Mosby's Ch13: Techniques of physical examination objectives
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- Describe physical examination techniques commonly used in the prehospital setting.
- Inspection is the visual assessment of the patient and surroundings. Palpation is the use of hands and fingers to examine by touch. Percussion is the process of striking one finger over another to produce sound waves in underlying tissues to evaluate the presence of air or fluids in underlying tissues. Auscultation is using a stethoscope to hear the movement of air or fluids in organs or tissues
- Describe the examination equipment commonly used in the prehospital setting.
- Stethoscope is used to evaluate sounds created in the cardiovascular, respiratory, and gastrointestinal. Ophthalmoscope is used to inspect the structures of the eye. Otoscope is used to inspect the deep structures of the middle and outer ear. Blood pressure cuff is used along with a stethoscope to measure systolic and diastolic blood pressures
- Describe the general approach to physical examination.
- Physical examination is a systematic examination with the emphasis on chief complaint and present illness. Establish trust early and ensure patient privacy to help relieve patient anxiety
- Outline the steps of a comprehensive physical examination.
- Mental status, general survey, vital signs, skin, HEENT, chest, abdomen, posterior body, extremities, neurological
- Detail the components of the mental status examination.
- Appearance and behavior, speech and language, thought and perceptions, memory and attention
- Distinguish between normal and abnormal findings in the mental status examination of appearance and behavior.
- Drowsiness, obtundation, stupor, or coma. Ataxia, paralysis, restlessness, agitation, bizarre body posture, immobility, involuntary movements. Poor hygiene or body odors. Appropriate facial expressions, unusual happiness in the face of a major illness, indifference, responses to imaginary people, unpredictable mood swings.
- Distinguish between normal and abnormal findings in the mental status examination of speech and language.
- Aphasia, dysphonia, dysarthia, and speech and language changes with mood
- Distinguish between normal and abnormal findings in the mental status examination of thought and perception.
- Abnormal thought process, abnormal thought content, abnormal perceptions
- Distinguish between normal and abnormal findings in the mental status examination of memory and attention.
- Healthy persons are oriented to person, place, and time
- Outline the steps in the general patient survey.
- Signs of distress, apparent state of health, skin color and obvious lesions, height and build, sexual development, weight, and vital signs
- Distinguish between normal and abnormal findings in the general patient survey of signs of distress.
- Cardiorespiratory insufficiency, pain, anxiety
- Distinguish between normal and abnormal findings in the mental status examination of apparent state of health.
- Note appearance as acutely or chronically ill, frail, feeble, robust, or vigorous
- Distinguish between normal and abnormal findings in the mental status examination of skin color and obvious lesions
- Abnormal skin color can be pallor, cyanosis, jaundice, and red. Lesions that can indicate illness or injury include rashes, bruises, scars, and discoloration
- Possible causes for abnormal skin coloration of pallor
- Shock, dehydration, fright
- Possible causes for abnormal skin coloration of cyanosis
- Cardiorespiratory insufficiency, cold environment
- Possible causes for abnormal skin coloration of jaundice
- Liver disease, red blood cell destruction
- Possible causes for abnormal skin coloration of red
- Fever, inflammation, CO poisoning
- Distinguish between normal and abnormal findings in the mental status examination of height and build
- Patients can be normally described as average, tall, slender, short, and muscular
- Distinguish between normal and abnormal findings in the mental status examination of sexual development
- Ascertain if certain sex characteristics are appropriate for patientÂ’s age such as facial hair, voice change, breast growth, axillary and groin hair
- Distinguish between normal and abnormal findings in the mental status examination of weight
- Recent weight loss, excessively thin or overweight
- Average vital signs for a newborn
- Pulse: 120-160 Respirations: 40-60 BP: 80/40
- Average vital signs for a child 1yo
- Pulse: 80-140 Respirations: 30-40 BP: 82/44
- Average vital signs of child 3yo
- Pulse: 80-120 Respirations: 25-30 BP: 86/50
- Average vital signs of a child 5yo
- Pulse: 70-115 Respirations: 20-25 BP: 90/52
- Average vital signs of a child 7yo
- Pulse: 70-115 Respirations: 20-25 BP: 94-54
- Average vital signs for a child 10yo
- Pulse: 70-115 Respirations: 15-20 BP: 100/60
- Average vital signs of a child 15yo
- Pulse: 70-90 Respirations: 15-20 BP: 110/64
- Average vital signs of an adult
- Pulse: 60-80 Respirations: 12-20 BP: 120/80
- Causes of abnormal pupil reactions
- Dilated or unresponsive: cardiac arrest, CNS injury, hypoxia, drug use (LSD, atropine, amphetamines). Constricted or unresponsive: CNS injury or disease, narcotic drug use, eye medications. Unequal, one eye dilated , or unresponsive: CVA, head injury, direct trauma to the eye, eye medications
- State modifications to the physical examination that are necessary when assessing children.
- When approaching the pediatric patient, remain calm and confident, avoid separation of child and parent, establish a rapport with parents and child, be honest, assign one caregiver to the child, and observe the child before beginning the physical examination
- State components of the physical examination when assessing general appearance of children.
- Alertness, distractibility, consolability, speech or cry, spontaneous activity, color, respiratory efforts, eye contact
- State modifications to the physical examination that are necessary when assessing the older adult.
- The paramedic should not assume that all older adults are victims of age-related disorders. Individual differences in knowledge, mental reasoning, experience, and personality will influence how these patients respond to examination.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the skin
- The comprehensive physical examination should include an evaluation of the skinÂ’s texture and turgor, hair, and fingernails and toenails.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the HEENT
- Examination of the structures of the head and neck involves inspection, palpation, and auscultation.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the chest
- A thorough knowledge of the structure of the thoracic cage is required to perform an adequate respiratory and cardiac assessment. Air movement creates turbulence as it passes through the respiratory tree and produces breath sounds during inhalation and exhalation. In the prehospital setting, the heart must be examined indirectly. However, information about the size and effectiveness of pumping action is obtained through a skilled assessment that includes palpation and auscultation.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the abdomen
- The four quadrants of the abdomen and their contents provide the basis for inspection, auscultation, percussion, and palpation of this body region.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the genitals
- An examination of the genitalia of either sex can be awkward and uncomfortable for the patient and the paramedic. The genitalia should be inspected for bleeding and signs of trauma (if indicated).
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the anus
- Examination of the anus is indicated in the presence of rectal bleeding or trauma to the area.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the extremities
- When examining the upper and lower extremities, the paramedic should direct his or her attention to function as well as structure.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the posterior body
- Assessment of the spine begins with a visual assessment of the cervical, thoracic, and lumbar curves and continues with a region-by-region examination for pain, swelling, and range of motion.
- Describe physical examination techniques used for assessment of and normal and abnormal findings in the neurological system
- A neurological examination may be organized into five categories: mental status and speech, cranial nerves, motor system, sensory system, and reflexes