Chapter 12 LO - Jones & Bartlett Learningems.jbpub.com/chapleau/emt/docs/PPT_lectures/Chap… ·...
Transcript of Chapter 12 LO - Jones & Bartlett Learningems.jbpub.com/chapleau/emt/docs/PPT_lectures/Chap… ·...
9/10/2012
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Detailed Physical Examination
Lesson Goal
Perform detailed physical examination, understand findings, and use findings to provide appropriate patient care
Lesson Objectives
Discuss components of detailed physical exam
State areas of body evaluated during detailed physical exam
Explain what additional care should be provided while detailed physical exam is performed
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9/10/2012
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Lesson Objectives
Distinguish between detailed physical exam performed on a trauma patient and that done on a medical patient
Explain rationale for feelings patients may experience during detailed physical exam
Introduction
Detailed physical exam Assesses individual body parts for signs of illness
or injury
Performed for:• Trauma patients with significant MOI
• Unresponsive medical patients
Conscious medical patients• Select components relative to patient complaint
Not every patient needs detailed physical exam
Overview
Techniques Expose, inspect, palpate, auscultate
Patient feelings Protect privacy, maintain professional demeanor
Process for adults is head to toe Toe-to-head for children
Begins after initial assessment is complete
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DCAPBTLS Method
Deformities
Contusions
Abrasions
Punctures
Burns
Tenderness
Lacerations
Swelling
Also: Crepitus
Distention
Equality
Function
Guarding
Masses
Assessing the Head
Scalp
Face
Eyes
Ears
Nose
Mouth
Assessing the Face
Symmetry Have patient smile and raise eyebrows
Consider airway
Consider potential for underlying brain injury
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Assessing the Eyes
Opening
Sclera
Bleeding
Bruising
Gaze
Pupils
Visual acuity
Assessing the Ears
Drainage Blood
CSF• Halo test
• Glucometer
Cover lightly
Battle’s sign
Assessing the Nose
Blood or fluid
Singed nasal hair
Drug residue
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Assessing the Mouth
Blood, fluids, vomit
Intact teeth
Consider airway compromise Dentures
Tongue lacerations or swelling
Odors
Assessing the Neck
Manual stabilization if trauma suspected Jugular vein distention Cover open wounds with occlusive dressing Accessory muscle use Swelling, foreign bodies, masses
Reassess airway frequently
Stridor during inspiration Tracheal deviation Bruising, abrasions
Assessing the Chest
Cover open wounds with occlusive dressing Seal on 3 sides
Scars
Shape/size of chest
Tenderness/crepitus
Expansion
Paradoxical movement
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Assessing the Chest
Auscultate lungs Normally clear & equal
Rales
Wheezes
Absence of sounds
Abnormal chest findings—administer O2
Assessing the Abdomen
Distention
Rigidity
Softness
Discoloration
Consider shock
Scars, colostomy bag
Guarding
Masses
Assessing the Pelvis
Bruising
Incontinence
Crepitus
Instability
Bleeding
Special considerations Urinary catheter
Crowning (pregnancy)
Priapism
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Assessing the Extremities
Symmetry
Positioning
Mottling/cyanosis
Pulses
Movement
Sensation
Strength
Pulses
Skin color, temperature
Edema
Pain
Crepitus
Deformity
Assessing the Back
Signs of injury
Breath sounds
Reassess Vital Signs
Once detailed assessment complete, reassess VS to detect any trends
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Skill 12-1: Detailed Examination
1. Inspect & palpate scalp
2. Inspect & palpate face
Skill 12-1: Detailed Examination
3. Look for eye injuries & pupil responses; do not palpate eye injuries
4. Look for fluid leaking out of ears
Skill 12-1: Detailed Examination
5. Check mouth for bleeding or injuries
6. Remove clothing from patient’s upper body
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Skill 12-1: Detailed Examination
7. Inspect & palpate neck (front & back)
8. Inspect & palpate chest
Skill 12-1: Detailed Examination
9. Compare both sides of chest for abnormalities
10. Auscultate chest
Skill 12-1: Detailed Examination
11. Inspect & palpate abdomen
12. Remove clothing from patient’s lower body
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Skill 12-1: Detailed Examination
13. Palpate pelvis
14. Inspect & palpate each upper leg
Skill 12-1: Detailed Examination
15. Inspect & palpate each lower leg
16. Assess movement & sensation in each foot
Skill 12-1: Detailed Examination
17. Assess pulses in each foot
18. Inspect & palpate each upper arm
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Skill 12-1: Detailed Examination
19. Inspect & palpate each lower arm
20. Assess radial pulse in each arm
Skill 12-1: Detailed Examination
21. Assess movement & sensation in each hand
22. If possible, log roll patient and assess back
Skill 12-1: Detailed Examination
23. Palpate back and inspect for signs of bleeding
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Other Assessment Tools
Glucometer
Pulse oximeter
Cardiac monitor
Summary
Perform detailed physical assessment selectively
DCAPBTLS
Also look for symmetry, masses, guarding
Auscultate breath sounds
Re-evaluate VS
Consider other assessment tools
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