Transcript Patient Assessment Beginning the Physical Examination: Scene Size-Up, General Survey, Vital Signs, and Pain.

Patient Assessment
Beginning the
Physical Examination:
Scene Size-Up, General Survey, Vital Signs,
and Pain
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Scene Size-Up
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6.
Scene Safety
BSI
MOI/NOI
# Patients
Additional Help?
C-Spine?
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Initial Assessment
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Initial /Primary Assessment
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1. General Impression
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2. Mental Status
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AVPU
3. Airway (C-Spine)
4. Breathing
5. Circulation
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Age, Sex, Race, CC, Environment
Pulse – Skin - Bleeds
6. Determine Priority
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Components of General Survey
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General
Appearance/Impression
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Height and Weight
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General Appearance - Description
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Apparent state of health
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Appropriate to weather
and temperature
Clean, properly
buttoned/zipped
Facial expression
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Cardiac or respiratory; pain;
anxiety/depression
Skin color and obvious
lesions
Dress, grooming, and
personal hygiene
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Awake, alert, responsive or
lethargic, obtunded,
comatose
Signs of distress
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Acute or chronically ill, frail
Level of consciousness
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Eye contact, appropriate
changes in facial expression
Odors of body and breath
Posture, gait, and motor
activity
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Mental Status and Behavior
Terminology
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To appreciate the differences in mental
status and behavior, you must learn the
terminology
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Level of consciousness: how aware the person is of
his environment
Attention: the ability to focus or concentrate
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Alert: the patient is awake and aware
Lethargic: you must speak to the patient in a
loud forceful manner to get a response
Obtunded: you must shake a patient to get a response
Stuporous: the patient is unarousable except
by painful stimuli (sternal rub)
Coma: the patient is completely unarousable
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Height and Weight
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Height
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Weight
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Short or tall
Build: slender and lanky, muscular, or stocky
Body symmetry
Note general body proportions and any deformities
Emaciated, slender, plump, obese
If obese, is fat distributed evenly or concentrated
over trunk, upper torso, or around the hips?
small – medium – large?
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Initial Assessment?
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What next
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Health form
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History
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Secondary Assessment:
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http://videos.med.wisc.edu/videos/33744
Detailed exam
Focused exam
Ongoing exam
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Health History: subjective
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Changes in weight
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Rapid or gradual
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Rapid changes over a few days suggest changes in fluid, not
tissue
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Weight gain: nutrition vs. medical causes
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Weight loss: medical vs. psychosocial causes
Fatigue and weakness
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Fatigue: a sense of weariness or loss of energy
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Weakness: a demonstrable loss of muscle power
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Medical vs. psychosocial causes
Fever, chills, and night sweats
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Ask about exposure to illness or any recent travel
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Some medications may cause elevated temperature
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Question
A patient presents with a 6-day history
of rapid weight gain, and increasing
fatigue. The most likely explanation is:
a.
Dysphagia
b.
Excessive absorption of nutrients
c.
Diabetes mellitus
d.
Accumulation of body fluids
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Answer
d.
Accumulation of body fluids
Rapid changes over a few days
suggest changes in fluid.
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Vital Signs
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Blood pressure
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Heart rate and rhythm
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Respiratory rate and rhythm
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Temperature
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Pain
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SaO2
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Question
A patient’s vital signs are recorded as
follows:
T 98.4 F, HR 74, R 18, BP 180/98
What would be the MOST appropriate action
related to this patient’s vital signs?
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b.
c.
d.
The blood pressure should not be repeated
Repeat the blood pressure and verify in contralateral arm
Check the heart rate again to see if it is regular
Listen to the patient’s lungs for adventitious sounds
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Answer
b.
Repeat the blood pressure measurement
and verify in the contralateral arm
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Pain
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Assess
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OPQRST
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Pain
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Types of pain
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Nociceptive or somatic – related to tissue damage
Neuropathic – resulting from direct trauma to the peripheral or
central nervous system
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Psychogenic – relates to factors that influence the patient’s
report of pain
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Psychiatric conditions
Personality and coping style
Cultural norms
Social support systems
Idiopathic – no identifiable etiology
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Examination Techniques
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Inspection
Palpation
Percussion
Auscultation
System with cc: function / physiology
System above and below
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Thoracic Landmarks—Anterior Chest
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Shoulders and Related Structures
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Percussion and Auscultation of Chest
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Thoracic Landmarks—Posterior Chest
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Spine
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Inspection
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Cervical, thoracic, and
lumbar curves
Lordosis (swayback)
 Kyphosis (hunchback)
 Scoliosis (razorback)
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Height differences of
shoulders
Height differences of
iliac crest
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Breath Sounds
Fig. 11-26
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Pulse
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Auscultate for:
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Frequency (pitch)
Intensity (loudness)
Duration
Timing in cardiac
cycle
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Abdomen
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four quadrants
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Inspect
Auscultate
Percuss
Palpate
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Abdomen—Inspection
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Skin
Umbilicus
Contour
Abdominal
movement
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Pelvis
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Pelvic structural
integrity
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Hands on anterior iliac
crests
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Press down and out
Heel of hand on
symphysis pubis
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Press down
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Ankles and Feet
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Range of motion
 Dorsiflexion
 Plantar flexion
 Inversion
 Eversion
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Ongoing Assessment
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Components
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Repeat initial assessment
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Stable patient: every 15 minutes
Unstable patient: every 5 minutes (minimum)
Reassess mental status
Reassess airway
Monitor breathing for rate and quality
Reassess circulation
Reestablish patient priorities
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