slide 1 copyright © 2007, 2005 by mosby, inc., an affiliate of elsevier inc. all rights reserved....

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

Detailed Physical ExaminationDetailed Physical ExaminationDr. Anmar MandourahDr. Anmar Mandourah


OverviewOverview

• Patients Needing a Detailed Patients Needing a Detailed ExaminationExamination

• Examination ProcedureExamination Procedure

• Assessing Vital SignsAssessing Vital Signs


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


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.


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


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


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.



• 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


FaceFace



• 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


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



• 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



• 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



• 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


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



• 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.



• 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 .



• 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



• 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.



• 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



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


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


Vital SignsVital Signs


Vital SignsVital Signs

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


SummarySummary

• Patients Needing a Detailed Patients Needing a Detailed ExaminationExamination

• Examination ProcedureExamination Procedure

• Assessing Vital SignsAssessing Vital Signs

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