1 patient assessment beginning the physical examination: scene size-up, general survey, vital signs,...
TRANSCRIPT
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Patient Assessment
Beginning the Physical Examination:
Scene Size-Up, General Survey, Vital Signs, and Pain
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Scene Size-Up
1. Scene Safety 2. BSI 3. MOI/NOI 4. # Patients 5. Additional Help? 6. C-Spine?
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Initial Assessment
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Initial /Primary Assessment
1. General Impression Age, Sex, Race, CC, Environment
2. Mental Status AVPU
3. Airway (C-Spine) 4. Breathing 5. Circulation
Pulse – Skin - Bleeds
6. Determine Priority
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Components of General Survey
General Appearance/Impression
Height and Weight
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General Appearance - Description
Apparent state of health Acute or chronically ill, frail
Level of consciousness Awake, alert, responsive or
lethargic, obtunded, comatose
Signs of distress Cardiac or respiratory; pain;
anxiety/depression Skin color and obvious
lesions
Dress, grooming, and personal hygiene Appropriate to weather
and temperature Clean, properly
buttoned/zipped Facial expression
Eye contact, appropriate changes in facial expression
Odors of body and breath Posture, gait, and motor
activity
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Mental Status and Behavior Terminology
To appreciate the differences in mental status and behavior, you must learn the terminology
Level of consciousness: how aware the person is of his environment
Attention: the ability to focus or concentrateo Alert: the patient is awake and awareo Lethargic: you must speak to the patient in a
loud forceful manner to get a responseo Obtunded: you must shake a patient to get a response o Stuporous: the patient is unarousable except
by painful stimuli (sternal rub)o Coma: the patient is completely unarousable
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Height and Weight Height
Short or tall Build: slender and lanky, muscular, or stocky Body symmetry Note general body proportions and any deformities
Weight Emaciated, slender, plump, obese If obese, is fat distributed evenly or concentrated
over trunk, upper torso, or around the hips? small – medium – large?
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Initial Assessment?
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What next
Health form History
http://videos.med.wisc.edu/videos/33744
Secondary Assessment: Detailed exam Focused exam
Ongoing exam
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Health History: subjective Changes in weight
Rapid or gradualo Rapid changes over a few days suggest changes in fluid, not tissue
Weight gain: nutrition vs. medical causes
Weight loss: medical vs. psychosocial causes
Fatigue and weakness Fatigue: a sense of weariness or loss of energy
Weakness: a demonstrable loss of muscle power
Medical vs. psychosocial causes
Fever, chills, and night sweats Ask about exposure to illness or any recent travel
Some medications may cause elevated temperature
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Question
A patient presents with a 6-day history of rapid weight gain, and increasing fatigue. The most likely explanation is:
a. Dysphagia
b. Excessive absorption of nutrients
c. Diabetes mellitus
d. Accumulation of body fluids
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Answer
d. Accumulation of body fluids
Rapid changes over a few days suggest changes in fluid.
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Vital Signs
Blood pressure
Heart rate and rhythm
Respiratory rate and rhythm
Temperature
Pain
SaO2
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QuestionA patient’s vital signs are recorded as follows:
T 98.4 F, HR 74, R 18, BP 180/98What would be the MOST appropriate action related to this patient’s vital signs?
a. The blood pressure should not be repeated
b. Repeat the blood pressure and verify in contralateral arm
c. Check the heart rate again to see if it is regular
d. Listen to the patient’s lungs for adventitious sounds
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Answerb. Repeat the blood pressure measurement
and verify in the contralateral arm
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Pain
Assess OPQRST
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Pain
Types of pain Nociceptive or somatic – related to tissue damage
Neuropathic – resulting from direct trauma to the peripheral or central nervous system
Psychogenic – relates to factors that influence the patient’s report of paino Psychiatric conditionso Personality and coping styleo Cultural normso Social support systems
Idiopathic – no identifiable etiology
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Examination Techniques
Inspection Palpation Percussion Auscultation
System with cc: function / physiology System above and below
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Thoracic Landmarks—Anterior Chest
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Shoulders and Related Structures
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Percussion and Auscultation of Chest
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Thoracic Landmarks—Posterior Chest
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Spine
Inspection Cervical, thoracic, and
lumbar curves Lordosis (swayback) Kyphosis (hunchback) Scoliosis (razorback)
Height differences of shoulders
Height differences of iliac crest
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Breath Sounds
Fig. 11-26Fig. 11-26
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Pulse
Auscultate for: Frequency (pitch) Intensity (loudness) Duration Timing in cardiac
cycle
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Abdomen
four quadrants
Inspect Auscultate Percuss Palpate
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Abdomen—Inspection
Skin Umbilicus Contour Abdominal
movement
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Pelvis
Pelvic structural integrity Hands on anterior iliac
crests Press down and out
Heel of hand on symphysis pubis
Press down
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Ankles and Feet
Range of motion Dorsiflexion Plantar flexion Inversion Eversion
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Ongoing Assessment
Components Repeat initial assessment
Stable patient: every 15 minutes Unstable patient: every 5 minutes (minimum)
Reassess mental status Reassess airway Monitor breathing for rate and quality Reassess circulation Reestablish patient priorities