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Chapter 15 Detailed Physical Examination. © 2005 by Thomson Delmar Learning,a part of The Thomson...
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Transcript of Chapter 15 Detailed Physical Examination. © 2005 by Thomson Delmar Learning,a part of The Thomson...
Chapter 15Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Detailed Physical Examination
Primary objective: Discover all signs of injury that may not have been uncovered during the rapid trauma assessment
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Detailed Physical Examination
Goal of an EMT: Uncover those signs of injury that could not be treated while en route to the hospital
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Detailed Physical Examination
Performed after the initial assessment and rapid trauma assessment have been completed
Measures the effectiveness of prehospital treatments that were initiated early in the assessment
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Detailed Physical Examination
May discover changes in the patient condition prompting an ALS intercept or change in priority of the patient
The detailed assessment is a methodical head-to-toe physical examination
Ongoing treatment of life-threatening conditions may preclude the completion of this examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Steps in the Detailed Physical Examination
Very much like the rapid trauma assessment DCAP-BTLS is used to describe the signs of
injury that should be sought
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Head– Palpate the entire skull, starting from the rear
of the skull in the occipital area (look for DCAP-BTLS)
– Remove glass shards that might cause injury
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Ears– Look for DCAP-BTLS– Look for drainage; clear fluid might indicate
cerebrospinal fluid• CSF indicates a skull fracture • Do not attempt to stop the flow of CSF, because doing so
can result in increased pressure inside the skull
– Check for Battle’s sign behind the ears, indicative of fracture to the base of the skull
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Watch this video showing how CSF can leak from the ears
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Eyes– Compare one eye to the other to examine for
differences while looking for DCAP-BTLS– Bruising around the eyes is sometimes called
raccoon’s eyes; it may be indicative of a fracture to the base of the skull
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Eyes– Assess pupils for size, shape, and reaction to light– Lack of constriction in response to light may
indicate serious eye or brain injury– Any foreign material such as dirt or glass should
be brushed away from the eyes, if possible• If it does not easily brush away, leave it alone and allow
hospital staff to remove it
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Nose– Check for DCAP-BTLS– Excessive bleeding may result if a NPA is inserted
into a broken nose– Check nares with penlight; blood running down the
back of throat may nauseate the patient and cause vomiting
– Clear fluid running from the nose may be CSF
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Face– EMT should next carefully assess the
face for DCAP-BTLS
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Mouth– Injury can cause airway problem– Assess for DCAP-BTLS inside and outside the
mouth– Check for loose teeth or other foreign objects and
remove to prevent aspiration– Dental hardware should be removed if it is loose;
otherwise leave it in place
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Mouth– Is the tongue swollen or the surrounding tissues
reddened or discolored?– Swelling in the mouth from burns can mean
swelling in the lower airways– Is voice hoarse after airway injury?
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Neck– Assess for DCAP-BTLS– Determine position of trachea
• Midline or deviated?
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Chest– Should be thoroughly examined– Assess using DCAP-BTLS– Check breathing (observe for any difficulties or
abnormalities); can the patient take a deep breath?
– Listen to breath sounds (both anterior and posterior)
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Abdomen– Explain to the patient what you are doing– Look for any injuries indicated by DCAP-BTLS– Check for distension (may indicate internal
bleeding)– Note urinary incontinence
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Abdomen– Listen to what the patient tells you– Where is the pain? Does one area of the abdomen
hurt more than another?– Feel the anterior abdomen gently; does it feel
soft? – A firm, tender abdomen indicates the natural
muscular guarding of an injury; guarding may suggest abdominal bleeding
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Abdomen– Don’t reassess areas where the patient has
complained of abdominal pain or has shown signs of tenderness and guarding on previous physical exams
– Little more can be gained from the information and the unnecessary creation of pain is cruel
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Pelvis– Compression and flexion of pelvis– Pressing inward on the hips will help discover
hip fracture– Press on the pubis to stress the bony pelvic ring– Tenderness during any part of this exam indicates
possible fracture
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Extremities– Look for DCAP-BTLS– Palpate each limb along the length of the bone– Compare one extremity with another– Reassess for pulses, movement, and
sensation (PMS)– Check grip strength and equality of grasp
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Vital signs revisited– Every exam should be followed up with a full
set of vitals– Compare with baseline– Establish a trend– Any significant change in vital signs should
be reported to the hospital staff
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Back and buttocks– Check back and buttocks for DCAP-BTLS– Carefully examine the back and buttocks for injury
• Do this while maintaining continuous manual stabilization of the head, preferably with a cervical collar in place
Steps in the Detailed Physical Examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Stop and Review
On whom should EMTs perform a detailed physical examination?
What is the primary objective of the detailed physical examination?
What are some of the things an EMT should check for when examining the head, ears, and eyes?