Physical examination
🌟
Z. Alshammeri
Physical examination technique
The important five main part of patient assessment
Rarely does one sign or symptoms show you the patient status or underlying problem ( true )
PPE it’s just mask, goggles and gloves (False)
What does PPE means?
It is personal protective equipment
Minimum we should wash hands to 20 second ( true )
Any suspect of a spinal injury, we should take procedure of spinal injury
The similarities between MOI and NOI ?
Never ever remove the impaled object except in three cases ?
If the foreign body close the airway
if the foreign body is stable it and I can’t move the patient
If the foreign body prevents me from performing CPR
Some situations may require?
More ambulance Air medical support
Specialized resources Fire department
Advance life support ( ALS ) Low enforcement
What is form a general impression?
Note the patient position Ask about the chief complaint
Overall a appearance Address life - threats immediately
Avoid standing over the patient
What is The physical examination the patient and assess ?
General impression
Level of consciousness ( LOC )
ABC
Level of consciousness assessment :
A alert
V Verbal communication
P Pain
U Unresponsive
The type of adult cardiac arrest algorithm ?
VF / PVT / A SYSTOLE / PEA
Can we recognise the rhythm shockable or not with sign and symptoms (true)
We need a Epinephrine and Amiodarone in cardiac arrest cases ( false )
We use Oropharyngeal with unconscious patients ( true )
The Most problem for close airway tongue ( true )
how to Observe how much effort is required for the patient to breathe ?
• Use of accessory muscles
• Nasal flaring
• Tripod position
• Labored breathing
One sign of patient breath is flared nostrils
The most common cause of paradoxical breathing ?
Chest trauma
Neurological problems that can paralyse the diaphragm
Electrolyte imbalance caused by :
Treatment :
Stabilizing the paradoxical movement
Allow the chest to expand and contract as fully as possible
Stopping movement of the flail segment helps the chest and lungs to move air more efficiently
Flail chest
Assist ventilation
Chest trauma Possible intubation
Load and go
Stabilise flail segment
Monitor for : Respiratory distress
Pulmonary contusion Increased work of breathing
Haemothorax Increased effort and rate
Pneumothorax
Respiratory failure
Occurs when the blood is inadequately oxygenated or ventilation
Is inadequate to meeting the oxygen demand of the body
PNEUMOTHORAX
is a collapsed lung occurs when air leaks into the space between your lung and chest wall. This air
pushes on the outside the lung and makes it collapse
Plunt , penetrating chest injury , ceratin medical procedures
Sudden chest pain / Shortness of breath
Usually involves inserting a needle between ribs to remove the excess air
It’s a pressure wave
occurs as each heartbeat causes a surge in the
ASSESS CIRCULATION
blood circulating through the arteries.
Why there’s special place to feel the pulse and where?
ASSESS CIRCULATION
Capillary refill BLEEDING
It’s Evaluated to assess the ability of the Assess and control external bleeding in trauma patients.
circulatory system to restore blood to
the capillary system • Should occur before addressing airway or
breathing concerns.
The steps:
• Press on the patient’s fingernail.
• Remove the pressure.
• The nail bed should restore to its normal pink color.
• Should be restored to normal within 2 sec.
How to controlling external bleeding ?
• Apply direct pressure, indirect pressure and elevate the limb.
• Wound packing is indicated for penetrating wounds where
bleeding cannot be controlled using direct pressure.
when we can apply a tourniquet ?
Determine Priority of Patient Care
• Direct pressure and other methods are not successful and Transport
• Hemorrhage of an extremity amputation
Secondary assessment • Transport decisions should be made at this point based on :
How and what to assess ? • Patient’s condition
• Availability of advanced care
• Distance of transport
• Local protocols
A normal rate in adults ranges from 12 to 20 breaths / min
Respiratory system Respiratory rhythm divided to regular and irregular
Normal breathing is silent we can always hear sound better
from the patient back
Count the number of breaths in a 30-second period and
multiply by two
Normal heart rates in adults is between 60 and 100 beats/ min
Pulse rhythm, it’s divided to regular and irregular Cardiovascular system
Why we don’t use the thump to feel the pulse ?
Because it has its own pulse that you may feel
blood pressure
Pressure of circulating blood against the walls of the arteries
A drop in blood pressure may indicate :
• A loss of blood or fluid components
• A loss of vascular tone and sufficient arterial constriction
• A cardiac pumping problem
The type of blood pressure?
Hypotension
Blood Pressure low than normal
Is late sign of shock Hypertension
Blood pressure higher than normal
may result in a rupture or other
critical damage in the arterial
system.
Neurogenic systems
The neurologic assessment should be performed
with any patient who has :
• Use the AVPU scale if appropriate.
• Changes in mental status
• A possible head injury • The Glasgow Coma Scale (GCS) can be helpful in providing
• Stupor additional information
• Dizziness/drowsiness
• Syncope
• Causes of depressed brain function :
PUPILS • Injury of the brain or brain stem
• Trauma or stroke
• Brain tumor
• Inadequate oxygenation or perfusion
• Drugs or toxins
All causes by head injury
Secondary assessment
Anatomic Regions Where is the appendix located ?
• Right lower quadrant (RLQ)
Assess vital signs
Pulse oximetry :
Measure the oxygen saturation of hemoglobin in the blood
Range for pulse oximetry:
95 - 100%
• Reading below 94% is cause for concern and below
90% is suggestive of hypoxemia
• There are factors that can affect pulse oximeter readings ?
Hyperventilation
Hypoventilation
Hypothermia
BLOOD PRESSURE MEASUREMENT Sphygmomanometer
• There are two different ways of measuring blood glucose levels ?
measured in millimoles per litre (mmol/L)
measured in Milligrams per decilitre (mg/dL) Hypoglycaemia
Blood glucose levels below 70
See In the insulin-dependent diabetic population
Normal blood glucose is between 70—110 mg/dL
Hypoglycaemia can result from ?
Hyperglycaemia Too much insulin is taken
Blood glucose levels more than 200 Patient eats too little
See in patient who are insulin dependent
Hypoglycaemia symptoms?
Hyperglycaemia Results from? Altered mental status
confusion
Eating too much food
sweating
Simple sugar
diaphoresis
Infection
shaking
Illness
Hyperglycaemia symptoms are?
Polydipsia Hypoglycemia can present as alcohol intoxication
Polyuria also occur in the non-diabetic
Polyphagia patient.
Mention 3 anther medical conditions can
Type of breathing in DKA ?
lead to hypoglycaemia?
Kussmaul’s respirations
Alcoholics
Cancer patients
Liver disease
🫶
ال تنسوني من دعواتكم
