Detailed Physical Exam

1. Detailed Physical Exam

2. Who Needs a Detailed Physical Exam? Determined by patient’s condition: • After critical interventions for a patient with significant MOI (i.e. typically a patient with a cut finger would not require the detailed physical exam) • Occasionally for a patient with no significant MOI • Rarely for a medical patient

3. Who Needs a Detailed Physical Exam? You may never have time to perform a detailed exam on a patient with critical injuries, due to the fact that you may never get past the initial assessment.

4. Steps in theDetailed Physical Exam (you are doing the Detailed Physical Exam to gather addition information about the patient)

5. The Detailed Physical Exam Assess areas examined in rapid trauma assessment plus: • Face • Ears • Eyes • Nose • Mouth

6. The Detailed Physical Exam • Examine slower than during rapid trauma assessment. • Often do during transport. • Reassess vital signs.

7. DCAP-BTLS = = = = = = = = Deformities Contusions Abrasions Punctures/ Penetrations Burns Tenderness Lacerations Swelling D C A P B T L S

8. Head DCAP-BTLS

9. Ears DCAP-BTLS + Drainage You should look for either blood or clear fluid coming from the patient’s ears.

10. Eyes • Discoloration • Unequal pupils • Foreign bodies • Blood in anterior chamber DCAP-BTLS +

11. Nose and Mouth • Teeth • Obstructions • Swollen or lacerated tongue • Odors • Discoloration • Drainage • Bleeding DCAP-BTLS +

12. Neck: Assessment Limited by Cervical Collar • If you did not apply a cervical collar in the rapid trauma assessment, you must now apply one. • Be sure to check for crepitation, JVD, Tracheal Deviation, and the back of the neck.

13. Chest: Reassess Breath Sounds Absence, Presence and Equality • You should also check for crepitation and paradoxical motion. • Breath sounds should be listened to in the apices, mid-clavicular line, bilaterally and at the bases, mid-axillary line, bilaterally.

14. Abdomen: DCAP-BTLS + Firmness and Distention Divide the abdomen into four quadrants – right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), and left lower quadrant (LLQ) Look also for softness and distention (appearing larger than normal)

15. Pelvis: DCAP-BTLS (Compress gently.) If no pain is noted or the patient is unresponsive, gently compress the pelvis to determine tenderness or motion (press in and down on pelvic wings) – DO NOT ROCK AND ROLL

16. The Detailed Physical Exam The abdomen, pelvis, and extremities may have already been assessed during rapid trauma assessment. If not yet done, assess these areas thoroughly. If already done, a re-check is never a bad idea.

17. Extremities (be sure to assess all four): DCAP-BTLS, Crepitation, Reassess Distal Pulse, Sensation, Motor Function

18. Posterior: DCAP-BTLS Roll patient with spinal precautions and assess posterior body, inspect and palpate, examining for injuries or signs of injury (check spine, sides of spine/body, posterior of extremities and buttocks for injuries

19. Perform the steps of the Rapid Trauma Assessment —BUT MORE SLOWLY.

20. Reassess Vital Signs • Respirations • Pulse • Skin color, temperature, condition • Pupils • Blood pressure