Techniques of the Comprehensive Physical Examination EMS Professions Temple College

Objectives n Review the general approach and systematic method used in performing a comprehensive PE –Pathophys will discuss abnormal findings specific to disease –Patient Assessment will discuss focusing the PE as needed –Use small group discussions to define the issues

Discussion Groups n Group 1 –Daniel, Stephanie, Kristine, Elvie n Group 2 –Jennifer P, Roy, Jennifer D n Group 3 –Angela, Crystal, Aaron

Discussion Group Guidelines n Work as a Team n Everyone contributes to the success & failure of the Team n Respect each team member’s ideas n Rotate the role of team leader, note- taker, and spokesperson n Open your minds; Think Broadly n Learn from each other

What is the purpose of a Comprehensive Physical Exam? n Why is it performed? –What should you expect to gain from it? –What should you not expect to gain from it? n Group Discussions

Techniques Used in Physical Exam n Inspection n Palpation n Percussion n Auscultation

Percussion

Tools of the Physical Exam n Stethoscope n BP cuff n Otoscope n Ophthalmoscope n Can you think of any other tools?

Other Data Obtained n Vital Signs –Pulse –Ventilations (Respirations) –Blood Pressure –Temperature n Height n Weight n Spo 2

Pulse Points

Breathing Patterns

Elements of the Comprehensive Physical Exam n General Survey n Mental Status n Vital Signs n HEENT n Neck n Chest n Abdomen n Pelvis (as needed) n Posterior Body n Extremities –Vascular –Musculoskeletal n Neurologic Exam

In the Beginning n Begin with Comp PE or Focus on CC? –What determines the direction you take? –Why?

Mental Status n AVPU vs A&O X 4 –What’s the difference? –When do you use one vs the other? n Non-Useful Terms to Avoid n What are other ways of assessing? n What does mental status tell you about the patient? n Group Discussions

General Survey of the Patient n What should we look for? –Why? –What do these things tell us?

General Survey of the Patient n Appearance & Behavior –Posture & Motor Activity –Dress, Grooming & Personal Hygiene –Facial Expression –Speech & Language –Mood –Thoughts & Perceptions –Insight & Judgment –Memory & Attention

General Survey of the Patient Class Exercise –You will have 3-5 seconds to view a scene and patient –Once you have done this, return to your desk and write down everything you know or suspect about the patient

General Survey of the Patient n Apparent State of Health –Before beginning the actual physical exam, What are the clues? What might they tell you? How would these things affect your physical exam? n Group Discussions

General Survey of the Patient n General Physical Appearance –Height, Weight & Build –Sexual & Physical Development –Posture, Gait & Motor Activity –Hair, Nails & Skin appearance –Dress, Grooming & Personal Hygiene –Odors –Facial Expressions & Body Language

Additions to the General Assessment n Vital Signs –Blood Pressure Palp or auscultated –Pulse Pulse or Heart Rate –Ventilations Ventilations or Respirations –Pulse Oximetry –Temperature