DTR' s, How do you do it?

It's been awhile since I've checked DTR's, so I won't attempt to advise you on technique or interpretation. I assume that this is in relation to the care of a patient on MgSo4. If so, your unit should have a MgSo4 emergency tray or box which is kept at the bedside of any patient receiving this drug. It should include a vial of Ca++, needle and syringe, and a reflex hammer, at the bare minimum. For the safety of your patients and your license, please check for these supplies at the beginning of your shift.

I had numerous rounds of MgSo4 for treatment of (very stubborn) preterm labor with both of my pregnancies, and nearly became toxic on the stuff. I was always reassured to see the supplies at my bedside!:)

I have had great results using the head of my stethoscope as the business end of a reflex hammer. Saves hunting for one or buying your own (and carrying it around).

I have trouble getting women to relax at times when I check leg reflexes, especially if they are lying in bed hooked up to the moniter. If they are able to dangle their legs over the side of the bed I have better luck.

I am more likely to get better results with a biceps reflex, and they are more consistent each time I do them too. If you can get someone to show you this it is simple to do, and you have more control over being consistent in how hard you tap. I feel for the tendon at the elbow, and keeping my finger on it I tap my finger. With this method I know I've tapped he right spot. But you need someone to take 5min to show you where to feel and let you try it once or twice.

reflexes give an idea but are somewhat subjective. Some people will write a 3 and some a 2+. But dont worry the purpose of DTR's is not to get a # but to assess the patients status. This can be done in several ways.

The overall goal is to evaluate the level of Mg effect. Mg levels are desired to be kept around 4 -8 (during labor and 24hrs postpartum and until labor stops and is stable in PTL). Patellar reflexes are almost absent around 8 and this is where respiratory depression begins. Most patients will also feel drowsy. Mg is excecreted by the kidney - if urine output is low Mg levels will increase faster especially in small women. I had a patient on Mg once who just didn't have reflexes (strange). We had to rely on other assessments.

You can also draw a serum Mg level if reflexes seem low and the pt seem more drowsy than normal.

sorry to be long winded. Im procrastinating putting off some case studies I have due tomorrow.

Jared