asked to touch the index finger to the nose (with eyes remaining closed)

+ = display of gross unsteadiness

indicates: cranial nerve 8 dysfunction, concussion

1. The patient walks heel-to-toe along the straight line for approximately 10 yards

2. The patient returns to the starting position by walking backward

+ = unable to maintain steady balance

indicates: cerebral or inner ear dysfunction that inhibits balance

Patient is barefoot, with eyes closed/hands on hips, and performs each stance twice for 20 seconds; first time on firm surface, and then while on foam surface

1. Double leg stance
2. Single leg stance - stand on non dominant leg, non weight bearing hip flexed 20-30 degrees and knee flexed to 40-50 degrees
3. Tandem leg stance - nondominant behind dominant leg in a heel-to-toe manner

errors include any lifting of hands, opening eyes, stepping/stumbling/falling, moving the hip into more than 30 defrees of flexion or abduction, lifting foot or heel

indicates: impaired cerebral function

1. Fold a piece of sterile gauze into a triangle
2. using the point of the gauze, collect a sample of the fluid leaking from the ear or nose and allow it to be absorbed by gauze

+ = a pale yellow "halo" will form around the sample on the gauze

indicates: CSF leakage, indicative of skull fracture, frontal and ethmoid bones most commonly involved

1. Soak fluorescein strip with sterile saline solution
2. lightly touch the wet fluorescein strip to the conjunctiva of the lower eyelid for a few seconds
3. avoid placing the strip directly on the cornea
4. ask the patient to blink the eye a few times to spread the solution
5. darken the room and use a cobalt blue light to illuminate the eye

+ = when viewed with cobalt blue light, corneal abrasions appear as a bright yellow-green pattern on the eye

indicates: corneal abrasion

1. have athlete prone
2. thumbs placed on spinous process, pushes anteriorly feeling for spring of vertebrae

+ = no movement, or pain is ilicited

indicates: hypermobility/hypomobility, ligament sprain

1. Athlete is supine
2. examiner runs device up plantar aspect of foot making an arc from the calcaneus medially to the ball of the great toe

in the presence of normal innervation, the toes should curl

+ = the great toe extends and the other toes splay

indicates: upper motor neuron lesion, caused by brain or spinal cord trauma or pathology

1. Supine
2. a blunt object or the examiner's fingernail is run along the crest of the anteromedial tibia

+ = the great toes extends and the other toes splay or the patient reports hypersensitivity to the test

indicates: upper motor neuron lesion caused by brain/spinal cord trauma or pathology