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Chapter 012[1]

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  • 1. Chapter 12 Focused History and Physical Examination for Medical PatientsCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 1
  • 2. Overview Responsive Medical Patients  Patient History  Rapid Assessment  Vital Signs  Emergency Care Unresponsive Medical Patients Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2
  • 3. Focused History and Physical Examination: Medical Patients Every patient receives a focused history and physical exam Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 3
  • 4. Focused History and Physical Examination: Medical Patients Unresponsive medical patients are treated as are unresponsive trauma patients Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 4
  • 5. Focused History and Physical Examination: Medical Patients Proceed to the focused history and physical exam after completing the scene size-up and initial assessment Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 5
  • 6. Responsive Medical PatientsCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 6
  • 7. Responsive Medical Patients Assess the patient’s history Assess complaints and signs or symptoms Use the techniques of physical exam learned in the Focused History and Physical Examination: Trauma Patients Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 7
  • 8. Responsive Medical PatientsO-P-Q-R-S-T acronym  The O-P-Q-R-S-T acronym is useful for remembering whatOnset questions should be asked.ProvocationQuality  Not all the questions will alwaysRadiation have to be asked, nor will theySeverity need to be asked in this order.Time  O-P-Q-R-S-T is primarily used to evaluate pain but can also be used for other medical conditions. Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 8
  • 9. OPQRST Acronym Onset  What was the patient doing when the signs/symptoms started? Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 9
  • 10. OPQRST Acronym Provocation/Palliation  What makes the signs and symptoms better or worse? Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10
  • 11. OPQRST Acronym Quality  The patient’s description of the symptom Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11
  • 12. OPQRST Acronym Radiation  Is there radiation of the symptoms? Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12
  • 13. OPQRST Acronym Severity  An opportunity for the patient to quantify the pain  Typically done with a 1-10 scale • The Wong-Baker Scale Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
  • 14. OPQRST Acronym Time  How long have the signs and symptoms been present? Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14
  • 15. Responsive Medical Patients Remember that a physical exam is required for all patients In the responsive patient, assess the body systems associated with the chief complaint Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15
  • 16. Responsive Medical PatientsD-C-A-P-B-T-L-S acronym Deformities Contusions Reminder of injuries Abrasions and signs of injuries Penetrations to look for while Burns Tenderness assessing. Lacerations Swelling Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16
  • 17. Responsive Medical Patients Assess the head, as necessaryCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17
  • 18. Responsive Medical Patients Assess the neck, as necessaryCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18
  • 19. Responsive Medical Patients Assess for JVD, as necessary Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19
  • 20. Responsive Medical Patients Assess the patient’s chest, as necessary Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20
  • 21. Responsive Medical Patients Assess the breath sounds Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21
  • 22. Responsive Medical Patients Assess the abdomen, as necessaryCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22
  • 23. Responsive Medical Patients Assess the four quadrants of the abdomen, as necessary Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23
  • 24. Responsive Medical Patients Assess the pelvis Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24
  • 25. Responsive Medical Patients Assess the lower extremities, as necessary Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
  • 26. Responsive Medical Patients Assess pulse, motor, and sensation in the lower extremities, as necessaryCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 26
  • 27. Responsive Medical Patients Assess the upper extremities, as necessary Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 27
  • 28. Responsive Medical Patients Log-roll the patient and assess the posterior, as necessary Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 28
  • 29. Patient HistoryCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 29
  • 30. Patient’s History Assess SAMPLE History S Signs and Symptoms A Allergies M Medications P Past medical history L Last oral intake E Events leading to injury or illness Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 30
  • 31. Vital SignsCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 31
  • 32. Vital Signs Assess baseline vital signs  Breathing  Skin  Pupils  Blood pressure Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 32
  • 33. Emergency Care forUnresponsive Medical PatientsCopyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 33
  • 34. Unresponsive Medical Patients Complete a rapid head-to-toe assessment, as in the Focused History and Physical Examination: Trauma Patients Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 34
  • 35. Summary Responsive Medical Patients  Patient History  Rapid Assessment  Vital Signs  Emergency Care Unresponsive Medical Patients Copyright © 2007, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 35