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DRS ABC

Collapsed patient
D = Danger: Check for any environmental/ equipment hazards e.g
electrical, chemical
R = Response – check if patient responding to stimuli, touch, verbal or
pain
S= Shout for help or call for help
Then undertake ABC checks
A = Airway,
B = Breathing and
C= Circulation
ABC
 Open the Airway with a head tilt – chin lift

 Look, listen, feel for Breathing – Hand on


chest or abdomen to feel chest movement
 Circulation – pulse not recommended in
firstaid situations

 If casualty is non responsive or is


without meaningful breaths
 Commence CPR
CPR
 If pulse is present but no respiration, give 1 rescue
breaths every 5 seconds and recheck pulse every 2
minutes
 Check for the chest rise when giving the breath,
otherwise adjust the position of the patient
 Start the CPR cycle in the absence of no pulse
30 compressions
2 breaths
Lift yours hands a little to allow full chest recoil
The four cardinal principles of
physical examination
 Inspection (望诊)
 Palpation(触诊)
 Percussion(叩诊)
 Auscultation(听诊)
“teach the eye to see, the finger to feel, and the ear
to hear”
 What is the fifth?
Smelling(嗅诊)
Equipment for physical
examination
Required Optional

Stethoscope(听诊器) Gloves(手套)
Tongue blades(压舌板) Gauze pads(纱布垫)
Penlight (电筒) Lubricant gel(润滑油)
Tape measure (卷尺) Nasal speculum(鼻反射镜)
Sphygmomanometer(血压计)Tuning fork: 128 Hz,512Hz
Reflex hammer (叩诊锤) (旋转叉)
Safety pins(大头针) Pocket visual acuity card
(袖珍视觉检测卡)
Oto-ophthalmoscope
(检耳-检眼镜)
Important aspects of physical
examination
Where does the examiner stand?

 Stand right side of the bed (left side if left handed)

 Exam with one’ right hand


How to inspect
 Make sure the room is at a comfortable temperature
 Use good lighting, preferably sunlight
 Look and observe before touching
 Completely expose the body part you are inspecting
while draping the rest
 Compare symmetrical body parts
Mental status and personal
grooming
 Does the patient look well or sick?
 Is he comfortable in bed?
 Does he appear in distress?
 Is he alert or is he groggy?
 Does he look acutely or chronically ill?
poor nutrition sunken eyes wasting (body mass) loose skin
 Does the patient appear clean?
 Is his/her hair clean?
 Does he/she bite her nails? (possible sign of
nervousness)
Types of palpation
 Light palpation(浅部触诊)

 Deep palpation(深部触诊)

deep slipping palpation(深部滑行触诊法)


bimanual palpation(双手触诊法)
deep press palpation(深压触诊法)
ballottement(冲击触诊法)
Light palpation
 Using the flat part of the right hand or the pads of
the fingers, not the fingertips(指尖)

 The fingers should be together for applying light


pressure

 Sudden jabs(突然冲击) are to be avoided

 The hand should be lifted from area to area instead


of sliding (滑行)over the abdominal wall
Deep palpation
 Used to determine organ size as well as the presence
of abdominal masses

 The flat portion of the right hand is placed on the


abdomen with the other hand placed on top

 Pressure should be applied to the abdomen gently


but steadily to progressively deeper and firmer

 The patient should be instructed to breathe quietly


through the mouth and to keep arms at the sides
Sounds produced by
Percussion
Record of finding Quality Where heard
Resonance Hollow Normal lung
Hyperresonance Booming Air-filled lungs
Tympany Drumlike Abdomen
Dullness Thudlike Liver
Flatness Flat Muscle, bone
Auscultation

do not try to listen through clothing


How to auscultate
 Eliminate distracting noises
 Expose the body part you are going to auscultate
 Use the diaphragm(膜型) to listen for normal heart
sounds, and bowel sounds
 Press the diaphragm firmly
 Use the bell(钟型) to listen for abnormal heart
sounds or bruits(杂音)
 Hold the bell lightly
Counting Respirations
 Respiration is both inhalation and exhalation.
 Determined by counting for 30 sec, and multiplying by
2.
 A hand on the stomach/chest may help
 Patient can “fake a respiration rate” May need to
pretend to take a pulse and count respirations
Normal Respirations
 Adult 12-20/min
 Child 15-30/min
 Infant 25-50/min
Pulse
 Determined by counting for 30 sec and multiplying by
2.
 Irregular pulse counted for 60 sec.
 Provides information about heart, blood volume and
perfusion.
 Taken at a pulse point
 Don’t use your thumb
Common Pulse Points
 Galen was the first
physiologist to describe
the pulse
 Tactile method to
determine systolic blood
pressure
 Pressure waves from
systolic heart beat move
the arterial walls
Normal Pulse Rate
 Adult 60-80/min
 Child 70-130 1yr and over
 Infant 80-120 3 to 6months
 Newborn 100-150
Normal Blood Pressure
 Male  Female
 Systolic = 100+age until  Systolic=90+age until 50
50  Diastolic = 50-80
 Diastolic =60-90
Your Role as an Observer:
Anxiety
 Common emotional  Severe anxiety
response  Difficulty focusing on
 White coat syndrome details
 Mild anxiety  Feels panicky and
helpless
 Heightened ability to
observe and make  Lack of focus
connections  Hinders your ability to get
the information and
cooperation needed
Your Role as an Observer:
Depression
 Common symptoms  Occurs in late
 Profound sadness adolescence, middle
age, and after
 Fatigue
retirement
 Difficulty falling
asleep or getting up in
the morning
 Signs of substance
abuse can be mistaken
 Loss of appetite
for depression
 Loss of energy
Your Role as an Observer:
Abuse
 Physical, emotional, or
psychological

 Suspect abuse
 If the patient speaks in a
guarded way

 Unlikely explanation for an


injury

 No history of the injury or


history may be suspicious
Your Role as an Observer: Abuse
(cont.)
 Signs of abuse
 Child’s failure to thrive
 Head injuries / skull
 Severe dehydration /
fractures
underweight
 Burns that appear  Delayed medical attention
deliberate – parents do not take child
 Broken bones to doctor immediately
 Hair loss
 Bruises – multiple in
 Drug use
various stages of
 Genital injuries
healing
Recording the Patient’s Medical
History
 Recording the Patient’s history
 Patient and patient’s family information
 Age, previous illness, surgical history, allergies,
medications history, and family medical history
 Questioning technique – PQRST
 Provoke – open ended questions
 Quality of pain
 Region where located
 Signs and symptoms
 Time of onset
SAMPLE
 Signs/Symptoms
 Allergies
 Medications
 Past Pertinent Medical Conditions, including family
history
 Last Oral Intake
 Events Leading to Injury or Illness
Medications
 Prescription and OTC drugs
 Including vitamins, herbal remedies
 Birth Control Pills
 Illicit Drugs
 Always get a list of medications patients are on
including
 Home O2 rate is also important
 What did you take, when, how much?
Practice
In groups of four discuss the
following
Scenario. Allocate a spokes person
to
Feed your conclusions back.

You have been called to assess an 86 Man who has


fallen and can’t get up. You are first on scene. After
determining
ABCs are Ok you are asked to do their
Vitals and take a history. What do you check/ ask?
 . What do you check?
 P: 78 regular R: 18 normal
 B/P 168/82 Skin:warm, good colour, dry
 Pupils: Equal & reacting to light
Taking the patients history using the SAMPLE technique
you establish:
 S: Pain in left hip (sign or symptom), leg is shortened
and rotated outward (sign or symptom)
 A: Allergy to Penicillin and M: Aspirin, vitamins
 P: Hip replacement 8 years ago
 L: Dinner last evening, glass of water while waiting for
ambulance
 E: Climbing on chair, slipped and fell about 9:00am
What do you think the diagnosis is?