Chap - 11 - Tech of Phys Exam

Techniques of Physical Examination
Objectives
 Describe prehospital physical examination
techniques
 Describe examination equipment
 Describe the general approach to the physical

examination
 Outline the steps of the comprehensive

physical examination
Objectives
 Detail the components of the mental status
examination
 Identify abnormal findings in the mental status

examination
 Outline steps in the general patient survey
 Distinguish between normal and abnormal

findings in the general survey
Objectives
 Describe examination techniques for specific
body regions
 Identify normal and abnormal findings in the

body region examination
 Describe examination techniques specific to

children and older adults
Scenario
You respond to a nursing home for an
“unresponsive person.” Your patient is a 92-
year-old woman who is recuperating from a
fractured hip. She takes cardiac and diabetic
medications. According to the nurse
assistant, she is normally alert, but is now
only responsive to pain. She has a bruise on
her forehead. The story of this evening’s
events seems inconsistent.
Discussion
 What priorities will you have in this patient’s physical
assessment?
 Assuming her airway and breathing are managed, what

examination techniques will you use to assess this
unconscious woman?
 What equipment will you need to perform your physical

exam?
 What areas will be of particular concern as you complete

your comprehensive physical examination?
Examination Techniques
 Inspection
 Palpation
 Percussion
 Auscultation
Inspection
 Visual assessment of the patient and surroundings
 Findings that may be significant:

 Patient hygiene
 Clothing
 Eye gaze
 Body language
 Body position
 Skin color
 Odor
Inspection
 If the emergency response was to the
patient's home, make a visual inspection for
 Cleanliness
 Prescription medicines
 Illegal drug paraphernalia
 Weapons
 Signs of alcohol use
Palpation
 A technique in which the hands and fingers are used
to gather information by touch
 Palmar surface of fingers and finger pads are used to

palpate for
 Texture
 Masses
 Fluid
 Crepitus
 And assess skin temperature
 Palpation may be either superficial or deep

Deep Bimanual Palpation
Percussion
 Used to evaluate for
presence of air or
fluid in body tissues
 Sound waves heard
as percussion tones
(resonance)
 Procedure
Auscultation
 Best performed in a quiet environment
 Requires a stethoscope
 Body sounds produced by movement of fluids or gases in
patient's organs or tissues
 Note:
 Intensity
 Pitch
 Duration
 Quality
Stethoscope
 Used to evaluate sounds created by
cardiovascular, respiratory, and
gastrointestinal systems
 Stethoscopes
 Acoustic
 Magnetic
 Electronic
Stethoscope
 Position stethoscope
between index and
middle fingers
Ophthalmoscope
 Used to inspect eye
structures:
 Retina
 Choroid
 Optic nerve disc
 Macula
 Retinal vessels
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Otoscope
 Used to examine
deep structures of
the external and
middle ear
Blood Pressure Cuff
 Sphygmomanometer
 Measures systolic and

diastolic blood pressure
 Manual or electronic
Comprehensive Physical Examination
 Mental status  Chest
 General survey  Abdomen
 Vital signs  Posterior body
 Skin  Extremities
 Head, eyes, ears, nose,  Neurological exam

and throat (HEENT)
Mental Status
 First step in patient care encounter
 Patient’s appearance and behavior
 Level of consciousness
• A healthy patient is expected to be alert, responsive to
touch, verbal instruction, and painful stimuli
Mental Status
 Appearance and behavior
 Posture, gait, and motor activity
 Dress, grooming, personal hygiene
 Breath or body odors
 Facial expression
 Mood and affect
 Speech and language
 Thought and perceptions
 Memory and attention
General Survey
 Signs of distress
 Cardiorespiratory insufficiency
• Labored breathing
• Wheezing
• Cough
 Pain
• Wincing
• Sweating
• Protectiveness of a painful body part or area
 Anxiety
• Restlessness
• Anxious expression
• Fidgety movement
• Cold, moist palms
General Survey
 Apparent state of health
 Skin color and obvious lesions
 Height and build
 Sexual development
 Weight
Skin Color
 Varies from person to person
 Varies based on ethnicity
 May range in tone from pink or ivory to deep

brown, yellow, or olive
 Observe for skin not exposed to sun (e.g.,

palms)
Skin Lesions
Height and Build
 Descriptions include:
 Average, tall, short, lanky, muscular
 May also be affected by age and lifestyle

Sexual Development
 Determine if age appropriate
 Observe for normal changes associated with

age
Weight
 Observe general appearance
 Obese to emaciated
 Recent changes may be key finding

 Recent weight loss or gain
Vital Signs
 Pulse
 Blood pressure
 Respirations
 Skin
 Pupils
Pulse
 Rate
 Rhythm
 Quality
 Consider ECG monitoring

Blood Pressure
Locations
Respirations
 Adult rate
 12-24 breaths per minute
 Observe
 Feel for chest movement
 Auscultate
Skin
 Texture
 Turgor
 Hair
 Fingernails and toenails

 Abnormal findings
Temperature Measurement
 Oral temperature
 Hold thermometer firmly

under tongue
 Tell child to “kiss”
 Caution to avoid biting

Axillary Temperature
 Hold arm down
firmly
 Should be
approximately 1° F
less than core temp
Tympanic Temperature
 Accuracy questionable
 Pull ear back
 Insert gently
Rectal Temperature
 Risk of perforation
 Avoid in
uncooperative, or
immuno-suppressed
patient
 Stabilize thermometer
Eyes—Visual Acuity
 Have patient
 Read printed material
 Count fingers at a
distance
 Demonstrate ability to tell
light from dark
 Use eye chart
• (e.g., Snellen chart)
Eyes—Pupils
 Findings may indicate neurological issues
 Examine response to light (PERRL)

 Pupils are equal, round, and react to light
Anatomical Regions
 Skin
 Texture
 Turgor
 Hair
 Fingernails and toenails
 Head, ears, eyes, nose, throat

Head and Face
 Inspect skull for shape and symmetry
 Palpate for swelling, tenderness, lesions,

indentations
 Inspect face for symmetry, expression,

edema, involuntary movements
Eyes
 Determine if contacts are present
 Determine that both eyes can see
 Assess visual acuity
 Inspect orbital area for edema
 Examine eyes for drainage or redness
 Determine structural integrity

Eyes—Visual Fields
Six cardinal fields of gaze
Visual Fields
 Ask the patient to look at his or her nose
 Test peripheral vision by extending your arms with
elbows at right angles and wiggle both index
fingers simultaneously
 Observe eyes for normal position and

alignment
Ophthalmoscopic Examination
 Used to evaluate:
 Cornea
 Hyphema
 Foreign bodies
 Hypopyon
 Lacerations
 Fundus
 Abrasions
 Optic nerve
 Infection
 Retina
 Anterior chamber
 Vitreous
 Eyelid
Cornea and Sclera
 Examine conjunctiva
and sclera
 Palpate lower orbital rim

 Inspect:
 Size, color, and clarity
of the disc
 Integrity of vessels
 Assess for retinal
lesions and appearance
of the macula
 Normal findings
 Clear, yellow optic nerve
disc
 Reddish pink
(European-American) or
darkened retina
(African-American)
 Light red arteries
 Dark red veins
 3:2 vein-to-artery ratio
c.
Otoscopic Examination
 Otoscope used to:
 Evaluate inner ear for discharge and foreign
bodies
 Assess eardrum
 Select speculum
 Turn on otoscope
 Insert speculum into ear canal,

slightly down and forward
 Look for foreign bodies, lesions,

discharge
 Inspect tympanic membrane
 Normal findings
 Cerumen is dry (tan or light yellow) or moist (dark
yellow or brown)
 Ear canal
• Not inflamed
 Tympanic membrane
• Translucent or pearly gray
Nose
 Inspect
 Palpate
 Discharge from the nose

 CSF
 Epistaxis
 Mucous discharge
Mouth and Pharynx
 Lips
 Gums
 Mouth and tongue
 Pharynx
Neck
 Inspect
 Use spinal precautions
if trauma is suspected
 Palpate trachea
 Midline position normal
Neck
 Palpate
 Place both thumbs along sides of distal trachea
 Systematically move toward head
 Do not apply bilateral pressure to carotid arteries
Head and Cervical Spine
 Temporomandibular joint (TMJ)
 Inspect and palpate cervical spine
 Range of motion
Chest
 Ribs
 Protect thoracic organs
 Support respiratory movements of diaphragm and
intercostal muscles
 Anatomical landmarks for examination
Topographical Landmarks
Thoracic Landmarks—Anterior Chest
Thoracic Landmarks—Posterior Chest
Inspection
 General appearance of chest
 Chest wall configuration

 Inspect for symmetry
 Chest wall should be symmetrical
Chest Wall Abnormalities
 Barrel chest
 Funnel chest (pectus

excavatum)
 Pigeon chest (pectus

carinatum)
 Thoracic kyphosis
 Scoliosis
Chest—Palpation
 Tracheal position
 Respiratory excursion
Percussion and Auscultation of Chest
Respiratory Effort
 Assess:
 Respiratory rate, rhythm, symmetry, and quality
 Patient position
 Accessory muscles
 Retractions (intercostal, supraclavicular, or both)
 Nasal flaring
 Pausing to take a breath
Respiratory Patterns
 Eupnea  Apnea
 Tachypnea  Cheyne-Stokes
 Bradypnea respiration
 Hyperpnea
 Kussmaul breathing
 Hyperventilation
 Biot’s respirations
 Dyspnea
 Central neurogenic
 Orthopnea hyperventilation
 Paroxysmal nocturnal
dyspnea
Auscultation
 Patient in sitting position (if possible)
 Instruct to breathe deeply and slowly through

open mouth
 Use diaphragm of stethoscope
 Evaluate anterior and posterior lung fields
Normal Breath Sounds
 Classified as:
 Vesicular
 Bronchovesicular
 Bronchial
Vesicular Breath Sounds
 Most of lung fields
 Lungs considered "clear"
make normal vesicular
breath sounds
 Harsh vesicular breath

sounds
 Diminished vesicular
breath sounds
Bronchovesicular Breath Sounds
 Major bronchi and
upper right posterior
lung field
 Louder and harsher than
vesicular breath sounds
 Medium pitch
 Equal inspiration and
expiration phases
 Heard throughout
respiration
Bronchial Breath Sounds
 Only over trachea
 Highest in pitch
 Coarse, harsh, loud sounds
 Short inspiratory phase and

long expiration
 Bronchial sound anywhere
but over trachea is abnormal
Abnormal Breath Sounds
 Absent
 Diminished
 Incorrectly located
bronchial sounds
 Adventitious
 Discontinuous
 Continuous
Breath Sounds
Fig.
Fig.11-26
11-26
Discontinuous Breath Sounds
 Crackles
 Formerly called rales
 High-pitched discontinuous sounds
 Usually at end of inspiration
 Disease of small airways or alveoli
 Coarse crackles: wet, low-pitched sounds
 Fine crackles: dry, high-pitched sounds
Continuous Breath Sounds
 Wheezes
 Rhonchi
 Stridor
 Pleural friction rub
Heart
 Assessment includes:
 Palpation
 Auscultation
Pulse
 Assess:
 Rate
 Rhythm
 Intensity
 Palpate pulses simultaneously on both sides

of body
 Except carotid
Pulse
 Auscultate for:
 Frequency (pitch)
 Intensity (loudness)
 Duration
 Timing in cardiac cycle
Auscultating Heart Sounds
Heart Sounds
 S1
 Instruct patient to breathe normally and then hold
breath in expiration
 S2
 Instruct patient to breathe normally again and then
hold breath in inspiration
Pericardial Friction Rub
 Inflammation of pericardial sac
 Scratching, grating, or squeaking quality

 Louder during inspiration
 Differs from pleural friction rubs by continued

presence during breath holding
Heart Murmurs
 Prolonged extra sounds
 Caused by disruption in flow of blood through

heart
 Most caused by valvular defects
 Some serious
 Others benign
• Have no apparent cause
Bruit
 Abnormal sound or
murmur
 Heard while
auscultating carotid
artery, organ or gland
 May be local obstruction
 Often low pitched
 Hard to hear
Thrills
 Vibrations or tremors
 May indicate blood flow obstruction

 May palpate over aneurysm or on precordium
 Serious or benign
Abdomen
 Two imaginary lines
separate abdominal
region into four
quadrants
Abdomen—Inspection
 Skin
 Umbilicus
 Contour
 Abdominal movement
Abdomen
 Auscultation
 Bowel sounds
 Bruits
 Percussion and palpation

 Detect:
• Fluid
• Air
• Solid masses
Percussion
 Evaluate four quadrants of abdomen:
 Tympany
• Air in stomach and intestines
 Dullness
• Solid abdominal organs and solid masses
 Proceed from tympany to dullness

 Change in sound easier to detect
Palpation of the Liver
Palpation of the Spleen
Female Genitalia
 If possible, use same-gender paramedics to
examine
 Chaperone if possible
 Inspect external genitalia for:

 Swelling
 Discoloration or redness
 Bleeding
 Trauma
 Lesions
 Discharge
Female Genitalia
 Normal vaginal discharge
 Clear or cloudy with little or no odor
 Yellow-green discharge
 Frothy, gray-green discharge with foul odor
 White, curdlike discharge with no odor
 Gray discharge with fishy, foul odor
Male Genitalia
 Inspect for bleeding or trauma
 Penis
 Shaft nontender and flaccid
 Priapism
 Urethral opening
 Free of blood and discharge
 Scrotum
 Nontender and slightly asymmetrical
Male Genitalia
 Anus
 Exam indicated if:
• Rectal bleeding
• Trauma to area
 Most patients find side-lying position most
comfortable
 Protect patient’s privacy
Male Genitalia
 Inspect sacrococcygeal and perineal areas for:
 Lumps
 Ulcers
 Inflammation
 Rashes
 Excoriations
 Inflamed external hemorrhoids common

 Adults and pregnant women
Musculoskeletal System
 Assess function and structure
 Patient position
 Evaluate head, neck, shoulders, and upper
extremities with patient in a sitting position
 Evaluate chest, back, and ilium with patient standing
 Evaluate hips, knees, ankles, feet with patient supine
 Observe general appearance, body proportions,

and ease of movement
General Principles
 Examine normal tissues before those injured,
inflamed, or otherwise affected
 Inspect and palpate each body part

 Then test range of motion and muscle strength
 Note differences between right and left
Extremities
 Evaluate:
 Skin and tissue over muscles, cartilage, bones
 Joints for injury, discoloration, swelling, masses
 Circulatory status
• Skin color and temperature
• Distal pulses
 Structural integrity of bones, joints, and tissues
 Muscle tone
Abnormal Findings
 Signs of inflammation
 Swelling  Asymmetry
 Tenderness  Crepitus
 Increased heat  Deformities
 Redness of overlying  Decreased muscle
skin strength
 Decreased function  Atrophy
Joints
 Bones move freely over one another
 No clicks, crepitation, or pain
 Move each joint through full range of motion

 Normal if no pain, deformity, limitation, or
instability
 Note:
 Limited range of motion
 Unusually increased joint mobility
Hands and Wrists
 Inspect for swelling,
redness, deformity,
nodules, muscular atrophy
 Palpate joint
 Note swelling, tenderness,
deformity
 Range of motion
 Test muscle strength by

hand grip
Elbows
 Inspection
 Examine in flexed and extended
position
 Note deformity, swelling,
nodules
 Palpation
 Lateral and medial epicondyles
of humerus
 Groove on sides of olecranon
process
 Range of motion
Shoulders and Related Structures
 Inspect shoulders, shoulder girdle,
scapulae, and related posterior muscles
 Symmetry of size and shape
 Note swelling, deformity, muscular atrophy
 Palpate for tenderness in:
 Sternoclavicular joint
 Acromioclavicular joint
 Subacromial area
 Biceps groove
 Note any tenderness or swelling
 Range of motion
Ankles and Feet
 Skin integrity
 Nodules
 Contour
 Swelling
 Position
 Calluses
 Deformities
 Corns
 Size
Ankles and Feet
 Palpate:
 Anterior aspects of each ankle joint
 Achilles tendon
 Metatarsophalangeal joints
 Note tenderness, swelling, deformity
Ankles and Feet
 Range of motion
 Dorsiflexion
 Plantar flexion
 Inversion
 Eversion
Pelvis
 Pelvic structural
integrity
 Hands on anterior iliac
crests
• Press down and out
 Heel of hand on
symphysis pubis
• Press down
Hips
 Inspect for symmetry
 Palpate:
 Instability, tenderness, and crepitus
 Range of motion (supine patient)

 Raises knee to chest, other leg straight
 Note flexion at hip and knee
Knees
 Inspection
 Patella smooth, firm, nontender, midline
 Alignment, swelling, and deformity
 Note atrophy of quadriceps
 Palpation
 Note thickening, swelling, tenderness
 Range of motion
 Bend, straighten each knee without pain
Peripheral Vascular System
 Arteries, veins,
lymphatic system
and lymph nodes,
fluids exchanged in
capillary bed
Arms
 Inspect fingertips to shoulders, noting:
 Size and symmetry
 Swelling
 Venous pattern
 Color of skin and nail beds
 Skin texture
 Palpate:
 Radial pulses bilaterally
 Epitrochlear node
• If palpable, note its size and consistency
Legs
 Patient supine and appropriately draped
 Inspect from groin and buttocks to feet:

 Size and symmetry
 Swelling
 Venous pattern and venous enlargement
 Pigmentation
 Rashes, scars, ulcers
 Color and texture of the skin
 Presence or absence of hair growth
Legs
 Palpate superficial inguinal nodes
 Swelling and tenderness
 Palpate pulses:
 Femoral
 Popliteal
 Dorsalis pedis
 Posterior tibial
 Temperature of feet and legs

Legs
 Check for pitting edema:
 Press firmly but gently with the thumb for at least 5
seconds
• Over dorsum of foot
• Behind medial malleolus
• Over shins
Abnormal Findings
 Swollen or asymmetrical extremities
 Pale or cyanotic skin
 Weak or diminished pulses
 Skin cold to the touch
 Absence of hair growth
 Pitting edema
Spine
 Inspection
 Cervical, thoracic, and
lumbar curves
• Lordosis (swayback)
• Kyphosis (hunchback)
• Scoliosis (razorback)
 Height differences of
shoulders
 Height differences of iliac
crest
Cervical Spine
 Inspection
 Should be in a midline position
 Look for deformities and abnormal posture
 Palpation
 If patient is alert and denies neck pain, palpate
posterior aspect of neck for point tenderness and
swelling
Cervical Spine
 Range of motion
 If no suspected injury:
• Bend head forward, chin
to chest (flexion)
• Bend head backward
(hyperextension)
• Move head side-to-side
(lateral bending)
 Should be no pain or
discomfort
Thoracic and Lumbar Spine
 Inspect for injury, swelling, discoloration
 Palpate from first thoracic vertebra

 Move downward to sacrum
 Range of motion
 Bend forward at waist
 Bend backward at waist
 Bend to each side
 Rotate upper trunk in a circular motion
Nervous System
 Detail of neurological examination varies
 Depends on patient’s complaint
• Peripheral nervous system vs. CNS problems
Neurological Examination
 Mental status and speech
 Cranial nerves
 Motor system
 Sensory system
 Reflexes
Mental Status and Speech
 Oriented to person, place, and time
 Organizes thoughts and converses freely

 If no hearing or speech impediments
Mental Status and Speech
 Abnormal findings
 Unconsciousness
 Confusion
 Slurred speech
 Aphasia
 Dysphonia
 Dysarthria
Cranial Nerve Assessment
 Cranial nerve I
 Olfactory: Test sense of smell with spirits of ammonia
 Cranial nerve II
 Optic: Visual acuity
 Cranial nerve II and III

 Optic and oculomotor
• Size and shape of pupils
• Pupil response to light
 Cranial nerves III, IV, VI
 Oculomotor, trochlear, abducens
• Extraocular movements
• Six cardinal directions of gaze
 Cranial nerve V
 Trigeminal
• Ask patient to clench teeth while palpating temporal and
masseter muscles
• Test sensation by touching forehead, cheeks, jaw on
each side
 Cranial nerve VII
 Facial
• Inspect face: note symmetry, tics, abnormal movements
• Raise eyebrows, frown, show both upper and lower
teeth, smile, puff out cheeks
• Close eyes tightly so they cannot be opened, gently
attempt to raise eyelids
• Observe for weakness or asymmetry
 Cranial nerve VIII

 Acoustic: Assess hearing acuity
 Cranial nerves IX and X
 Glossopharyngeal and vagus
• Ability to swallow with ease; to produce saliva; produce
normal voice sounds
• Patient holds breath: assess for normal slowing of heart
rate
• Testing for gag reflex will test cranial nerves
 Cranial nerve XI
 Spinal Accessory
• Raise and lower shoulders, turn head
 Cranial nerve XII

 Hypoglossal
• Stick out tongue and move it in several directions
Motor System
 Observe patient during movement and at rest
 Abnormal involuntary movements evaluated

for:
 Quality
 Rate
 Rhythm
 Amplitude
Motor System
 Other body movement assessments:
 Posture
 Level of activity
 Fatigue
 Emotion
 Muscle strength
 Bilaterally symmetrical
 Resistance to opposition
Muscle Strength
 Patient to move against resistance:
 No muscular contraction detected
 A barely detectable flicker or trace of contraction
 Active movement of body part with gravity
eliminated
 Active movement against gravity
 Active movement against gravity and some
resistance
 Active movement against full resistance
• This is normal muscle tone
Upper Extremity Evaluation
 Patient to extend
elbow and pull it
toward the chest
against resistance
Lower Extremity Evaluation
 Patient pushes
soles of feet against
examiner’s palms
 Patient pulls toes
toward head against
resistance
 Should be easily
performed by patient
without fatigue
Muscle Strength
 Other methods can be used to evaluate
muscle strength, including tests for:
 Flexion
 Extension
 Abduction
 Upper and lower extremities
Coordination
 Point-to-point movements
 Gait
 Stance
 Romberg test
 Pronator drift test
Romberg Test
Pronator Drift Test
Sensory System
 Conduct sensations of:
 Pain
 Temperature
 Position
 Vibration
 Touch
 A healthy patient is responsive to these

stimuli
Sensory System
 Patient’s response to pain and light touch
 Response considered in relation to dermatomes
 Perform light touch on hands and feet

 If patient cannot feel or is unconscious, gently
prick extremities with sharp object that will not
penetrate skin
 Head to toe
 Compare symmetrical areas
Approaching the Pediatric Patient
 Remain calm, confident
 Avoid separating child from parent
 Establish rapport with parents and child
 Be honest with child and parent
 Have one paramedic stay with child
 Observe child before physical examination
 Begin assessment without touching patient
 Note:
 Skin color
 Respiratory rate
 Assess behavior
 Note area of body that appears painful
 Avoid painful area until end of examination
 Warn child before you touch painful area(s)
General Appearance
 Assess from a distance:
 Spontaneous movement
 Respiratory effort
 Skin color
 Body position
 Seriously ill or injured child does not

hide or disguise condition
Birth to 6 Months
 Maintain body temperature
 Poor head control normal under 3 months of

age
 Infants are abdominal breathers

 Stomach protrudes and chest wall retracts during
inspiration
Birth to 6 Months
 Assess anterior
fontanel:
 Present up to 18 months
 Bulges during crying
 Firm if child is supine
• If sunken, may be
dehydration
• Bulging fontanel may
mean increased
intracranial pressure
7 Months to 3 Years
 Usually cooperative
 Minimal speech, unreliable history
 May have separation anxiety
 If possible, have parent hold child for exam
 May see illness or injury as punishment
 Approach slowly and speak in reassuring
tones
 Use simple and direct questions
4 to 10 Years
 May be cooperative
 May provide limited history of event
 May have separation anxiety and view illness
or injury as punishment
 Approach slowly
 Speak in quiet, reassuring tones
 Allow child to "help"
 Reluctant to show "private parts“
 Advise of any expected pain or discomfort
Adolescents (11 to 18 years)
 Generally calm, mature, helpful
 Concerned about modesty, disfigurement,
pain, disability, and death
 Reassure when appropriate
 Respect patient's need for privacy
 If possible, interview privately
 Consider alcohol, drug use, pregnancy
Communicating with the Older Adult
 Allow time for effective communication
 Stay close to patient during interview
 Repetition of questions may be needed
 Do not patronize or offend patient
Patient History
 Multiple health problems
 Difficult to isolate injury or illness
 Decreased sensory function may disguise signs and

symptoms
 Watch for illness from medication use or misuse
 Consider relationship between drug interactions,

disease, and aging process
Patient History
 Functional ability and daily activities
 Walking
 Getting out of bed
 Dressing
 Driving a car
 Using public transportation
 Preparing meals
 Taking medications
 Sleeping habits
 Bathroom habits
Physical Examination
 Try to ensure patient comfort
 Offer clear explanations
 Answer questions
 Be alert to chronic pain
 If hospital transport necessary
 Attempt to calm patient
 Reassure patient he or she will be cared for in
hospital
 Record examination findings
Conclusion
The paramedic must have a wide range of
knowledge and skills to perform a
comprehensive physical examination and to
make effective clinical patient care decisions.
Questions?

Chap - 11 - Tech of Phys Exam

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Chap - 11 - Tech of Phys Exam

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Techniques of Physical Examination

 Describe examination equipment

 Describe the general approach to the physical

 Outline the steps of the comprehensive

 Identify abnormal findings in the mental status

 Outline steps in the general patient survey

 Distinguish between normal and abnormal

 Identify normal and abnormal findings in the

 Describe examination techniques specific to

 Assuming her airway and breathing are managed, what

 What equipment will you need to perform your physical

 What areas will be of particular concern as you complete

 Findings that may be significant:

 Palmar surface of fingers and finger pads are used to

 Palpation may be either superficial or deep

 Measures systolic and

 General survey  Abdomen

 Vital signs  Posterior body

 Head, eyes, ears, nose,  Neurological exam

 Skin color and obvious lesions

 Height and build

 Varies based on ethnicity

 May range in tone from pink or ivory to deep

 Observe for skin not exposed to sun (e.g.,

 May also be affected by age and lifestyle

 Observe for normal changes associated with

 Recent changes may be key finding

 Consider ECG monitoring

 Feel for chest movement

 Fingernails and toenails

 Hold thermometer firmly

 Tell child to “kiss”

 Caution to avoid biting

 Pull ear back

 Examine response to light (PERRL)

 Head, ears, eyes, nose, throat

 Palpate for swelling, tenderness, lesions,

 Inspect face for symmetry, expression,

 Determine that both eyes can see

 Assess visual acuity

 Inspect orbital area for edema

 Examine eyes for drainage or redness

 Determine structural integrity

 Observe eyes for normal position and

 Palpate lower orbital rim

 Insert speculum into ear canal,

 Look for foreign bodies, lesions,

 Inspect tympanic membrane

 Discharge from the nose

 Mouth and tongue

 Inspect and palpate cervical spine

 Chest wall configuration

 Funnel chest (pectus

 Pigeon chest (pectus

 Instruct to breathe deeply and slowly through

 Use diaphragm of stethoscope

 Evaluate anterior and posterior lung fields

 Harsh vesicular breath

 Coarse, harsh, loud sounds

 Short inspiratory phase and

 Pleural friction rub

 Palpate pulses simultaneously on both sides

 Scratching, grating, or squeaking quality