One carpal spasm question-please guess

nurseprnRN, BSN, RN · Nov 11, 2011

see below

morte, LPN, LVN · Nov 11, 2011

I can't say I have ever seen a pt. with a carpal spasm secondary to C-spine nerve impingement. Usually they present with paresthesias (numbness/tingling in upper extremities)

horses and zebras....

nurseprnRN, BSN, RN · Nov 11, 2011

"i'm thinkin, she's thinkin, an irritated nerve in the c-spine contributing to the carpal spasm??"

nah, this is a classic sign of low serum ca++, when you occlude arterial flow (remember, this was observed while taking bp) and get carpal spasm. the next-best clinical assessment to confirm this is chvostek's.

somewhere diagnosticians of old are smiling. newer tech and faster labs are making it less likely for these little clinical pearls to be learned and remembered. sad, because when your resident and nurse aren't good at listening to your heart they won't pick up those new changes of chf in the s3-s4 or your mitral regurg by the murmur because they are too used to getting a bnp or a bedside us. hint: they won't always be working in a hospital when they need to be able to make that assessment.

morte, LPN, LVN · Nov 11, 2011

"i'm thinkin, she's thinkin, an irritated nerve in the c-spine contributing to the carpal spasm??"
nah, this is a classic sign, when serum ca++ is low and you occlude blood flow (remember, this is happening when the bp is being checked) you get carpal spasm. the next step is the next-easiest clinical way to check for low ca++ is to check chvostek's.
somewhere real diagnosticians are smiling-- clinical exam skills are so fading away with the advent of instant labs and noninvasive exams at the bedside. i'm seeing med students and residents who don't really know how to make decisions about cardiac valves because they don't know how to listen to them because they just grab a bedside us, and don't think to listen carefully for s3/4 because they just check the bnp. sad, and not helpful if you find yourself in somewhere other than a hospital and needing to make an assessment.

why pray tell did you quote me and not the original? i do agree with you on too much dependence on assessment tools rather than hands on..... how many nurses have you seen with a patient pale as a ghost sucking air with a pulse ox of 98, and the assessment is that the patient is fine because the pulse is fine? etc,etc

Esme12, ASN, BSN, RN · Nov 11, 2011

"i'm thinkin, she's thinkin, an irritated nerve in the c-spine contributing to the carpal spasm??"
nah, this is a classic sign of low serum ca++, when you occlude arterial flow (remember, this was observed while taking bp) and get carpal spasm. the next-best clinical assessment to confirm this is chvostek's.
somewhere diagnosticians of old are smiling. newer tech and faster labs are making it less likely for these little clinical pearls to be learned and remembered. sad, because when your resident and nurse aren't good at listening to your heart they won't pick up those new changes of chf in the s3-s4 or your mitral regurg by the murmur because they are too used to getting a bnp or a bedside us. hint: they won't always be working in a hospital when they need to be able to make that assessment.

you said exactly what i was thinking....... :rolleyes: or they won't recognize the development of a murmur in an acute mi when the blow the papplillary muscle of their patient....s3s4....summation gallop

http://medical-dictionary.thefreedictionary.com/summation+gallop

nurseprnRN, BSN, RN · Nov 11, 2011

just wanted to reinforce your point with a little more expansion is all. no criticism intended.

LisDavis · Jun 21, 2015

I am taking this same class in a couple of weeks and I did not find the answer to that question. Did you have any luck with it?