Techniques of the Physical Examination
Part 2
EMS Professions Temple College
Objectives
Discuss methods of examining each body system
Compare
normal vs. abnormal
findings
Review potential abnormal findings and their potential relevance
Reminders
Keys to the Physical Exam
Inspection Palpation Auscultation Percussion
Key Tools in the Physical Exam
BP
cuff & Stethoscope Senses
Skin & Nails
General Appearance & Potential Abnormalities
Jaundice,
Cyanotic, Pale, Pink/Norm Moist, dry, exfoliation Hot, warm, cool, cold Lesions Petechiae, Purpura (blanching?) cellulitis, pressure ulcer, burn, scar
The Skin
Skin Lesions
Primary Lesions
Primary Lesions
Skin Lesions
Kaposi’s sarcoma
Bates, Barbara, MD. A Guide to Physical Examination and History Taking, fourth edition. J.B. Lippincott. 1987.
Malignant Melanoma
Bates, Barbara, MD. A Guide to Physical Examination and History Taking, fourth edition. J.B. Lippincott. 1987.
Skin Lesions
Varicella
Cellulitis
Skin Lesions
Urticaria
Lyme Disease Rash
Skin Lesions
Port-Wine Stain
Rash from Rubber Product
Nails
Nail Psoriasis
Bates, Barbara, MD. A Guide to Physical Examination and History Taking, fourth edition. J.B. Lippincott. 1987.
Skin Lesions
What type of work might this person do? What might have caused this?
HEENT
Head & Face
old
scar, size/shape, appearance
Eyes
Pupils
protruding periorbital ecchymosis or edema visual acuity
Sunken,
Nose & throat
growths, tonsils Color (white, red, pink)
sounds,
HEENT
HEENT
Cushing’s Disease
Myxedema
HEENT
Goiter
Exophthalmos
HEENT
Tonsils
Ulcerative basal cell carcinoma
HEENT
Acromegaly
HEENT
HEENT
SLE - Butterfly Rash
HEENT
What specific testing or examinations should be done with regard to the HEENT exam? What specific abnormalities might you find and why?
Neck
Neck
Chest & Respiratory System
Chest & Respiratory System
What specific things should you consider evaluating or examining with regard to the chest & respiratory system? (Groups 1 & 2) What are some abnormal findings and what might they tell you about the patient? (Group 3) Group Discussions
Cardiovascular
What is this condition?
What is a likely chronic illness for this person?
Cardiovascular
Thrombophlebitis
Cardiovascular
What specific questions, tests, examinations, etc should you include when assessing the entire cardiovascular system (include peripheral vascular)? (Groups 2 & 3) What might these findings tell you about your patient? What are the specific organs and structures involved in the assessment? (Group 1) Group Discussions
Abdominal
Abdominal
Nervous System
Neurologic System Exam
LOC, Pulse, Motor and Sensory are the basics Cranial Nerves
response to light (III) Ocular movement (III, IV, VI) Clench teeth (V) Show teeth; Raise eyebrows (VII) Open mouth and stick out tongue (XII) Gag Reflex (IX, X) Shrug shoulders (XI)
Pupillary
Symmetry, Pain response, Point discrimination
Nervous System
What specific questions, tests, examinations, etc should you include when assessing the entire nervous system (exclude equipment testing such as CT, MRI)? (Groups 1 & 3) What might these findings tell you about your patient? What organs or structures are you assessing? (Group 2) Group Discussions
Additional Diagnostics
Blood glucose level Pulse oximetry ECG Diagnostic (12 Lead) ECG Cincinnati Prehospital Stroke Scale Future
Cardiac
Enzymes, Predictive instruments, Abdominal Ultrasound
Summary
Examine each body system area when performing the comprehensive physical exam Consider knowledge of pathophysiologies and apply to the physical exam