1.  External nose comprises the nasal bones and cartilage covered by skin  Cartilaginous bony septum divides the left and right nasal cavities  Turbinates  Mucous membrane for filtration Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

2.  Check your patient’s nose from the front and from the side.  Inspect the nose’s internal structures.  Insert the speculum of your otoscope.  Examine the nasal mucosa for evidence of drainage.  Test for nasal obstruction. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

3.  The lips mark the entrance to the mouth.  The mouth houses the tongue, gums, and teeth.  The hard and soft palate  Uvula  Glands  Parotid and sub-mandibular Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

4.  To examine the mouth, you will need a bright light and a tongue blade.  Examine the oral mucosa for color.  Examine the tongue.  Examine the palate.  Note any odors.  Observe for presence of fluids. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

5.  The neck houses many life-sustaining structures.  Any major disruption of these vital structures can cause rapid deterioration or immediate death. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

6.  Inspect your patient’s neck for general symmetry and visible masses.  Palpate the trachea for midline position.  Palpate the carotid arteries.  Palpate the thyroid gland.  Examine the lymph nodes. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

7.  The chest is a protective cage of bones, muscles, and cartilage.  The chest is divided into three cavities:  Mediastinum  Right pleural cavity  Left pleural cavity Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

8.  To assess the chest and thorax:  Gather the necessary equipment.  Have your patient sit upright, if possible, and expose his entire chest.  Perform the exam in standard sequence. Inspect, palpate, percuss, auscultate  Compare the findings from side to side. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

9.  Observe your patient’s breathing.  Inspect the anterior chest wall and assess its symmetry.  Palpate the rib cage for rigidity.  Evaluate for equal expansion  Tactile fremitus  Percuss your patient’s chest. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

10.  Auscultate your patient’s chest for normal breath sounds, adventitious breath sounds, and voice sounds. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

11.  Normal breath sounds  Adventitious breath sounds  Crackles  Wheezes  Stridor  Pleural friction rub Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

12.  The heart sits just behind the sternum between the 3rd and 6th costal cartilages.  The apical impulse is at the 5th intercostal space. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

13.  Anatomy of the heart and blood flow  Cardiac cycle  Stroke volume  Cardiac output Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

14.  Inspect for signs of arterial insufficiency.  Look for skin pallor and other signs of decreased perfusion.  Palpate the carotid arteries.  Vibration or humming (thrills).  Auscultate with your stethoscope for bruits. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

15.  Check for jugular venous pressure.  Approximates right atrial pressure  Auscultate your patient’s anterior chest for normal heart sounds. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

16.  The abdominal cavity is divided into four quadrants.  Visualize the organs in the region you are examining. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

17.  Organs of the digestive, urinary, reproductive, cardiovascular, and lymphatic systems lie in the abdomen.  Peritoneum Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

18.  Examination of the Abdomen  Inspection Contour, pulsations/masses, bulging flanks, skin, and umbilicus.  Auscultation Note frequency/character of the bowel sounds with stethoscope. Listen for aortic, renal, iliac, and femoral bruits.  Palpation Palpate lightly then deeply in all four quadrants. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

19.  Cullen’s sign—discoloration around the umbilicus suggestive of intra-abdominal hemorrhage  Grey-Turner’s sign—discoloration over the flanks suggesting intra-abdominal bleeding  Ascites—swelling in the flanks and abdomen  Borborygmi—loud, prolonged, gurgling bowel sounds Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

20.  External female genitalia consist of highly vascular tissues that protect the entrance to the birth canal.  The age in which sexual development occurs varies among individuals. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

21.  You would rarely be expected to examine the female genitalia.  Maintain privacy, expose her body areas only as necessary, be sensitive to her feelings, and project a professional demeanor.  It is customary for male clinicians to have a female partner present during the examination. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

22.  The external male genitalia consist of the penis and scrotum.  You would rarely be expected to inspect the male genitalia. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

23.  Inspect your patient’s penis and scrotum.  Priapism  Lift the scrotum to inspect its posterior surface and note any swelling.  Assess any discharge from the urethral meatus. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

24.  The most distal end of the GI system.  The lower anus is rich in venous circulation.  Examining the anus is normally not a prehospital practice. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

25.  Maintain privacy during this examination.  Explain what you are doing during the exam.  Position patient on his left side with his legs flexed.  Inspect the sacrococcygeal and perianal areas. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

26.  The musculoskeletal system consists of 206 bones and their associated muscles, tendons, ligaments, and cartilage.  Gives form to the body and allows for movement. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

28.  Each joint’s structure determines it’s range of motion.  Bones within a joint do not touch each other.  Synovial joint Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

29.  General Impression  Observe how the patient moves as he goes into the room or moves to the stretcher.  General appearance  Body proportions  Observe, inspect, and palpate the joints,structure, and movement. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

30.  Assess patient’s range of motion.  Active  Passive  Palpate each area of the structure in turn, evaluating for pain and abnormalities as compared to the other side. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

31.  A complete examination of the extremities includes wrists and hands, elbows, shoulders, ankles and feet, knees, and hips. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

32.  Wrist and Hand  Inspect for swelling or deformities.  Palpate.  Assess flexion, extension, ulnar and radial deviation of the wrist. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

33.  The Elbow  Palpation: lateral and medial epicondyles, olecranon, radial head, groove on either side of the olecranon  Inspect the carrying angle, and any nodules or swelling. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

34.  The Elbow  Assess elbow flexion and extension.  Assess supination and pronation of the wrist. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

35.  Examining the Shoulder  Inspection  Palpation  Passive range of motion  Active range of motion Apply scratch test for internal/external rotation.  Impingement signs Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

39.  Ankles and Feet  Inspect the foot and ankle for obvious deformities, nodules, swelling, calluses, or corns.  Palpate the anterior aspect of each ankle joint. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

40.  Ankles and Feet  Test range of motion.  Assess inversion and eversion of the foot. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

41.  The Knee  Inspect your patient’s knees for alignment and deformities.  Range of motion  Stability of the medial and collateral ligaments Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

42.  The Knee  Evaluate the anterior and posterior cruciate ligaments by using the “drawer” test.  Flexion and extension Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

43.  The Hip Joint  Inspect the hips for deformities, symmetry, and swelling.  Palpate for tenderness. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

44.  The Hip Joint  Assess external and internal rotation of the hip.  Assess hip abduction and adduction. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

45.  The Spine  Inspect head and neck for deformities, abnormal posture, and asymmetrical skin folds.  Evaluate the curves of the cervical, thoracic, and lumbar spine. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

46.  The Spine Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

47.  The Spine  Palpate the spinous processes.  Test flexion and extension of the head and neck.  Test rotation of the head and neck.  Assess lateral bending of the head and neck. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

48.  The Spine  Assess flexion of the lower spine.  Assess lateral bending of the lower spine.  Assess spinal extension.  Assess spinal rotation. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

49.  Delivers oxygenated blood to the tissues of the extremities  Major blood vessels Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

50.  The Lymphatic System  Plays an important role in the body’s immune system  Important role in our circulatory system Collects the remaining fluid from the tissues and returns it to the heart Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

51.  Assess a peripheral pulse.  Note the rate, regularity, equality, and quality of the pulses.  Compare peripheral pulses bilaterally. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

52.  Assess for edema.  Pitting vs. non-pitting  Feel the temperature of the extremity.  Look for visible venous distention. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ