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Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
Baseline Vitals and SAMPLE History
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Baseline Vitals and SAMPLE History

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  • Next 3 slides (1) Upper Respiratory Infection (URI). (a) Definition- acute viral infection of the upper airway (b) Common causes- URIs are usually a result of different viruses. (c) Chief Complaint- sore throat, nasal congestion/discharge, low-grade fever, and sinus pressure (d) Signs and Symptoms- sore throat and/or cough, which may be either productive or non-productive; sputum may be clear or purulent. There may be a low-grade fever. Physical examination is usually unremarkable except for nasal congestion and the appearance of a slightly reddened pharynx with mucous streaking. Lungs are clear to auscultation. Vital signs are usually normal with the possible exception of a low-grade (slight) fever. Management-Treatment is symptomatic in nature, such as cough suppressants, decongestants, throat lozenges, and analgesics such as acetaminophen for fever and body aches. Antibiotics are not indicated for URIs. (f) Referral- Your medical officer will discuss referral options with you when you start screening patients
  • Transcript

    1. <ul><li>Baseline Vital Signs and SAMPLE History </li></ul>
    2. <ul><li>Given a patient care scenario and the proper medical equipment in a clinical environment or field setting, </li></ul><ul><li>Assess a baseline set of patient vital signs and obtain an accurate SAMPLE history </li></ul><ul><li>Describe the basic principles, sequence and components of an accurate baseline set of vital signs </li></ul>Terminal Learning Objective
    3. <ul><li>Demonstrate the proper technique(s) for obtaining a complete set of baseline vital signs and a concise patient history using the acronym SAMPLE </li></ul><ul><li>IAW Emergency Care and Transportation of the Sick and Injured, 9 th Edition, American Academy of Orthopedic Surgeons (AAOS). </li></ul>Terminal Learning Objective
    4. Given a patient with Eye, Ear, Nose, or Throat complaints Treat EENT Complaints IAW A Guide to Physical Examination and History Taking, Lippincott Co, Chapter 11 & Current Medical Diagnosis and Treatment, Chapter 7 and 8. Terminal Learning Objective
    5. Baseline Vital Signs and SAMPLE History <ul><li>Assessment is the most essential skill EMT-Bs learn. </li></ul><ul><li>During assessment you will: </li></ul><ul><ul><li>Gather key information </li></ul></ul><ul><ul><li>Evaluate the patient </li></ul></ul><ul><ul><li>Learn the history </li></ul></ul><ul><ul><li>Learn about the patient’s overall health </li></ul></ul>
    6. Gathering Key Patient Information <ul><li>Obtain the patient’s name. </li></ul><ul><li>Note the age, gender and </li></ul><ul><li>race. </li></ul><ul><li>Look for identification if the </li></ul><ul><li>patient is unconscious. </li></ul>
    7. Baseline Vital Signs <ul><li>During the assessment, the EMT-B uses many senses and a few basic medical instruments. </li></ul><ul><li>First set is known as the baseline vitals. </li></ul><ul><li>Repeated vital signs are compared to the baseline. </li></ul>
    8. Baseline Vital Signs and SAMPLE History <ul><li>Chief Complaint ( CC ); Mechanism of Injury ( MOI ): </li></ul><ul><ul><li>Chief complaints are the major signs, symptoms or events that caused the call or complaint </li></ul></ul><ul><ul><li>Symptoms : what the patient tells you </li></ul></ul><ul><ul><li>Signs : can be seen, heard , felt, smelled or measured </li></ul></ul>
    9. Obtaining a SAMPLE History <ul><li>S : Signs and Symptoms of the episode: </li></ul><ul><ul><li>What signs and symptoms occurred at onset? </li></ul></ul><ul><ul><li>Does the patient report pain? </li></ul></ul>
    10. Obtaining a SAMPLE History <ul><li>A : Allergies: </li></ul><ul><ul><li>Is the patient allergic to medications, foods or other substance? </li></ul></ul><ul><ul><li>What reactions did the patient have to any of them? </li></ul></ul><ul><ul><li>Note: If the patient has no know allergies, you should note this on the run sheet as “no known allergies” or “NKA” </li></ul></ul>
    11. Obtaining a SAMPLE History <ul><li>M : Medications: </li></ul><ul><ul><li>What medications was the patient prescribed? </li></ul></ul><ul><ul><li>What dosage was prescribed? </li></ul></ul><ul><ul><li>How often is the patient supposed to take the medication? </li></ul></ul><ul><ul><li>What prescription, over-the-counter (OTC) medications, and herbal medications has the patient taken in the last 12 hours? </li></ul></ul><ul><ul><li>How much was taken and when? </li></ul></ul>
    12. Obtaining a SAMPLE History <ul><li>P : Pertinent past history: </li></ul><ul><ul><li>Does the patient have any history of medical, surgical, or trauma occurrences? </li></ul></ul><ul><ul><li>Has the patient had a recent illness or injury, fall or blow to the head? </li></ul></ul>
    13. Obtaining a SAMPLE History <ul><li>L : Last oral intake: </li></ul><ul><ul><li>When did the patient last eat or drink? </li></ul></ul><ul><ul><li>What did the patient eat or drink, and how much was consumed? </li></ul></ul><ul><ul><li>Did the patient take any drugs or drink alcohol? </li></ul></ul><ul><ul><li>Has there been any other oral intake in the last 4 hours? </li></ul></ul>
    14. Obtaining a SAMPLE History <ul><li>E : Events leading to injury or illness </li></ul><ul><ul><li>What are the key events that led up to this incident? </li></ul></ul><ul><ul><li>What occurred between the onset of the incident and your arrival? </li></ul></ul><ul><ul><li>What was the patient doing when this illness started? </li></ul></ul><ul><ul><li>What was the patient doing when this injury happened? </li></ul></ul>
    15. O - P - Q - R - S - T <ul><li>Mnemonic device to help you remember questions you should ask to obtain a patient history. </li></ul><ul><ul><li>O : Onset: When did the problem begin and what caused it? </li></ul></ul><ul><ul><li>P : Provocation or Palliation: Does anything make it feel better? Worse? </li></ul></ul>
    16. O - P - Q - R - S - T <ul><ul><li>Q : Quality: What is the pain like? Sharp, dull, crushing, tearing? </li></ul></ul><ul><ul><li>R : Region/Radiation: Where does it hurt? Does the pain move anywhere? </li></ul></ul><ul><ul><li>S : Severity: On a scale of 1 to 10, how would you rate your pain? </li></ul></ul><ul><ul><li>T : Timing of pain: Has the pain been constant or does it come and go? How long have you had the pain? </li></ul></ul>
    17. Baseline Vital Signs <ul><li>Baseline vital signs always include </li></ul><ul><ul><li>Respirations, Pulse & Blood Pressure </li></ul></ul><ul><li>Other key indicators: </li></ul><ul><ul><li>Skin: color, condition, temperature ( CCT ) </li></ul></ul><ul><ul><li>Capillary refill time (in children) </li></ul></ul><ul><ul><li>Pupillary response </li></ul></ul><ul><ul><li>Level of Consciousness ( LOC ) </li></ul></ul><ul><ul><li>Sometimes Temperature (medical patients) </li></ul></ul>
    18. Respirations <ul><li>A patient who is breathing without assistance: spontaneous respirations . </li></ul><ul><li>Each complete breath consists of two distinct phases: </li></ul><ul><ul><li>Inspiration (inhalation): the chest rises up and out, drawing oxygenated air into the lungs </li></ul></ul><ul><ul><li>Expiration (exhalation): the chest returns to its original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs </li></ul></ul>
    19. Respirations <ul><li>Rate: </li></ul><ul><ul><li>The number of breaths in 30 seconds x 2 </li></ul></ul><ul><li>Quality: character of breathing: </li></ul><ul><ul><li>Rhythm (regular or irregular) </li></ul></ul><ul><ul><li>Effort (normal or labored) </li></ul></ul><ul><li>Depth: </li></ul><ul><li>- Tidal Volume (the amount of air exchanged with each breath) </li></ul><ul><li>-Depth and rate of breathing determines the tidal volume </li></ul>
    20. Respiratory Rate <ul><ul><ul><li>Adults: 12 to 20 breaths/minute </li></ul></ul></ul><ul><ul><ul><li>(over age 8) </li></ul></ul></ul><ul><ul><ul><li>Children: 18 to 30 breaths/minute </li></ul></ul></ul><ul><ul><ul><li>(1 to 8 years of age) </li></ul></ul></ul><ul><ul><ul><li>Infants: 30 to 60 breaths/minute </li></ul></ul></ul><ul><ul><ul><li>(under 1 year of age) </li></ul></ul></ul>
    21. Respirations <ul><li>Effort (labored): </li></ul><ul><ul><li>Unable to speak more than 2-3 words at a time </li></ul></ul><ul><ul><li>Assuming a “tripod” position </li></ul></ul><ul><ul><li>Assuming a “sniffing” position (children) </li></ul></ul><ul><ul><li>Noisy breathing: </li></ul></ul><ul><ul><ul><li>Stridor </li></ul></ul></ul><ul><ul><ul><li>Wheezes, snoring </li></ul></ul></ul><ul><ul><ul><li>Coughing (productive?) </li></ul></ul></ul>
    22. Pulse Oximetry <ul><li>Evaluates the effectiveness of oxygenation. </li></ul><ul><li>Normal value: 95% - 100%. </li></ul>
    23. Pulse <ul><li>With each heartbeat, ventricle contract, forcefully ejecting blood from the heart and propelling it into the arteries. </li></ul><ul><li>A pulse is the pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries. </li></ul>
    24. Pulse Carotid Pulse Radial Pulse
    25. Pulse Brachial Pulse
    26. Pulse <ul><li>Rate: </li></ul><ul><ul><li>Number of beats in 30 seconds x 2 </li></ul></ul><ul><li>Strength: </li></ul><ul><ul><li>Stronger than normal ( bounding ), strong or weak ( thready ) </li></ul></ul><ul><li>Regularity: </li></ul><ul><ul><li>Regular or irregular </li></ul></ul>
    27. Normal Pulse Ranges <ul><li>Adults: 60 to 100 beats/minute </li></ul><ul><li>Children: 70 to 120 beats/minute </li></ul><ul><li>Toddlers: 90 to 150 beats/minute </li></ul><ul><li>Newborns: 120 to 160 beats/minute </li></ul>29
    28. The Skin <ul><li>The condition of the patient’s skin can tell you a lot about the patient’s: </li></ul><ul><ul><li>Peripheral circulation and perfusion </li></ul></ul><ul><ul><li>Blood oxygen levels </li></ul></ul><ul><ul><li>Body temperature </li></ul></ul>
    29. The Skin ( CCT ) <ul><li>Color: </li></ul><ul><ul><li>Pink, pale, blue, red, or yellow </li></ul></ul><ul><li>Condition: (moisture) </li></ul><ul><ul><li>Dry, moist or wet </li></ul></ul><ul><li>Temperature: </li></ul><ul><ul><li>Warm, hot or cool </li></ul></ul>
    30. Capillary Refill <ul><li>Evaluates the ability of the circulatory system to restore blood to the capillary system (perfusion). </li></ul><ul><ul><li>Evaluated at the nail bed (finger) </li></ul></ul><ul><ul><li>Depress the finger tip, pressure forcing blood from the capillaries and look for return of blood </li></ul></ul>
    31. Capillary Refill <ul><li>As the capillaries refill, should return to its normal deep pink color </li></ul><ul><li>Color should be restored within 2 seconds (about the time it takes to say, “ Capillary refill ” </li></ul><ul><li>Invalid test in a cold environment; elderly </li></ul><ul><li>Used for < 6 years old </li></ul>
    32. Blood Pressure <ul><li>Blood pressure is a vital sign. </li></ul><ul><li>Pressure of circulating blood against the walls of the arteries. </li></ul><ul><li>A drop in blood pressure may indicate: </li></ul><ul><ul><li>Loss of blood </li></ul></ul><ul><ul><li>Loss of vascular tone </li></ul></ul><ul><ul><li>Cardiac pumping problem </li></ul></ul><ul><li>Blood pressure should be measured in all patients older than 3 years of age. </li></ul>
    33. Blood Pressure <ul><li>Diastolic: </li></ul><ul><ul><li>Pressure during relaxing phase of the heart’s cycle </li></ul></ul><ul><li>Systolic: </li></ul><ul><ul><li>Pressure during contraction </li></ul></ul><ul><li>Measured as millimeters of mercury (mmHg). </li></ul><ul><li>Recorded as systolic/diastolic. </li></ul>
    34. Blood Pressure Equipment
    35. Auscultation of Blood Pressure <ul><li>Place cuff on patient's arm (1” above elbow). </li></ul><ul><li>Palpate brachial artery and place diaphragm of stethoscope over artery. </li></ul><ul><li>Inflate cuff until you no longer hear pulse sounds. </li></ul><ul><li>Continue pumping to increase pressure by an additional 20 mmHg. </li></ul>
    36. Auscultation of Blood Pressure <ul><li>Note the systolic and diastolic pressures as you let air escape slowly. </li></ul><ul><li>As soon as pulse sounds stop, open the valve and release the air quickly. </li></ul>
    37. Palpation of Blood Pressure <ul><li>Secure cuff. </li></ul><ul><li>Locate radial pulse. </li></ul><ul><li>After the pulse disappears continue to inflate another 30mmHg. </li></ul><ul><li>Release air until pulse is felt. </li></ul><ul><li>Method only obtains systolic pressure. </li></ul>
    38. Normal BP Ranges <ul><li> Age Range </li></ul><ul><li>Adults 90 to 140 mmHg (s) </li></ul><ul><li>60 to 90 mmHg (d) </li></ul><ul><li>Children (1-8) 80 to 110 mmHg (s) </li></ul><ul><li>Infants (up to 1 yr) 50 to 90 mmHg (s) </li></ul><ul><li>*Varies with age and gender. </li></ul>
    39. Blood Pressure <ul><li>Hypotension : </li></ul><ul><ul><li>BP significantly lower than the normal range </li></ul></ul><ul><ul><li>Critical hypotension: BP is no longer able to compensate sufficiently to maintain adequate perfusion </li></ul></ul><ul><li>Hypertension : </li></ul><ul><ul><li>BP significantly higher than the normal range </li></ul></ul>
    40. Level of Consciousness <ul><li>A - A lert </li></ul><ul><li>V - Responsive to </li></ul><ul><li>V erbal stimulus </li></ul><ul><li>P - Responsive to P ain </li></ul><ul><li>U - U nresponsive </li></ul>
    41. Pupil Assessment <ul><li>P - P upils </li></ul><ul><li>E - E qual </li></ul><ul><li>A - A nd </li></ul><ul><li>R - R ound </li></ul><ul><li>R - R egular in size </li></ul><ul><li>L - React to L ight </li></ul>
    42. Abnormal Pupil Reactions
    43. Reassessment of Vital Signs <ul><li>The vital signs you obtain serve two important functions: </li></ul><ul><ul><li>First set establishes a baseline of respiratory and cardiovascular system status </li></ul></ul><ul><ul><li>Serves as a key baseline </li></ul></ul>
    44. Reassessment of Vital Signs <ul><li>Reassess stable patients every 15 minutes. </li></ul><ul><li>Reassess unstable patients every 5 minutes. </li></ul><ul><li>Reassess/record VS after all medical interventions. </li></ul>
    45. EENT Disorders <ul><li>Eyes, Ears, Nose, and Throat disorders are commonly found during sick call and in the field, and medical personnel need to be able to accurately assess patients as well as treat them. </li></ul>
    46. Lacrimal Glands Sclera 1. Pupil Structures of the Eye Iris 2. 3. 4. 6 5 7 8 9 10
    47. Eye Anatomy <ul><li>Conjunctiva </li></ul><ul><li>Sclera </li></ul><ul><li>Retina </li></ul><ul><li>Cornea . </li></ul><ul><li>Lens </li></ul><ul><li>Iris </li></ul><ul><li>Pupil </li></ul><ul><li>Lacrimal Glands </li></ul>Mucus membrane that lines the eyelid White of the eye Contains rods and cones Tough and Transparent Covers Pupil and Iris Adjusts focus of eye Controls light entering eye Window of the eye Moistens the eye
    48. Assessment of Ocular Complaints <ul><li>Gathering the Patient’s History </li></ul><ul><li>MOI? Blunt trauma or penetrating trauma? </li></ul><ul><li>Glasses or contact lenses? </li></ul><ul><li>Eye disease or previous trauma/surgery? </li></ul><ul><li>Pain? Loss of Vision? One eye or both? </li></ul>Soldier vs crowbar Soldier vs aluminum shard
    49. Assessment of Ocular Complaints <ul><li>Physical Examination </li></ul><ul><li>Visual Acuity Screening </li></ul><ul><ul><li>What is one tool used to assess visual acuity? </li></ul></ul><ul><ul><li>Snellen Visual Acuity Test </li></ul></ul><ul><ul><li>You should complete a visual acuity screening on all patient’s with an ocular complaint except… </li></ul></ul><ul><ul><li>Ocular Burns </li></ul></ul>
    50. Discuss: Indication, Purpose and Procedure for the Snellen Visual Acuity Test
    51. Gross Vision Examination <ul><li>Visual Acuity testing can be conducted even when equipment, lighting, space and environment are not “ideal”. </li></ul><ul><li>What other ways can vision be measured? </li></ul><ul><li>Near Card or Printed Material </li></ul><ul><li>Counting Fingers </li></ul><ul><li>Light / Dark Distinction </li></ul>
    52. Near Card
    53. What abnormalities do you see? BLOOD IN THE ANTERIOR CHAMBER
    54. What abnormalities do you see? RED CONJUNCTIVA AND SCLERA
    55. What abnormalities do you see? UNEQUAL PUPILS
    56. What abnormalities do you see? LACERATION TO THE EYE LID
    57. Assessment of Ocular Complaints <ul><li>Physical Examination Con’t. </li></ul><ul><li>You have gathered a history and completed a visual acuity test. </li></ul><ul><li>What other parts of the eye should be assessed? </li></ul><ul><li>Eyelids – Conjunctiva – Sclera – Pupils </li></ul><ul><li>Note any abnormalities, drainage or bleeding </li></ul>
    58. Eye Complaints <ul><li>Loss of Vision </li></ul><ul><li>Eye Pain with Decrease in Vision </li></ul><ul><li>History of Trauma </li></ul><ul><li>What should you do with a patient that presents with a red flag? </li></ul><ul><li>Refer to medical officer </li></ul>RED FLAGS
    59. Common Eye Complaints <ul><li>What is Red Eye? </li></ul><ul><li>A sign of many possible eye problems. </li></ul><ul><li>What are the possible causes of Red Eye? </li></ul><ul><li>Infection, Allergies, Drugs, Chemical Exposure, Trauma, Systematic Disease </li></ul><ul><li>What causes the “red” appearance? </li></ul><ul><li>Vascular dilation & engorgement of the sclera and conjunctiva. </li></ul>
    60. Examples of “Red Eye” Red Eye Due to Infection Red Eye Due to Chemical Burns
    61. <ul><li>What is the most common cause of red eye? </li></ul><ul><li>Conjunctivitis </li></ul><ul><li>What is conjunctivitis? </li></ul><ul><li>The sclera and conjunctivae are reddened. Clear watery (viral or allergy) or purulent (bacterial) discharge . </li></ul><ul><li>What are some of the Chief Complaints? </li></ul>Common Eye Complaints <ul><li>Eye Discharge </li></ul><ul><li>Blurry Vision </li></ul><ul><li>Grittiness </li></ul><ul><li>Redness </li></ul><ul><li>Burning </li></ul><ul><li>Sneezing and Nasal Discharge </li></ul>(Allergic Conjunctivitis)
    62. Bacterial Conjunctivitis Usually starts in one eye, may spread to other eye Sclera and conjunctivae are commonly reddened with a purulent (pus-like) discharge
    63. Viral Conjunctivitis Usually starts in one eye, may spread to other eye Sclera and conjunctivae are commonly reddened with a clear, watery discharge
    64. Check on your learning… <ul><li>When recording distant vision visual acuity, what does each number mean? </li></ul><ul><li>Distance away from Chart </li></ul><ul><li>Distance normal eye can read the line </li></ul><ul><li>What is the procedure for examining the conjunctiva? Normal findings? </li></ul><ul><li>Ask patient to look upward - you pull lower lid downward </li></ul><ul><li>Normal: Pink to dark pink color </li></ul><ul><li>Abnormal: erythema (redness) or exudates (pus) </li></ul>20 200
    65. Check on your learning… <ul><li>Abbreviations for: </li></ul><ul><li>Right Eye </li></ul><ul><li>Left Eye </li></ul><ul><li>Both Eyes </li></ul><ul><li>What are the Red Flags of Eye Complaints? </li></ul><ul><li>Loss of Vision </li></ul><ul><li>Eye Pain with Decrease in Vision </li></ul><ul><li>History of Trauma </li></ul>O.D. O.S. O.U.
    66. Structures of the Ear 1 2 3 4 6 5 7 8
    67. Ossicles of the Middle Ear Stapes Incus (Anvil) Malleus (Hammer)
    68. The Eustachian Tube
    69. Ear Anatomy <ul><li>Pinna (Auricle) </li></ul><ul><li>Eustachian Tube </li></ul><ul><li>External Auditory Canal (EAC) </li></ul><ul><li>Tympanic Membrane (TM) </li></ul>External part of ear collects fluid waves and directs into the ear Drain middle ear into the nasopharynx Pathway from the external ear to the tympanic membrane Ear Drum. Thin translucent membrane
    70. Physical Exam of the Ear <ul><li>The Auricle </li></ul><ul><li>Inspect </li></ul><ul><li>Palpate </li></ul><ul><li>Inspect this patient. </li></ul><ul><li>What should be noted? </li></ul>
    71. Physical Exam of the Ear <ul><li>External Auditory Canal </li></ul><ul><li>Inspect for discharge </li></ul><ul><li> What do you see in each of </li></ul><ul><li> these EACs? </li></ul>Can you do any further inspection of this ear? What would you do next?
    72. Physical Exam of the Ear <ul><li>The Otoscope </li></ul><ul><li>What is inspected? </li></ul><ul><li>EAC and TM </li></ul><ul><li>Use what sized speculum? </li></ul><ul><li>The largest the canal will </li></ul><ul><li>accommodate. </li></ul><ul><li>As you insert the speculum, </li></ul><ul><li>what should you look for? </li></ul><ul><li>Discharges, Lesions, Narrowing of the EAC, Foreign Bodies, Presence of Cerumen </li></ul>
    73. Physical Exam of the Ear <ul><li>Tympanic Membrane </li></ul><ul><li>This is what normal looks like </li></ul>
    74. Physical Exam of the Ear <ul><li>Tympanic Membrane </li></ul><ul><li>What abnormalities do you see? </li></ul>Perforations Scarring
    75. Physical Exam of the Ear Tympanic Membrane What abnormalities do you see? Bubbles Air/Fluid Levels
    76. Inner Ear Exams <ul><li>The inner ear is tested by evaluating the patient’s hearing. </li></ul><ul><li>What type of hearing test do you perform on the patient? </li></ul><ul><li>A gross hearing test. </li></ul><ul><li>Does the patient respond to your questions? </li></ul><ul><li>AND - Note patient’s balance. </li></ul>
    77. Ear Complaints <ul><li>Fever of 101 degrees F or greater </li></ul><ul><li>Embedded Foreign Objects </li></ul><ul><li>What should you do with a patient who has a fever and complaining of ear pain? </li></ul><ul><li>Refer to medical officer </li></ul>RED FLAGS
    78. Common Ear Complaints <ul><li>Cerumen (Ear Wax) Impaction </li></ul><ul><li>Patient’s Chief Complaint? </li></ul><ul><li>Hearing Loss </li></ul><ul><li>Definition? </li></ul><ul><li>Build up of ear wax </li></ul><ul><li>Pain or No Pain? </li></ul><ul><li>USUALLY pain is not present </li></ul><ul><li>Cause? </li></ul><ul><li>Natural by-product of the body </li></ul><ul><li>Ear Irrigation? </li></ul><ul><li>Once the medic has been trained to irrigate by a medical officer. Ear drops may be given to dissolve the wax. </li></ul>
    79. <ul><li>Otitis Externa (Swimmer’s Ear) </li></ul><ul><li>Patient’s Chief Complaint? </li></ul><ul><li>Pain, canal swelling, drainage </li></ul><ul><li>Definition? </li></ul><ul><li>Inflammation/infection of external </li></ul><ul><li>ear canal </li></ul><ul><li>Pain or No pain? </li></ul><ul><li>Pain (maybe severe), increases </li></ul><ul><li>with external ear movement </li></ul><ul><li>Cause? </li></ul><ul><li>Bacterial or fungal (rare) infection </li></ul><ul><li>Medical Officer Referral? </li></ul><ul><li>Refer. Medical Officer may recommend antibiotic/steroid ear drops. Possibly Motrin for the pain. </li></ul>Common Ear Complaints
    80. Common Ear Complaints <ul><li>Otitis Media </li></ul><ul><li>Patient’s Chief Complaint? </li></ul><ul><li>Pain, fever, nasal congestion, cough </li></ul><ul><li>Definition? </li></ul><ul><li>Middle Ear Infection </li></ul><ul><li>Pain or No pain? </li></ul><ul><li>Yes and decreased hearing in affected ear </li></ul><ul><li>Refer? </li></ul><ul><li>Yes. </li></ul><ul><li>Medical Officer may recommend antibiotics and/or decongestants. </li></ul>
    81. Abnormal Foreign Body Embedded Tic after removal by Medical Officer
    82. Normal Tympanic Membrane
    83. Abnormal – Ear Vs Pencil Eraser
    84. Check on your learning… <ul><li>Patient c/o ear pain, especially upon touch. </li></ul><ul><li>He has a temperature of 99 degrees. </li></ul><ul><li>You inspect the ear and see… </li></ul><ul><li>What is the possible problem? </li></ul><ul><li>Otitis Externa </li></ul><ul><li>Should you irrigate? </li></ul><ul><li>Management? </li></ul><ul><li>Antibiotic/steroid ear drop </li></ul><ul><li>NSAID (Motrin) for the pain </li></ul>No
    85. Check on your learning… <ul><li>Your patient complains of ear pain and decreased hearing. She has a fever of 102 degrees. </li></ul><ul><li>You inspect the ear and see… </li></ul><ul><li>What is the possible problem? </li></ul><ul><li>Otitis Media </li></ul><ul><li>Viral or Bacteria? </li></ul><ul><li>Management? </li></ul><ul><li>Refer to a Medical Officer for </li></ul><ul><li>oral antibiotics and decongestants. </li></ul>Pus behind the ear drum
    86. Structures of the Nose Nare Frontal Maxilla 1 2 3
    87. Structures of the Sinues 1 2 3
    88. Physical Exam of the Nose <ul><li>Inspect for Shape, Size, Symmetry, Color, Presence of Deformities or Lesions. </li></ul><ul><li>Palpate for Tenderness, Swelling, Masses. </li></ul><ul><li>What do you see? </li></ul>
    89. Physical Exams of the Sinuses <ul><li>Which two sinuses are accessible for physical examination? </li></ul><ul><li>Maxillary and Frontal </li></ul><ul><li>Inspect for swelling </li></ul><ul><li>Palpate for tenderness </li></ul>
    90. Sinus Complaints <ul><li>Fever of 101 degrees F or greater </li></ul><ul><li>What should you do with a patient who has a fever and complains of sinus pain? </li></ul><ul><li>Refer to a medical officer </li></ul>RED FLAGS
    91. Common Complaints of the Nose <ul><li>Epistaxis (ep- uh -stak-sis) </li></ul><ul><li>Commonly known as? </li></ul><ul><li>Nosebleed </li></ul><ul><li>What are some common causes? </li></ul><ul><li>External Trauma, Nose Picking, Infection from Plucking Hairs, Vigorous Nose Blowing, Drying of Nasal Mucosa </li></ul><ul><li>Chronic nose bleeds could be early signs of what? </li></ul><ul><li>Hypertension (high blood pressure) or Blood Clotting Disorder </li></ul>
    92. <ul><li>Epistaxis (ep- uh -stak-sis) </li></ul><ul><li>What is your first priority? </li></ul><ul><li>Stop the Bleeding </li></ul><ul><li>Most cases should be treated how? </li></ul><ul><li>Patient should sit up, lean forward, tip head down </li></ul><ul><li>Pinch entire nose firmly (10-15 min) </li></ul><ul><li>What if this doesn’t work? </li></ul><ul><li>Use a vasoconstrictive spray (Afrin or NeoSynephrine) </li></ul><ul><li>If the patient has a history of nosebleeds, what else should be asked about? </li></ul><ul><li>Family History </li></ul><ul><li>Medications (Aspirin, NSAIDs) </li></ul><ul><li>History of Chronic Illnesses </li></ul>Common Complaints of the Nose If yes, REFER
    93. Common Complaints of the Nose <ul><li>Allergies (Allergic Rhinitis or Hay Fever) </li></ul><ul><li>What is Rhinitis? </li></ul><ul><li>Inflammation of the nasal membranes </li></ul><ul><li>Once the sensitized immune system releases histamines what symptoms are caused? </li></ul><ul><li>Itching, Swelling of Tissues, Mucus Production, Hives, Rashes </li></ul><ul><li>What is used to treat minor and severe nasal congestion? </li></ul><ul><li>Minor – Decongestant Severe – Nasal Decongestion Spray (Afrin) </li></ul><ul><li>Afrin use should not exceed 3 days </li></ul>
    94. Common Sinus Complaints <ul><li>What causes sinus complaints? </li></ul><ul><li>Anything that interferes with airflow into the sinuses or mucus flow out </li></ul><ul><li>What could interfere with air or mucus flow? </li></ul><ul><li>Swelling Tissue, Tumors, Thickening of Mucus, Damage to Cilia </li></ul>
    95. Common Sinus Complaints <ul><li>Acute Sinusitis </li></ul><ul><li>Definition? </li></ul><ul><li>Inflammation/infection of paranasal sinuses </li></ul><ul><li>Bacterial – Viral – Allergic </li></ul>
    96. Common Sinus Complaints <ul><li>Acute Sinusitis (con’t.) </li></ul><ul><li>Patient’s Chief Complaint? </li></ul><ul><li>Headache, Facial Tenderness, Fever (few), Nasal Discharge and Stuffiness, Sore Throat, Cough, Itchy Eyes*, Sneezing* </li></ul><ul><li>*Allergic Sinusitis </li></ul><ul><li>Should this patient be referred to a medical officer? </li></ul><ul><li>Yes </li></ul><ul><li>How should the patient be managed? </li></ul><ul><li>Antibiotics and decongestants. </li></ul><ul><li>Patient should be educated to avoid antihistamines. </li></ul>
    97. Check on your learning… <ul><li>A Soldier comes to you complaining of a nosebleed. What is your first priority? </li></ul><ul><li>What is the initial procedure? </li></ul>Stop the Bleeding Patient should sit up, lean forward, tip head down Pinch entire nose firmly (10-15 min)
    98. Check on your learning… <ul><li>Where should treatment for Allergic Rhinitis be aimed? </li></ul><ul><li>What is Sinusitis? </li></ul>Identification and avoidance of the offending allergen. Inflammation/infection of the paranasal sinuses.
    99. Structures of the Mouth Lips Tongue Uvula Tonsils Soft Palate Hard Palate Teeth Gums 1 2 3 4 5 6 7 8
    100. Examination of the Mouth Lips Inspect and palpate for symmetry, color, edema and abnormalities. What do you see?
    101. Examination of the Mouth What is the procedure for examining the mucosa, teeth and gums? Patient is instructed to: Remove Dental Appliances Open Mouth Stick Out Tongue Say “Aaahhh” Inspect with a Light and Tongue Depressor WHAT ARE YOU LOOKING FOR?
    102. Mouth and Throat Complaints RED FLAGS Difficulty Breathing Difficulty Swallowing Fever of 101 degrees F or greater Tonsillar Exudates If a patient displays any of these signs or symptoms, what should you do? Refer to a medical officer
    103. Common Complaints of the Throat <ul><li>Upper Respiratory Infection </li></ul><ul><li>Definition? </li></ul><ul><li>Acute viral infection of the upper airway </li></ul><ul><li>Patient’s Chief Complaints? </li></ul><ul><li>Sore Throat, Nasal Congestion/Discharge </li></ul><ul><li>Low-Grade Fever, Sinus Pressure </li></ul><ul><li>Signs and Symptoms </li></ul><ul><li>Sore Throat and/or Cough </li></ul><ul><li>(Both productive or not/clear or purulent) </li></ul>
    104. <ul><li>Upper Respiratory Infection </li></ul><ul><li>Physical Examination </li></ul><ul><li>How will the Pharynx look? </li></ul><ul><li>Slightly reddened and mucous streaked </li></ul><ul><li>Lungs? </li></ul><ul><li>Clear </li></ul><ul><li>Vital Signs? </li></ul><ul><li>Normal </li></ul><ul><li>(possible low-grade fever) </li></ul>Common Complaints of the Throat
    105. <ul><li>Upper Respiratory Infection </li></ul><ul><li>Treatment is based on symptoms. </li></ul><ul><li>Cough Suppressants, Decongestants, </li></ul><ul><li>Throat Lozenges, </li></ul><ul><li>Acetaminophen for fever and body aches </li></ul><ul><li>Are antibiotics indicated? </li></ul><ul><li>No </li></ul>Common Complaints of the Throat
    106. <ul><li>Streptococcal Pharyngitis (Strep) </li></ul><ul><li>Definition? </li></ul><ul><li>Infection of the Posterior Pharynx and/or Tonsils </li></ul><ul><li>Common Cause? </li></ul><ul><li>Group A Streptococcus bacteria </li></ul><ul><li>Patient’s Chief Complaint? </li></ul><ul><li>Sore Throat, Fever </li></ul><ul><li>Signs / Symptoms? </li></ul><ul><li>Sudden Onset of Severe Sore Throat, Fever, Tender/Swollen Neck Glands, Exudate (pus) on Reddened Tonsils and Pharynx </li></ul>Common Complaints of the Throat
    107. <ul><li>Streptococcal Pharyngitis (Strep) </li></ul><ul><li>Referral to a Medical Officer? </li></ul><ul><li>Yes </li></ul><ul><li>Management? </li></ul><ul><li>Antibiotics (Penicillin) </li></ul>Common Complaints of the Throat
    108. <ul><li>Peri-tonsillar Abscess (PTA) </li></ul><ul><li>Definition? </li></ul><ul><li>Bacterial infection of the tonsils. </li></ul><ul><li>Spreads into a cellulitis and abscess. </li></ul><ul><li>Common Cause? </li></ul><ul><li>Complication of Strep </li></ul><ul><li>Chief Complaint? </li></ul><ul><li>Severe Sore Throat, Pain/Difficulty Swallowing </li></ul>Common Complaints of the Throat
    109. <ul><li>Signs / Symptoms? </li></ul><ul><li>Trismus*, Fever </li></ul><ul><li>(*difficulty opening the mouth) </li></ul><ul><li>Management? </li></ul><ul><li>Surgical Drainage </li></ul><ul><li>Antibiotics </li></ul><ul><li>Referral? </li></ul><ul><li>Immediate referral. </li></ul><ul><li>This is a surgical emergency </li></ul>Common Complaints of the Throat Peri-tonsillar Abscess (PTA) Usually affects one side
    110. <ul><li>Mononucleosis (Mono) </li></ul><ul><li>Definition and Cause? </li></ul><ul><li>Viral infection </li></ul><ul><li>Chief Complaint? </li></ul><ul><li>Sore Throat, Fatigue </li></ul><ul><li>Signs / Symptoms? </li></ul><ul><li> Lymph Node Enlargement </li></ul><ul><li>Abdominal Pain </li></ul>Common Complaints of the Throat Infected Tonsils Uvula 10 year old with massive tonsillar enlargement from Mono
    111. <ul><li>Mononucleosis (Mono) </li></ul><ul><li>Management? </li></ul><ul><li>Blood test (to confirm Mono) </li></ul><ul><li>Throat Culture (to rule out strep) </li></ul><ul><li>No contact sports/activity for a min. of 30 days </li></ul><ul><li>Treat the symptoms: </li></ul><ul><li>throat lozenges, acetaminophen, decongestants, </li></ul><ul><li>oral steroids </li></ul><ul><li>Referral? </li></ul><ul><li>Yes </li></ul>Common Complaints of the Throat
    112. Checking on your learning… <ul><li>What are the RED FLAGS of Throat Complaints? </li></ul><ul><li>Difficulty Breathing </li></ul><ul><li>Difficulty Swallowing </li></ul><ul><li>Fever of 101 degrees F </li></ul><ul><li>Tonsillar Exudates </li></ul>
    113. Checking on your learning… <ul><li>Your patient complains of a sore throat and difficulty swallowing. </li></ul><ul><li>You complete a physical exam of the patient and note he has a fever and see the following when you inspect his mouth. </li></ul><ul><li>What do you think the problem may be? </li></ul><ul><li>Would you refer this patient and why? </li></ul>Yes – PTAs commonly require surgical drainage and antibiotics Peri-tonsillar Abscess (PTA)
    114. Summary <ul><li>What are the RED FLAGS of Ocular Complaints? </li></ul><ul><li>Loss of Vision </li></ul><ul><li>Eye Pain with Decrease in Vision </li></ul><ul><li>History of Trauma </li></ul><ul><li>Common Ocular Complaints? </li></ul><ul><li>Red Eye </li></ul><ul><li>Conjunctivitis </li></ul>
    115. Summary <ul><li>What are the RED FLAGS of Ear Complaints? </li></ul><ul><li>Fever of 101 degrees F or greater </li></ul><ul><li>Embedded Foreign Objects </li></ul><ul><li>Common Ear Complaints? </li></ul><ul><li>Cerumen Impaction </li></ul><ul><li>Otitis Externa (Swimmers’ Ear) </li></ul><ul><li>Otitis Media </li></ul>
    116. Summary <ul><li>What are the RED FLAGS of Sinus Complaints? </li></ul><ul><li>Fever of 101 degrees F or greater </li></ul><ul><li>Common Nose and Sinus Complaints? </li></ul><ul><li>Epistaxis </li></ul><ul><li>Allergies (Allergic Rhinitis or Hay Fever) </li></ul><ul><li>Acute Sinusitis </li></ul>
    117. Summary <ul><li>What are the RED FLAGS of Mouth Complaints? </li></ul><ul><li>Difficulty Breathing </li></ul><ul><li>Difficulty Swallowing </li></ul><ul><li>Fever of 101 degrees F or greater </li></ul><ul><li>Tonsillar Exudates </li></ul><ul><li>Common Complaints of the Mouth and Throat? </li></ul><ul><li>URI Mono </li></ul><ul><li>Strep PTA </li></ul>
    118. <ul><li>Questions? </li></ul>

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