Fundamentals Flashcards
Examinations
Approach from the right
WIPER Wash hands Introduction - Full name, who (Student Dr.), where from, what you are going to do (fully explain), consent, check name and age. Pain Exposure - as much and when required Reposition
Examination
IPPA - Inspect, Palpate, Percussion Auscultation
Stand back first - inspect around patient (paraphenalia), inspect patient
?Wellness ?Pain ?Positioning
?Breathing quality
?Body habitus/cachectic
?Particular special signs indicative of cetrain diseases
Start from peripheries and work centrally
?Stigmata - skin colour, charts, fluid status
Talk through what you would do and for how long
Palpate - soft (pain), deep (ID masses etc.). Pivot at Phal-Metacarp. Work towards pain. Note location, size and character. Look at face.
Percuss - middle to middle, resting hand press hard.
Leave them as you find them and ask to help
To complete this examination…
History
Presenting complaint - open, summarising and screening
History of this - time framing and direct questioning
SOCRATES
Past medical history
MIJTHREADS
Drug/medication history
Allergies
Social history
Who else is there at home? Job? Visitors? Exercise?
Alcohol, tabacco, recreational drugs - CAGE, pack years, Holts Law
Family history
Relevant diseases
Systemic enquiry
See specifics
MIJTHREADS
MI Jaundice TB High BP Rheumatic fever Epilepsy Asthma Diabetes Stroke
Observations
Acronyms BP O2 sats TPR - temp, pulse, respiration rate Dinomap - machine for BP and sats AVPU - Alert, voice, pain, unresponsive NEWS - National Early Warning Score
Respiratory rate as first measure - BP and pulse compensate
Cardio
Rate - 100-60, NB context
Rhythm - Reg (sinus), reg irreg (brady), irreg irreg (AF)
Character - Full (bounding) or Thready (weak)
Pulse - take for 30s, then in second 30 do resp Carotid Radial Brachial Femoral Popliteal Posterior tibial - NB diabetes Dorsalis pedis - NB diabetes
BP - 120/80mmmHg Korotkoff sounds (different can be used e.g. in pregnancy where the is no end) I - first appearance = systolic II - murmur III - gong IV - muffled V - disappear = diastolic
NB size of cuff, orientation and allignment. Release 2mmHg/sec
MAP = 2xDBP+SBP/3
indication of vital organ perfussion
SOCRATES
Site Onset Character Radiation Associations Timing (duration) Exacerbating (and alleviating) Severity
Surgical sieve
Vasculature Inflammatory Trauma Autoimmune Metabolic Idiopathic Neoplastic
Congenital
Degenerative
Environmental
Endocrine
Functional
