chapter 15 detailed physical examination. © 2005 by thomson delmar learning,a part of the thomson...

Chapter 15Detailed Physical Examination

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Detailed Physical Examination

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Primary objective: Discover all signs of injury that may not have been uncovered during the rapid trauma assessment

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Goal of an EMT: Uncover those signs of injury that could not be treated while en route to the hospital

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Performed after the initial assessment and rapid trauma assessment have been completed

Measures the effectiveness of prehospital treatments that were initiated early in the assessment

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May discover changes in the patient condition prompting an ALS intercept or change in priority of the patient

The detailed assessment is a methodical head-to-toe physical examination

Ongoing treatment of life-threatening conditions may preclude the completion of this examination

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Steps in the Detailed Physical Examination

Very much like the rapid trauma assessment DCAP-BTLS is used to describe the signs of

injury that should be sought

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Head– Palpate the entire skull, starting from the rear

of the skull in the occipital area (look for DCAP-BTLS)

– Remove glass shards that might cause injury


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Ears– Look for DCAP-BTLS– Look for drainage; clear fluid might indicate

cerebrospinal fluid• CSF indicates a skull fracture • Do not attempt to stop the flow of CSF, because doing so

can result in increased pressure inside the skull

– Check for Battle’s sign behind the ears, indicative of fracture to the base of the skull


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Watch this video showing how CSF can leak from the ears


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Eyes– Compare one eye to the other to examine for

differences while looking for DCAP-BTLS– Bruising around the eyes is sometimes called

raccoon’s eyes; it may be indicative of a fracture to the base of the skull


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Eyes– Assess pupils for size, shape, and reaction to light– Lack of constriction in response to light may

indicate serious eye or brain injury– Any foreign material such as dirt or glass should

be brushed away from the eyes, if possible• If it does not easily brush away, leave it alone and allow

hospital staff to remove it


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Nose– Check for DCAP-BTLS– Excessive bleeding may result if a NPA is inserted

into a broken nose– Check nares with penlight; blood running down the

back of throat may nauseate the patient and cause vomiting

– Clear fluid running from the nose may be CSF


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Face– EMT should next carefully assess the

face for DCAP-BTLS


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Mouth– Injury can cause airway problem– Assess for DCAP-BTLS inside and outside the

mouth– Check for loose teeth or other foreign objects and

remove to prevent aspiration– Dental hardware should be removed if it is loose;

otherwise leave it in place


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Mouth– Is the tongue swollen or the surrounding tissues

reddened or discolored?– Swelling in the mouth from burns can mean

swelling in the lower airways– Is voice hoarse after airway injury?


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Neck– Assess for DCAP-BTLS– Determine position of trachea

• Midline or deviated?


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Chest– Should be thoroughly examined– Assess using DCAP-BTLS– Check breathing (observe for any difficulties or

abnormalities); can the patient take a deep breath?

– Listen to breath sounds (both anterior and posterior)


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Abdomen– Explain to the patient what you are doing– Look for any injuries indicated by DCAP-BTLS– Check for distension (may indicate internal

bleeding)– Note urinary incontinence


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Abdomen– Listen to what the patient tells you– Where is the pain? Does one area of the abdomen

hurt more than another?– Feel the anterior abdomen gently; does it feel

soft? – A firm, tender abdomen indicates the natural

muscular guarding of an injury; guarding may suggest abdominal bleeding


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Abdomen– Don’t reassess areas where the patient has

complained of abdominal pain or has shown signs of tenderness and guarding on previous physical exams

– Little more can be gained from the information and the unnecessary creation of pain is cruel


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Pelvis– Compression and flexion of pelvis– Pressing inward on the hips will help discover

hip fracture– Press on the pubis to stress the bony pelvic ring– Tenderness during any part of this exam indicates

possible fracture


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Extremities– Look for DCAP-BTLS– Palpate each limb along the length of the bone– Compare one extremity with another– Reassess for pulses, movement, and

sensation (PMS)– Check grip strength and equality of grasp


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Vital signs revisited– Every exam should be followed up with a full

set of vitals– Compare with baseline– Establish a trend– Any significant change in vital signs should

be reported to the hospital staff


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Back and buttocks– Check back and buttocks for DCAP-BTLS– Carefully examine the back and buttocks for injury

• Do this while maintaining continuous manual stabilization of the head, preferably with a cervical collar in place


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Stop and Review

On whom should EMTs perform a detailed physical examination?

What is the primary objective of the detailed physical examination?

What are some of the things an EMT should check for when examining the head, ears, and eyes?

chapter 15 detailed physical examination. © 2005 by thomson delmar learning,a part of the thomson...

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