Positive Dubowksi Reflex

I am blessed in my district with a large population of wealthy folk.   I say this because the well to do often can afford healthcare that looks past the immediate and takes the time to educate them on their conditions.   And when given this information, have the time and money to follow up with medications, referrals to specialists etc.   So when these folks dial 911 it is usually an actual emergency.

 

Oh, OK, not really.

 

THE EMERGENCY

Dispatchers are reporting an aneurism in an elderly woman.

 

THE ACTION

Odd how Erma knows the problem requires surgical intervention, but she knows more than me at the time of dispatch so I’m thinking ahead to possibly managing a tanking BP in a system with a hole in it.

Little did I know I’d be bumping into separation anxiety.

Ritchie, the home owner, is off traveling North Africa for business (Isn’t that always the way?) and his lovely wife and kids are home alone in their 8-10 room likely 6000 sq foot home and not feeling well.

Through our assessment we’ve been able to assess diffuse abdominal discomfort in the lower quadrants without re-creation or increased intensity on palpation, and given her age (no where near the 86 we were told) we have to assume a certain condition until otherwise proven false.

As we’re prepping for transport to St Cleanest a young woman comes down the stairs nearby and identifies herself as the live in maid/nanny who will watch the children after we all leave.

As I’m reassuring our new friend everything will be fine, we’re listening on the radio to other calls going out without an ambulance the system is so busy.   We are 5th in line for an ambulance.

With time to spare I decide to complete a Dubowski Reflex Test.

You ARE doing Dubowskis in your system, right?   I often score a Dubowski in the following situations:

  • You’re lying
  • I think you’re lying
  • I have nothing else to do but go through the fridge looking for a snack

The Dubowski reflex is credited to my first Paramedic partner Bill, who’s singular mission in life was to make you laugh on scene when it was inappropriate.

Bill would explain to the patient that he was going to perform a very sensitive examination using partial cerebral spinal fluid pressure.   The patient would get an explanation of the circulation of spinal fluid just enough for it to make sense to them and justify what he was about to do.

You see, when he administers the exam, the slight pressure on the occipital skull will create an increase of fluid pressure through the Foramen magnum, down the spine and into the abdomen.   This may cause brief pain but could help determine the problem.

I explained the procedure to our calm, seated, on the phone with North Africa patient and when I gently touched the back of her head she screamed in pain and covered her abdomen.   At first I thought she was genuinely in discomfort, but instead of having a recovery period she immediately went into telling the man on the phone that her injury was serious enough to require a “Dubewski” test.

I swear for a moment I saw Bill in the corner of the room laughing his ass off.

Positive Dubowski aside, the ambulance arrived to a stable patient, ECG normal, fluids running TKO, full history documented, meds in a bag and listed and requesting they talk to north Africa about how dangerous it is for her to stay home alone.

 

Engine 99 in service.

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4 thoughts on “Positive Dubowksi Reflex”

  1. Dubowski, That makes me want to ride the medic unit on Thursday when I go back to work…just to try it…almost! I will ride the engine and hope for an EMS call that I can reproduce this on!

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