1. Slide 1 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Dr. Anmar Mandourah

2. Slide 2 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Overview Patients Needing a Detailed ExaminationPatients Needing a Detailed Examination Examination ProcedureExamination Procedure Assessing Vital SignsAssessing Vital Signs

3. Slide 3 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Patients needing a detailed examinationPatients needing a detailed examination –Patient- and injury-specific (e.g., cut finger would not require a detailed physical exam) –Patients with significant injuries, significant mechanisms of injury, and unresponsive patients require a detailed physical exam

4. Slide 4 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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.

5. Slide 5 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Examination Procedure Perform a detailed physical examination on the patient to gather additional information.Perform a detailed physical examination on the patient to gather additional information. As you inspect and palpate, look and/or feel for the following examples of injuries or signs of injuryAs you inspect and palpate, look and/or feel for the following examples of injuries or signs of injury –Deformities –Contusions –Abrasions –Punctures/penetrations –Burns –Tenderness –Lacerations –Swelling

6. Slide 6 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. This assessment is similar to the rapid trauma assessment. The detailed physical examination should be tailored to fit the needs of each individual patient.

7. Slide 7 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the head; inspect and palpate for injuries or signs of injuryAssess the head; inspect and palpate for injuries or signs of injury –DCAP- BTLS –Wounds - Fractures Bleeding – swelling Bleeding – swelling -Check your gloves for blood. -Check your gloves for blood.

8. Slide 8 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the face; inspect and palpate for injuries or signs of injuryAssess the face; inspect and palpate for injuries or signs of injury –DCAP-BTLS

9. Slide 9 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Face

10. Slide 10 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the ears; inspect and palpate for injuries or signs of injuryAssess the ears; inspect and palpate for injuries or signs of injury –DCAP-BTLS DrainageDrainage bleedingbleeding

11. Slide 11 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Battle signs (Bluish discoloration of the Mastoid Process)

12. Slide 12 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the eyes; inspect for injuries or signs of injuryAssess the eyes; inspect for injuries or signs of injury –DCAP-BTLS DiscolorationDiscoloration Unequal pupilsUnequal pupils Foreign bodiesForeign bodies Blood in anterior chamberBlood in anterior chamber

13. Slide 13 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the nose; inspect and palpate for injuries or signs of injuryAssess the nose; inspect and palpate for injuries or signs of injury –DCAP-BTLS Drainage (CSF)Drainage (CSF) BleedingBleeding

14. Slide 14 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the mouth; inspect for injuries or signs of injuryAssess the mouth; inspect for injuries or signs of injury –DCAP-BTLS TeethTeeth ObstructionsObstructions Swollen or lacerated tongueSwollen or lacerated tongue OdorsOdors DiscolorationDiscoloration

15. Slide 15 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the neck; inspect and palpate for injuries or signs of injuryAssess the neck; inspect and palpate for injuries or signs of injury –DCAP-BTLS –Jugular vein dissention (JVD) –Crepitation

16. Slide 16 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure 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.

17. Slide 17 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the chest; inspect and palpate for injuries or signs of injuryAssess the chest; inspect and palpate for injuries or signs of injury –DCAP-BTLS –Crepitation –Paradoxical motion* –Breath sounds in the apices, midclavicular line, bilaterally and at the bases, midaxillary line, bilaterally.

18. Slide 18 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the abdomen, inspect and palpate for injuries or signs of injuryAssess the abdomen, inspect and palpate for injuries or signs of injury –DCAP-BTLS –Firm –Soft –Distended

19. Slide 19 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the pelvis; inspect and palpate for injuries or signs of injuryAssess the pelvis; inspect and palpate for injuries or signs of injury –DCAP-BTLS If the patient does not complain of pain or is unresponsive, gently flex and compress the pelvis to determine stability.

20. Slide 20 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the legs; inspect and palpate for injuries or signs of injuryAssess the legs; inspect and palpate for injuries or signs of injury –DCAP-BTLS –Distal pulses –Sensation –Motor function

21. Slide 21 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Procedure Assess the arms in the same manner as the legsAssess the arms in the same manner as the legs

22. Slide 22 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Detailed Physical Examination Roll with spinal precautions and assess posterior aspect of body; inspect and palpate for injuries or signs of injuryRoll with spinal precautions and assess posterior aspect of body; inspect and palpate for injuries or signs of injury –DCAP-BTLS

23. Slide 23 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Vital Signs

24. Slide 24 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Vital Signs Assess baseline vital signsAssess baseline vital signs –Breathing –Skin –Pupils –Blood pressure

25. Slide 25 Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Summary Patients Needing a Detailed ExaminationPatients Needing a Detailed Examination Examination ProcedureExamination Procedure Assessing Vital SignsAssessing Vital Signs