Basic Clinical Skills Flashcards
Prior to starting any examination remember the 2 C’s
- CLEAN
o Make sure your hands are clean
o Gel before touching a patient (for their protection)
o Gel after touching a patient (for your protection)
o Use GLOVES if near body fluids - CONSENT
o ALWAYS get permission before touching a patient, a model or a fellow student
Sphygmomanometer
- Examination sequence
- Rest the patient for 5 minutes
- Measure BP in both arms (brachial arteries)
- With patient seated or lying, support arm comfortably at heart level, with no tight clothing constricting upper arm.
- Apply cuff to upper arm
- Palpate the brachial pulse (or radial if unable to locate brachial)
- Inflate cuff until pulse is impalpable and then inflate another 30mmHg.
- Slowly reduce pressure (2-3mmHg/s) until you hear a regular tapping sound (Phase 1 Korotkoff). Record the reading to the nearest 2mmHg, this is the systolic pressure.
- Continue to deflate until sound disappers.
- Record diastolic pressure when sounds completely disappear. If muffled sounds persist (phase 4) and do not disappear, use the point of muffling as the diastolic pressure.
No more than two measurements on an arm in 30 minutes!
Tympanic Digital Thermometer - Examination sequence
Examination sequence
- Do NOT touch the probe cover either putting it on or discarding it
- Turn machine on
- Check no discharges
- Pull up pinner, take reading from external auditory meatus
Peripheral (Arterial) Pulses
Ejection of blood from the left ventricle into the systemic arterial circulation creates a pressure wave that can be felt as a ‘pulse’. The pressure wave is not the same as, and travels faster than, the blood flow itself.
These pulses can be palpated wherever an artery passes near to the skin and over a bony or firm surface. There is one pulse for each heartbeat.
Radial artery – at the radial bone side of the wrist
Brachial artery – inner side of the biceps
Carotid artery – on the side of the neck between the larynx and the anterior border of the sternocleidomastoid muscle
Femoral artery – in the groin
Posterior tibial artery – behind the inner ankle
Dorsalis pedis artery – best felt in the groove between the first and second metatarsals. It may be absent or abnormally sited in 10% of normal subjects.
When assessing the pulse, need to check:
Rate - resting HR = 60-90bpm, bradycardia = <60bpm, tachycardia >100bpm. However, this should be assessed in clinical context.
Rhythm – regular or irregular. If irregular, it may be regularly irregular, due to an ectopic beat occurring at a regular intervals. Atrial fibrillation (AF) is the most common cause of an irregularly irregular pulse.
Volume – refers to the perceived degree of pulsation and reflects the pulse pressure. Large pulse volume is a reflection of a large pulse pressure which can be physiological or pathological. A low pulse volume may be due to reduced stroke volume.
Character – refers to the waveform or shape of the arterial pulse.
Urine Dipstick
Some uses of urinalysis:
Some uses of urinalysis:
- Screening: Random (diabetes) or Selective (hypertensive patients)
- Diagnosis: UTI
- Monitoring: Drug compliance (rifampicin therapy)
Urinalysis is a fast and convenient way to test for the presence of a number of different markers. You will be provided with Multistix 8 SG reagent strips that can test for the presence of:
Blood, Leucocytes, Nitrite, Specific Gravity, Glucose, Protein, Ketones and pH.
WEAR GLOVES!
Is it fresh (warm)?
Is it labelled?
Is it urine?
Follow instructions re-timing and reading.
Colour, cloudy, blood?
Always discard in clinical bins!
Pulse Oximeter
Measures arterial oxygen saturation (SpO2) by determining the proportion of haemaglobin that is oxygenated.
It can be fooled (e.g. cold fingers, nail varnish, carboxyhaemaglobin, skin pigmentation, etc).
Not a reliable pulse rate.
QRISK3
The QRISK3 calculator works out the risk of an individual developing a heart attack or stroke over the next 10 years.
