1. Physical Examination of the Injured Patient
PHED 120
Krzyzanowicz – Fall ‘12

2. Objectives
Identify and define the components of a physical examination for an injured patient in an emergency situation.
Discuss appropriate scene assessment measures in order to establish safety relative to the provision of emergency care.
Identify measures and supplies utilized to protect against the transmission of infectious diseases when providing emergency care.
Identify and discuss the components of the primary survey using the ABCDE mnemonic.
Identify and discuss the components of the secondary survey.
Identify and discuss the six easily measured vital signs.

3. Physical Exam Procedures
Four components:
Inspection
Examine the injured area looking for deformity, contusions, abrasions, swelling, bleeding
Palpation
Touch the injured area, feel for deformity/crepitus
Percussion
Not used often-used for thoracic and abdominal injuries
Auscultation
Listening to lungs and bowels with stethoscope

4. Scene Assessment Avoid tunnel vision Get a global picture of the scene
How many patients are there?
Hazards, such as electrical cords, water, blood?
Is the patient moving?

5. Primary Survey Rapid head to toe assessment
ID and immediately correct life and/or limb threatening injuries
If yes, activate EAP
ABCDE
Stabilize cervical spine and check airway
Check for breathing
Check for circulation
Check for neurological disability (or apply defibrulator)
Check level of exposure

6. Airway and Cervical Spine
Always assume an injured athlete has a neck injury
Do not move this patient
Check ABC’s
Airway
If no airway perform head-tilt-chin-lift or jaw-thrust (if on their back)
Remove mouth guard if needed
Listen for sounds

7. Breathing Look and feel for the chest to rise
Patient is breathing in chest rises
If no rise in chest, suspect patient isn’t breathing
Will proceed to circulation
Check nail beds for cynosis-a bluish color tint
Normal breaths per minute for an adult is (wide ranging)

8. Circulation Find pulse Radial pulse in wrist
Is it strong? Weak? Irregular? Or absent?
Check for 10 seconds, multiple number by 6
I.E., pulse of 12 for 10 seconds (12*6=72 bpm)
Check capillary bed refill
Press on nail bed of any finger
Release quickly
Note how quickly color returns

9. Disability/Defibrillation
Disability refers to a brief neurological exam
Will not do in this course
AT students will do later on in program
Defibrillation
Will review this with CPR/AED sections later this semester

10. Exposure Clothing or equipment may need to be removed
Hot and humid days
Heat illness
Cold weather
Frostbite

11. Secondary Survey
Complete head-to-toe examine to rule out other injuries that may not be apparent on the primary survey
Look at Pupils
PERRLA
Pupils
Equal
Round
Reactive
Light
Accommodation

12. Vital Signs Pulse Rate Blood Pressure Respiratory Rate Temperature
Pulse Oximetry
Pain

13. Pulse Rate Assessment sites Take for at least 30 seconds now
Radial pulse (wrist)
Brachial pulse (humerus)
Inguinal pulse (groin)
Dorsal pedal pulse (foot)
Take for at least 30 seconds now
Multiple number by 2

14. Pulse Rate Normal pulse rate Tachycardia Bradycardia Can vary
60 to 100 bpm
Tachycardia
Heart rate higher than 100 bpm
Bradycardia
Heart rate lower than 60 bpm
Can vary
Athlete in competition=high heart rate
Runners-resting heart rate can be low, in the 40’s!

15. Blood Pressure How to take a blood pressure Patient is sitting
Left arm exposed (shirt off, sleeve rolled, etc)
Examiner is seated
Place cuff around biceps
Place stethoscope in cubital fossa (elbow)
Pump cuff up to 200 mmHg
Listen for first sound (top number) systolic
Listen for second sound (bottom number) diastolic
Release rest of air

16. Blood Pressure Normal Hypotension Hypertension 120/80 Usually 100/60
Over 120/80
Newer definition on hypertension
Athletes should have a lower BP than normal population due to training
Except football-lineman

17. Respiratory Rate Never tell the patient you are watching the breathe
They will change their breathing pattern
I try to do this while taking pulse
I take pulse for 30 seconds; then next 30 seconds watch them breathe

18. Respiratory Rate Normal Tachypnea Bradypnea 12-24 breaths per minute
Rapid rate
Above 20 breaths per minute
Asthma attack
Bradypnea
Slow rate
Less than 10 breaths per minute
Head injury, heart attack, etc

19. Body Temperature Normal 98.6 deg F Sites to take temperature
Oral (most common and 2nd best)
Tympanic (ear-not very reliable)
Axillary (arm pit- not very reliable)
Forehead (place hand on head-actually pretty good indicator, if you’re trained)
Rectal
Best and most accurate measurement
Gold standard

20. Pulse Oximetry Usually pocket sized devices
Shows how much oxygen is in your blood
Oxygen saturation
Should be close to 100
Never will be 100
Below 95 is a start of concern
Below 90 is a huge concern

21. Pain Always ask about pain using a scale 0-10
Zero means no pain
Ten means worst pain ever felt
Actually a good indicator as well