Slide 1 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved....

Post on 20-Jan-2016

212 views 0 download

Transcript of Slide 1 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved....

Slide 1Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical ExaminationDetailed Physical ExaminationDr. Anmar MandourahDr. Anmar Mandourah

Slide 2Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

OverviewOverview

• Patients Needing a Detailed Patients Needing a Detailed ExaminationExamination

• Examination ProcedureExamination Procedure

• Assessing Vital SignsAssessing Vital Signs

Slide 3Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical ExaminationDetailed Physical Examination

• Patients needing a detailed examinationPatients needing a detailed examination– Patient- and injury-specific (e.g., cut finger Patient- and injury-specific (e.g., cut finger

would not require a detailed physical would not require a detailed physical exam)exam)

– Patients with significant injuries, Patients with significant injuries, significant significant mechanisms of injury, and mechanisms of injury, and unresponsive unresponsive patients require a detailed physical exampatients require a detailed physical exam

Slide 4Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Ideally, the detailed examination should be performed en route(in the Ambulance) to the appropriate facility. This assessment should be performed on unresponsive patients (trauma and medical), provided that life threats are managed.

Slide 5Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Examination ProcedureExamination Procedure

• Perform a detailed physical Perform a detailed physical examination on the patient to gather examination on the patient to gather additional information.additional information.

• As you inspect and palpate, look As you inspect and palpate, look and/or feel for the following examples and/or feel for the following examples of injuries or signs of injuryof injuries or signs of injury– DDeformitieseformities– CContusionsontusions– AbrasionsAbrasions– PPunctures/penetrationsunctures/penetrations– BBurnsurns– TTendernessenderness– LLacerationsacerations– SSwellingwelling

Slide 6Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

This assessment is similar to the rapid trauma assessment. The detailed physical examination should be tailored to fit the needs of each individual patient.

Slide 7Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the head; Assess the head; inspect and palpate inspect and palpate for injuries or signs for injuries or signs of injury of injury – DCAP- BTLSDCAP- BTLS– Wounds - FracturesWounds - Fractures

Bleeding – swellingBleeding – swelling

-Check your gloves -Check your gloves for blood.for blood.

Slide 8Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the face; Assess the face; inspect and palpate inspect and palpate for injuries or signs for injuries or signs of injury of injury – DCAP-BTLSDCAP-BTLS

Slide 9Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

FaceFace

Slide 10Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the Assess the earsears; inspect and palpate for injuries or ; inspect and palpate for injuries or signs of injury signs of injury – DCAP-BTLSDCAP-BTLS

• DrainageDrainage• bleedingbleeding

Slide 11Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Battle signsBattle signs(Bluish discoloration of the Mastoid Process)(Bluish discoloration of the Mastoid Process)

Slide 12Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the eyes; Assess the eyes; inspect for injuries inspect for injuries or signs of injury or signs of injury – DCAP-BTLSDCAP-BTLS

• DiscolorationDiscoloration• Unequal pupilsUnequal pupils• Foreign bodiesForeign bodies• Blood in anterior Blood in anterior

chamberchamber

Slide 13Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the Assess the nosenose; inspect and palpate for ; inspect and palpate for injuries or signs of injuryinjuries or signs of injury– DCAP-BTLSDCAP-BTLS

• Drainage (CSF)Drainage (CSF)• BleedingBleeding

Slide 14Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the mouth; Assess the mouth; inspect for injuries inspect for injuries or signs of injuryor signs of injury– DCAP-BTLSDCAP-BTLS

• TeethTeeth• ObstructionsObstructions• Swollen or lacerated Swollen or lacerated

tonguetongue• OdorsOdors• DiscolorationDiscoloration

Slide 15Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination Procedure Procedure

• Assess the Assess the neckneck; inspect and palpate for ; inspect and palpate for injuries or signs of injury injuries or signs of injury – DCAP-BTLSDCAP-BTLS– Jugular vein dissention (JVD)Jugular vein dissention (JVD)– CrepitationCrepitation

Slide 16Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Many cervical collars have openings large enough to allow the EMT to assess the neck without removing the collar.

• If the collar obstructs the view, manually stabilize the head and open the collar.

Slide 17Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the chest; Assess the chest; inspect and palpate for inspect and palpate for injuries or signs of injuryinjuries or signs of injury– DCAP-BTLSDCAP-BTLS– CrepitationCrepitation– Paradoxical motion* Paradoxical motion* – Breath sounds in the Breath sounds in the

apices, midclavicular line, apices, midclavicular line, bilaterally and at the bilaterally and at the bases, midaxillary line, bases, midaxillary line, bilaterally .bilaterally .

Slide 18Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the abdomen, Assess the abdomen, inspect and palpate inspect and palpate for injuries or signs of for injuries or signs of injuryinjury

– DCAP-BTLSDCAP-BTLS– FirmFirm– SoftSoft– DistendedDistended

Slide 19Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the pelvis; inspect Assess the pelvis; inspect and palpate for injuries or and palpate for injuries or signs of injury signs of injury – DCAP-BTLSDCAP-BTLS

If the patient does not complain of pain or is unresponsive, gently flex and compress the pelvis

to determine stability.

Slide 20Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the legs; Assess the legs; inspect and palpate inspect and palpate for injuries or signs of for injuries or signs of injury injury – DCAP-BTLSDCAP-BTLS– Distal pulsesDistal pulses– SensationSensation– Motor functionMotor function

Slide 21Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical Examination Detailed Physical Examination ProcedureProcedure

• Assess the arms in Assess the arms in the same manner the same manner as the legs as the legs

Slide 22Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Detailed Physical ExaminationDetailed Physical Examination

• Roll with spinal precautions and assess Roll with spinal precautions and assess posterior aspect of body; inspect and posterior aspect of body; inspect and palpate for injuries or signs of injurypalpate for injuries or signs of injury– DCAP-BTLSDCAP-BTLS

Slide 23Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Vital SignsVital Signs

Slide 24Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Vital SignsVital Signs

• Assess baseline vital signsAssess baseline vital signs– BreathingBreathing– SkinSkin– PupilsPupils– Blood pressureBlood pressure

Slide 25Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

SummarySummary

• Patients Needing a Detailed Patients Needing a Detailed ExaminationExamination

• Examination ProcedureExamination Procedure

• Assessing Vital SignsAssessing Vital Signs