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Slide 1 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Chapter 12
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Slide 2 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case History Your ambulance responds to a pedestrian who was struck by a car. You determine the scene is safe to approach and find a 28-year-old female who is alert and oriented. There were no significant findings in the initial assessment and rapid trauma assessment. You are now ready to conduct your detailed physical examination en route to the hospital. Your ambulance responds to a pedestrian who was struck by a car. You determine the scene is safe to approach and find a 28-year-old female who is alert and oriented. There were no significant findings in the initial assessment and rapid trauma assessment. You are now ready to conduct your detailed physical examination en route to the hospital.
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Slide 3 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination More deliberate and comprehensive than the rapid trauma assessment Conducted as patient is being transported to the hospital Areas such as the face, eyes, nose, mouth, and ears are checked more closely
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Slide 4 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Situation- and time-dependent Depends on severity of patient’s condition Example: Cardiac arrest Attention devoted to CPR, use of an AED Attention devoted to CPR, use of an AED EMTs are busy administering critical treatments EMTs are busy administering critical treatments Detailed exam is not possible Detailed exam is not possible
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Slide 5 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Injury-specific May or may not be complete head-to-toe Example: Ballplayer struck in the face Detailed assessment of the eyes, nose, mouth, and ears Detailed assessment of the eyes, nose, mouth, and ears Assessment of abdomen or lower extremities may not be appropriate Assessment of abdomen or lower extremities may not be appropriate Example: Victim of car crash Detailed head-to-toe examination Detailed head-to-toe examination
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Slide 6 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Usually performed en route to hospital Responsive patients May feel exam is a repeat May view it as an invasion of privacy Explain that you have only checked briefly for critical injuries; now need to examine in more detail Ambulance provides a degree of privacy
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Slide 7 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Inspect and Palpate DCAP/BTLS Deformities Contusions Abrasions Punctures/penetrations Burns Tenderness Lacerations Swelling
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Slide 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Head DCAP/BTLS Pay attention to the scalp. Wounds can be hidden by hair. Injuries may not be obvious on quick inspection. Gently palpate swollen areas of the head. Avoid inadvertently depressing bone fragments onto the brain.
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Slide 9 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Face DCAP/BTLS Gently palpate facial bones. Pay attention to the airway. Facial injuries can cause airway compromise. Aspiration is a major concern. Make certain suction is available to deal with secretions.
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Slide 10 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Ears DCAP/BTLS Check inside and behind ears for signs of injury. Battle’s sign Discoloration behind the ear May be a sign of a skull injury Takes time to develop Check for drainage of blood or blood-tinged cerebrospinal fluid. If drainage is noted, apply loose dressing over ear.
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Slide 11 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Eyes DCAP/BTLS Inspect the eyes for injuries, discoloration, and foreign bodies May be blood Under the cornea In the anterior chamber between the cornea and the iris Behind the sclera Inspect the pupils and note Size Equality Response to light
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Slide 12 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Eyes Closely examine penetrating injuries Entire eye may be exposed Small wound may be evident through which the fluid can escape. Do not place pressure on the eyeball. Especially if penetration is suspected
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Slide 13 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Nose DCAP/BTLS Note drainage or active bleeding. May indicate skull injury Nasopharyngeal airway should not be used. May actually penetrate the brain space May actually penetrate the brain space If the patient has a burn injury Note singed nasal hairs May point to respiratory involvement May point to respiratory involvement Bleeding from the nose may complicate airway. Have suction ready.
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Slide 14 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Mouth Examine for Discoloration Loose teeth Foreign bodies Risk of airway obstruction Dentures can be left in place if they are stable. Remove and save fragments of broken teeth since they may be re- planted.
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Slide 15 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Mouth Tongue Swollen (injury or allergic reaction) Lacerations Bites (seizure) Check for odors. Clues to medical or toxic problems Examples Examples Alcohol Acetone-like odor from diabetic patients EMT is not expected to know the cause of the odor. Describe the odor to medical direction and receiving hospital.
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Slide 16 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Examination — Neck DCAP/BTLS Crepitation Subcutaneous emphysema Jugular venous distention Tracheal shift
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Slide 17 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Chest DCAP/BTLS Breath sounds Paradoxical breathing
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Slide 18 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Abdomen DCAP/BTLS Firm vs. soft Distended
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Slide 19 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Pelvis DCAP/BTLS Crepitation Tenderness Motion
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Slide 20 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Lower Extremities DCAP/BTLS Distal pulse
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Slide 21 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Lower Extremities Sensation Motor function
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Slide 22 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Upper Extremities DCAP/BTLS Distal pulse
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Slide 23 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Upper Extremities Sensation Motor function
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Slide 24 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination — Back DCAP/BTLS Look for exit wounds with penetrating trauma.
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Slide 25 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Summary Detailed exam is more deliberate and comprehensive than the focused physical exam. Detailed exam is performed during transport. Areas such as the face, eyes, nose, mouth, and ears are checked more closely. Perform detailed physical examination. Check for signs of injury (DCAP/BTLS) in all body regions. Maintain spinal immobilization. Log-roll the patient to assess the posterior body.
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