Download - Baseline Vitals and SAMPLE History
Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History
Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History
Given a patient care scenario and the proper Given a patient care scenario and the proper medical equipment in a clinical environment medical equipment in a clinical environment or field setting, or field setting,
Assess a baseline set of patient vital signs and Assess a baseline set of patient vital signs and obtain an accurate SAMPLE history obtain an accurate SAMPLE history
Describe the basic principles, sequence and Describe the basic principles, sequence and components of an accurate baseline set of components of an accurate baseline set of vital signsvital signs
Given a patient care scenario and the proper Given a patient care scenario and the proper medical equipment in a clinical environment medical equipment in a clinical environment or field setting, or field setting,
Assess a baseline set of patient vital signs and Assess a baseline set of patient vital signs and obtain an accurate SAMPLE history obtain an accurate SAMPLE history
Describe the basic principles, sequence and Describe the basic principles, sequence and components of an accurate baseline set of components of an accurate baseline set of vital signsvital signs
Terminal Learning ObjectiveTerminal Learning Objective
Demonstrate the proper technique(s) for Demonstrate the proper technique(s) for obtaining a complete set of baseline vital signs obtaining a complete set of baseline vital signs and a concise patient history using the and a concise patient history using the acronym SAMPLE acronym SAMPLE
IAW Emergency Care and Transportation of IAW Emergency Care and Transportation of the Sick and Injured, 9the Sick and Injured, 9thth Edition, American Edition, American Academy of Orthopedic Surgeons (AAOS). Academy of Orthopedic Surgeons (AAOS).
Demonstrate the proper technique(s) for Demonstrate the proper technique(s) for obtaining a complete set of baseline vital signs obtaining a complete set of baseline vital signs and a concise patient history using the and a concise patient history using the acronym SAMPLE acronym SAMPLE
IAW Emergency Care and Transportation of IAW Emergency Care and Transportation of the Sick and Injured, 9the Sick and Injured, 9thth Edition, American Edition, American Academy of Orthopedic Surgeons (AAOS). Academy of Orthopedic Surgeons (AAOS).
Terminal Learning ObjectiveTerminal Learning Objective
Given a patient with Eye, Ear, Nose, or Given a patient with Eye, Ear, Nose, or Throat complaints Throat complaints
Treat EENT Complaints Treat EENT Complaints
IAW A Guide to Physical Examination and IAW A Guide to Physical Examination and History Taking, Lippincott Co, Chapter 11 History Taking, Lippincott Co, Chapter 11
& Current Medical Diagnosis and & Current Medical Diagnosis and Treatment, Chapter 7 and 8.Treatment, Chapter 7 and 8.
Terminal Learning ObjectiveTerminal Learning Objective
Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History
Assessment is the most essential skill Assessment is the most essential skill EMT-Bs learn.EMT-Bs learn.
During assessment you During assessment you will: will:– Gather key informationGather key information
– Evaluate the patientEvaluate the patient
– Learn the historyLearn the history
– Learn about the patient’s overall healthLearn about the patient’s overall health
Assessment is the most essential skill Assessment is the most essential skill EMT-Bs learn.EMT-Bs learn.
During assessment you During assessment you will: will:– Gather key informationGather key information
– Evaluate the patientEvaluate the patient
– Learn the historyLearn the history
– Learn about the patient’s overall healthLearn about the patient’s overall health
Gathering Key Patient InformationGathering Key Patient Information
Obtain the patient’s name.Obtain the patient’s name.
Note the age, gender and Note the age, gender and
race.race.
Look for identification if the Look for identification if the
patient is unconscious.patient is unconscious.
Obtain the patient’s name.Obtain the patient’s name.
Note the age, gender and Note the age, gender and
race.race.
Look for identification if the Look for identification if the
patient is unconscious.patient is unconscious.
Baseline Vital SignsBaseline Vital Signs
During the assessment, the EMT-B uses During the assessment, the EMT-B uses many senses and a few basic medical many senses and a few basic medical instruments.instruments.
First set is known as First set is known as the baseline vitals.the baseline vitals.
Repeated vital signs Repeated vital signs are compared to the are compared to the baseline.baseline.
During the assessment, the EMT-B uses During the assessment, the EMT-B uses many senses and a few basic medical many senses and a few basic medical instruments.instruments.
First set is known as First set is known as the baseline vitals.the baseline vitals.
Repeated vital signs Repeated vital signs are compared to the are compared to the baseline.baseline.
Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History
Chief Complaint (Chief Complaint (CCCC); Mechanism of Injury ); Mechanism of Injury ((MOIMOI):):– Chief complaints are the major signs, Chief complaints are the major signs,
symptoms or events that caused the call or symptoms or events that caused the call or complaintcomplaint
– SymptomsSymptoms: what the patient tells you: what the patient tells you
– SignsSigns: can be seen, heard , felt, smelled or : can be seen, heard , felt, smelled or measured measured
Chief Complaint (Chief Complaint (CCCC); Mechanism of Injury ); Mechanism of Injury ((MOIMOI):):– Chief complaints are the major signs, Chief complaints are the major signs,
symptoms or events that caused the call or symptoms or events that caused the call or complaintcomplaint
– SymptomsSymptoms: what the patient tells you: what the patient tells you
– SignsSigns: can be seen, heard , felt, smelled or : can be seen, heard , felt, smelled or measured measured
Obtaining a SAMPLE HistoryObtaining a SAMPLE History
S S :: Signs and Symptoms of the episode:Signs and Symptoms of the episode:– What signs and symptoms occurred at onset?What signs and symptoms occurred at onset?– Does the patient report pain?Does the patient report pain?
S S :: Signs and Symptoms of the episode:Signs and Symptoms of the episode:– What signs and symptoms occurred at onset?What signs and symptoms occurred at onset?– Does the patient report pain?Does the patient report pain?
Obtaining a SAMPLE HistoryObtaining a SAMPLE History AA :: Allergies:Allergies:
– Is the patient allergic to medications, foods or Is the patient allergic to medications, foods or other substance?other substance?
– What reactions did the patient have to any of What reactions did the patient have to any of them?them?
Note: If the patient has no know allergies, you Note: If the patient has no know allergies, you should note this on the run sheet as “no should note this on the run sheet as “no known allergies” or “NKA” known allergies” or “NKA”
AA :: Allergies:Allergies:– Is the patient allergic to medications, foods or Is the patient allergic to medications, foods or
other substance?other substance?– What reactions did the patient have to any of What reactions did the patient have to any of
them?them?
Note: If the patient has no know allergies, you Note: If the patient has no know allergies, you should note this on the run sheet as “no should note this on the run sheet as “no known allergies” or “NKA” known allergies” or “NKA”
Obtaining a SAMPLE HistoryObtaining a SAMPLE History
M M :: Medications:Medications:– What medications was the patient prescribed?What medications was the patient prescribed?– What dosage was prescribed?What dosage was prescribed?– How often is the patient supposed to take the How often is the patient supposed to take the
medication? medication? – What prescription, over-the-counter (OTC) What prescription, over-the-counter (OTC)
medications, and herbal medications has the medications, and herbal medications has the patient taken in the last 12 hours?patient taken in the last 12 hours?
– How much was taken and when? How much was taken and when?
M M :: Medications:Medications:– What medications was the patient prescribed?What medications was the patient prescribed?– What dosage was prescribed?What dosage was prescribed?– How often is the patient supposed to take the How often is the patient supposed to take the
medication? medication? – What prescription, over-the-counter (OTC) What prescription, over-the-counter (OTC)
medications, and herbal medications has the medications, and herbal medications has the patient taken in the last 12 hours?patient taken in the last 12 hours?
– How much was taken and when? How much was taken and when?
Obtaining a SAMPLE HistoryObtaining a SAMPLE History
P P :: Pertinent past history:Pertinent past history:– Does the patient have any history of medical, Does the patient have any history of medical,
surgical, or trauma occurrences?surgical, or trauma occurrences?– Has the patient had a recent illness or injury, fall Has the patient had a recent illness or injury, fall
or blow to the head? or blow to the head?
P P :: Pertinent past history:Pertinent past history:– Does the patient have any history of medical, Does the patient have any history of medical,
surgical, or trauma occurrences?surgical, or trauma occurrences?– Has the patient had a recent illness or injury, fall Has the patient had a recent illness or injury, fall
or blow to the head? or blow to the head?
Obtaining a SAMPLE HistoryObtaining a SAMPLE History
L L :: Last oral intake:Last oral intake:– When did the patient last eat or drink?When did the patient last eat or drink?– What did the patient eat or drink, and how What did the patient eat or drink, and how
much was consumed?much was consumed?– Did the patient take any drugs or drink alcohol?Did the patient take any drugs or drink alcohol?– Has there been any other oral intake in the last Has there been any other oral intake in the last
4 hours? 4 hours?
L L :: Last oral intake:Last oral intake:– When did the patient last eat or drink?When did the patient last eat or drink?– What did the patient eat or drink, and how What did the patient eat or drink, and how
much was consumed?much was consumed?– Did the patient take any drugs or drink alcohol?Did the patient take any drugs or drink alcohol?– Has there been any other oral intake in the last Has there been any other oral intake in the last
4 hours? 4 hours?
Obtaining a SAMPLE HistoryObtaining a SAMPLE History
E E :: Events leading to injury or illnessEvents leading to injury or illness– What are the key events that led up to this What are the key events that led up to this
incident?incident?– What occurred between the onset of the What occurred between the onset of the
incident and your arrival?incident and your arrival?– What was the patient doing when this illness What was the patient doing when this illness
started?started?– What was the patient doing when this injury What was the patient doing when this injury
happened? happened?
E E :: Events leading to injury or illnessEvents leading to injury or illness– What are the key events that led up to this What are the key events that led up to this
incident?incident?– What occurred between the onset of the What occurred between the onset of the
incident and your arrival?incident and your arrival?– What was the patient doing when this illness What was the patient doing when this illness
started?started?– What was the patient doing when this injury What was the patient doing when this injury
happened? happened?
OO--PP--QQ--RR--SS--TT
Mnemonic device to help you remember Mnemonic device to help you remember questions you should ask to obtain a questions you should ask to obtain a patient history.patient history.– OO : Onset: When did the problem begin and : Onset: When did the problem begin and
what caused it?what caused it?
– PP : Provocation or Palliation: Does anything : Provocation or Palliation: Does anything make it feel better? Worse?make it feel better? Worse?
Mnemonic device to help you remember Mnemonic device to help you remember questions you should ask to obtain a questions you should ask to obtain a patient history.patient history.– OO : Onset: When did the problem begin and : Onset: When did the problem begin and
what caused it?what caused it?
– PP : Provocation or Palliation: Does anything : Provocation or Palliation: Does anything make it feel better? Worse?make it feel better? Worse?
OO--PP--QQ--RR--SS--TT
– QQ : Quality: What is the pain like? Sharp, dull, : Quality: What is the pain like? Sharp, dull, crushing, tearing?crushing, tearing?
– RR : Region/Radiation: Where does it hurt? : Region/Radiation: Where does it hurt? Does the pain move anywhere?Does the pain move anywhere?
– SS : Severity: On a scale of 1 to 10, how would : Severity: On a scale of 1 to 10, how would you rate your pain?you rate your pain?
– TT : Timing of pain: Has the pain been constant : Timing of pain: Has the pain been constant or does it come and go? How long have you or does it come and go? How long have you had the pain?had the pain?
– QQ : Quality: What is the pain like? Sharp, dull, : Quality: What is the pain like? Sharp, dull, crushing, tearing?crushing, tearing?
– RR : Region/Radiation: Where does it hurt? : Region/Radiation: Where does it hurt? Does the pain move anywhere?Does the pain move anywhere?
– SS : Severity: On a scale of 1 to 10, how would : Severity: On a scale of 1 to 10, how would you rate your pain?you rate your pain?
– TT : Timing of pain: Has the pain been constant : Timing of pain: Has the pain been constant or does it come and go? How long have you or does it come and go? How long have you had the pain?had the pain?
Baseline Vital SignsBaseline Vital Signs
Baseline vital signs always include Baseline vital signs always include – Respirations, Pulse & Blood PressureRespirations, Pulse & Blood Pressure
Other key indicators:Other key indicators:– Skin: color, condition, temperature (Skin: color, condition, temperature (CCTCCT))
– Capillary refill time (in children)Capillary refill time (in children)
– Pupillary responsePupillary response
– Level of Consciousness (Level of Consciousness (LOCLOC))
– Sometimes Temperature (medical Sometimes Temperature (medical patients)patients)
Baseline vital signs always include Baseline vital signs always include – Respirations, Pulse & Blood PressureRespirations, Pulse & Blood Pressure
Other key indicators:Other key indicators:– Skin: color, condition, temperature (Skin: color, condition, temperature (CCTCCT))
– Capillary refill time (in children)Capillary refill time (in children)
– Pupillary responsePupillary response
– Level of Consciousness (Level of Consciousness (LOCLOC))
– Sometimes Temperature (medical Sometimes Temperature (medical patients)patients)
RespirationsRespirations
A patient who is breathing without A patient who is breathing without assistance: assistance: spontaneous respirationsspontaneous respirations. .
Each complete breath consists of two Each complete breath consists of two distinct phases: distinct phases: – Inspiration (inhalation): the chest rises up and Inspiration (inhalation): the chest rises up and
out, drawing oxygenated air into the lungs out, drawing oxygenated air into the lungs
– Expiration (exhalation): the chest returns to its Expiration (exhalation): the chest returns to its original position, releasing air with an increased original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs carbon dioxide (CO²) level out of the lungs
A patient who is breathing without A patient who is breathing without assistance: assistance: spontaneous respirationsspontaneous respirations. .
Each complete breath consists of two Each complete breath consists of two distinct phases: distinct phases: – Inspiration (inhalation): the chest rises up and Inspiration (inhalation): the chest rises up and
out, drawing oxygenated air into the lungs out, drawing oxygenated air into the lungs
– Expiration (exhalation): the chest returns to its Expiration (exhalation): the chest returns to its original position, releasing air with an increased original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs carbon dioxide (CO²) level out of the lungs
RespirationsRespirations
Rate:Rate:– The number of breaths in 30 seconds x 2The number of breaths in 30 seconds x 2
Quality: character of breathing:Quality: character of breathing:– Rhythm (regular or irregular)Rhythm (regular or irregular)
– Effort (normal or labored)Effort (normal or labored) Depth:Depth: - Tidal Volume (the amount of air exchanged with each - Tidal Volume (the amount of air exchanged with each
breath)breath)
-Depth and rate of breathing determines the tidal -Depth and rate of breathing determines the tidal volumevolume
Rate:Rate:– The number of breaths in 30 seconds x 2The number of breaths in 30 seconds x 2
Quality: character of breathing:Quality: character of breathing:– Rhythm (regular or irregular)Rhythm (regular or irregular)
– Effort (normal or labored)Effort (normal or labored) Depth:Depth: - Tidal Volume (the amount of air exchanged with each - Tidal Volume (the amount of air exchanged with each
breath)breath)
-Depth and rate of breathing determines the tidal -Depth and rate of breathing determines the tidal volumevolume
Respiratory RateRespiratory Rate
Adults: 12 to 20 breaths/minuteAdults: 12 to 20 breaths/minute(over age 8)(over age 8)
Children: 18 to 30 breaths/minuteChildren: 18 to 30 breaths/minute(1 to 8 years of age)(1 to 8 years of age)
Infants: 30 to 60 breaths/minuteInfants: 30 to 60 breaths/minute(under 1 year of age)(under 1 year of age)
Adults: 12 to 20 breaths/minuteAdults: 12 to 20 breaths/minute(over age 8)(over age 8)
Children: 18 to 30 breaths/minuteChildren: 18 to 30 breaths/minute(1 to 8 years of age)(1 to 8 years of age)
Infants: 30 to 60 breaths/minuteInfants: 30 to 60 breaths/minute(under 1 year of age)(under 1 year of age)
RespirationsRespirations
Effort (labored):Effort (labored):– Unable to speak more than 2-3 words at a timeUnable to speak more than 2-3 words at a time– Assuming a “tripod” positionAssuming a “tripod” position– Assuming a “sniffing” position (children)Assuming a “sniffing” position (children)– Noisy breathing:Noisy breathing:
• StridorStridor• Wheezes, snoringWheezes, snoring• Coughing (productive?) Coughing (productive?)
Effort (labored):Effort (labored):– Unable to speak more than 2-3 words at a timeUnable to speak more than 2-3 words at a time– Assuming a “tripod” positionAssuming a “tripod” position– Assuming a “sniffing” position (children)Assuming a “sniffing” position (children)– Noisy breathing:Noisy breathing:
• StridorStridor• Wheezes, snoringWheezes, snoring• Coughing (productive?) Coughing (productive?)
Pulse OximetryPulse Oximetry
Evaluates the effectiveness of oxygenation.Evaluates the effectiveness of oxygenation. Normal value: 95% - 100%.Normal value: 95% - 100%.
Evaluates the effectiveness of oxygenation.Evaluates the effectiveness of oxygenation. Normal value: 95% - 100%.Normal value: 95% - 100%.
PulsePulse
With each heartbeat, ventricle contract, With each heartbeat, ventricle contract, forcefully ejecting blood from the heart forcefully ejecting blood from the heart and propelling it into the arteries.and propelling it into the arteries.
A pulse is the pressure wave that occurs A pulse is the pressure wave that occurs as each heartbeat causes a surge in the as each heartbeat causes a surge in the blood circulating through the arteries. blood circulating through the arteries.
With each heartbeat, ventricle contract, With each heartbeat, ventricle contract, forcefully ejecting blood from the heart forcefully ejecting blood from the heart and propelling it into the arteries.and propelling it into the arteries.
A pulse is the pressure wave that occurs A pulse is the pressure wave that occurs as each heartbeat causes a surge in the as each heartbeat causes a surge in the blood circulating through the arteries. blood circulating through the arteries.
PulsePulse
Carotid Pulse Radial Pulse Carotid Pulse Radial Pulse
PulsePulse
Brachial PulseBrachial Pulse
PulsePulse
Rate:Rate:– Number of beats in 30 seconds x 2Number of beats in 30 seconds x 2
Strength:Strength:– Stronger than normal (Stronger than normal (boundingbounding), strong or ), strong or
weak (weak (threadythready))
Regularity:Regularity:– Regular or irregularRegular or irregular
Rate:Rate:– Number of beats in 30 seconds x 2Number of beats in 30 seconds x 2
Strength:Strength:– Stronger than normal (Stronger than normal (boundingbounding), strong or ), strong or
weak (weak (threadythready))
Regularity:Regularity:– Regular or irregularRegular or irregular
29
Normal Pulse Ranges Normal Pulse Ranges
Adults: Adults: 60 to 100 beats/minute60 to 100 beats/minute
Children:Children: 70 to 120 beats/minute70 to 120 beats/minute
Toddlers:Toddlers: 90 to 150 beats/minute90 to 150 beats/minute
Newborns:Newborns: 120 to 160 beats/minute120 to 160 beats/minute
Adults: Adults: 60 to 100 beats/minute60 to 100 beats/minute
Children:Children: 70 to 120 beats/minute70 to 120 beats/minute
Toddlers:Toddlers: 90 to 150 beats/minute90 to 150 beats/minute
Newborns:Newborns: 120 to 160 beats/minute120 to 160 beats/minute
The SkinThe Skin
The condition of the patient’s skin can tell The condition of the patient’s skin can tell you a lot about the patient’s:you a lot about the patient’s:– Peripheral circulation and perfusionPeripheral circulation and perfusion– Blood oxygen levelsBlood oxygen levels– Body temperatureBody temperature
The condition of the patient’s skin can tell The condition of the patient’s skin can tell you a lot about the patient’s:you a lot about the patient’s:– Peripheral circulation and perfusionPeripheral circulation and perfusion– Blood oxygen levelsBlood oxygen levels– Body temperatureBody temperature
The Skin (The Skin (CCTCCT))
Color:Color:– Pink, pale, blue, Pink, pale, blue,
red, or yellowred, or yellow Condition: Condition:
(moisture)(moisture)– Dry, moist or wetDry, moist or wet
Temperature:Temperature:– Warm, hot or coolWarm, hot or cool
Color:Color:– Pink, pale, blue, Pink, pale, blue,
red, or yellowred, or yellow Condition: Condition:
(moisture)(moisture)– Dry, moist or wetDry, moist or wet
Temperature:Temperature:– Warm, hot or coolWarm, hot or cool
Capillary RefillCapillary Refill
Evaluates the ability of the circulatory Evaluates the ability of the circulatory system to restore blood to the capillary system to restore blood to the capillary system (perfusion).system (perfusion).
– Evaluated at the nail bed (finger) Evaluated at the nail bed (finger)
– Depress the finger tip, pressure forcing blood Depress the finger tip, pressure forcing blood from the capillaries and look for return of bloodfrom the capillaries and look for return of blood
Evaluates the ability of the circulatory Evaluates the ability of the circulatory system to restore blood to the capillary system to restore blood to the capillary system (perfusion).system (perfusion).
– Evaluated at the nail bed (finger) Evaluated at the nail bed (finger)
– Depress the finger tip, pressure forcing blood Depress the finger tip, pressure forcing blood from the capillaries and look for return of bloodfrom the capillaries and look for return of blood
Capillary RefillCapillary Refill
– As the capillaries refill, As the capillaries refill, should return to its should return to its normal deep pink colornormal deep pink color
– Color should be restored Color should be restored within 2 seconds (about within 2 seconds (about the time it takes to say, the time it takes to say, ““Capillary refillCapillary refill” ”
– Invalid test in a cold Invalid test in a cold environment; elderlyenvironment; elderly
– Used for < 6 years oldUsed for < 6 years old
– As the capillaries refill, As the capillaries refill, should return to its should return to its normal deep pink colornormal deep pink color
– Color should be restored Color should be restored within 2 seconds (about within 2 seconds (about the time it takes to say, the time it takes to say, ““Capillary refillCapillary refill” ”
– Invalid test in a cold Invalid test in a cold environment; elderlyenvironment; elderly
– Used for < 6 years oldUsed for < 6 years old
Blood Pressure Blood Pressure
Blood pressure is a vital sign. Blood pressure is a vital sign. Pressure of circulating blood against the Pressure of circulating blood against the
walls of the arteries.walls of the arteries. A drop in blood pressure may indicate:A drop in blood pressure may indicate:
– Loss of bloodLoss of blood– Loss of vascular toneLoss of vascular tone– Cardiac pumping problemCardiac pumping problem
Blood pressure should be measured in all Blood pressure should be measured in all patients older than 3 years of age.patients older than 3 years of age.
Blood pressure is a vital sign. Blood pressure is a vital sign. Pressure of circulating blood against the Pressure of circulating blood against the
walls of the arteries.walls of the arteries. A drop in blood pressure may indicate:A drop in blood pressure may indicate:
– Loss of bloodLoss of blood– Loss of vascular toneLoss of vascular tone– Cardiac pumping problemCardiac pumping problem
Blood pressure should be measured in all Blood pressure should be measured in all patients older than 3 years of age.patients older than 3 years of age.
Blood PressureBlood Pressure
Diastolic:Diastolic:– Pressure during relaxing Pressure during relaxing
phase of the heart’s cyclephase of the heart’s cycle Systolic:Systolic:
– Pressure during contractionPressure during contraction Measured as millimeters Measured as millimeters
of mercury (mmHg).of mercury (mmHg). Recorded as systolic/diastolic.Recorded as systolic/diastolic.
Diastolic:Diastolic:– Pressure during relaxing Pressure during relaxing
phase of the heart’s cyclephase of the heart’s cycle Systolic:Systolic:
– Pressure during contractionPressure during contraction Measured as millimeters Measured as millimeters
of mercury (mmHg).of mercury (mmHg). Recorded as systolic/diastolic.Recorded as systolic/diastolic.
Blood Pressure EquipmentBlood Pressure Equipment
Auscultation of Blood PressureAuscultation of Blood Pressure
Place cuff on patient's arm (1” above elbow).Place cuff on patient's arm (1” above elbow). Palpate brachial artery and place diaphragm Palpate brachial artery and place diaphragm
of stethoscope over artery.of stethoscope over artery. Inflate cuff until you no Inflate cuff until you no
longer hear pulse sounds.longer hear pulse sounds. Continue pumping to Continue pumping to
increase pressure by increase pressure by an additional 20 mmHg.an additional 20 mmHg.
Place cuff on patient's arm (1” above elbow).Place cuff on patient's arm (1” above elbow). Palpate brachial artery and place diaphragm Palpate brachial artery and place diaphragm
of stethoscope over artery.of stethoscope over artery. Inflate cuff until you no Inflate cuff until you no
longer hear pulse sounds.longer hear pulse sounds. Continue pumping to Continue pumping to
increase pressure by increase pressure by an additional 20 mmHg.an additional 20 mmHg.
Auscultation of Blood PressureAuscultation of Blood Pressure
Note the systolic and Note the systolic and diastolic pressures diastolic pressures as you let air escape as you let air escape slowly.slowly.
As soon as pulse As soon as pulse sounds stop, open the sounds stop, open the valve and release the valve and release the air quickly. air quickly.
Note the systolic and Note the systolic and diastolic pressures diastolic pressures as you let air escape as you let air escape slowly.slowly.
As soon as pulse As soon as pulse sounds stop, open the sounds stop, open the valve and release the valve and release the air quickly. air quickly.
Palpation of Blood PressurePalpation of Blood Pressure
Secure cuff.Secure cuff. Locate radial pulse.Locate radial pulse. After the pulse disappears After the pulse disappears
continue to inflate another continue to inflate another 30mmHg.30mmHg.
Release air until pulse is Release air until pulse is felt.felt.
Method only obtains Method only obtains systolic pressure.systolic pressure.
Secure cuff.Secure cuff. Locate radial pulse.Locate radial pulse. After the pulse disappears After the pulse disappears
continue to inflate another continue to inflate another 30mmHg.30mmHg.
Release air until pulse is Release air until pulse is felt.felt.
Method only obtains Method only obtains systolic pressure.systolic pressure.
Normal BP RangesNormal BP Ranges
Age Range
Adults 90 to 140 mmHg (s)
60 to 90 mmHg (d)
Children (1-8) 80 to 110 mmHg (s)
Infants (up to 1 yr) 50 to 90 mmHg (s)
*Varies with age and gender.
Age Range
Adults 90 to 140 mmHg (s)
60 to 90 mmHg (d)
Children (1-8) 80 to 110 mmHg (s)
Infants (up to 1 yr) 50 to 90 mmHg (s)
*Varies with age and gender.
Blood PressureBlood Pressure
HypotensionHypotension: : – BP significantly lower than the normal rangeBP significantly lower than the normal range– Critical hypotension: BP is no longer able to Critical hypotension: BP is no longer able to
compensate sufficiently to maintain adequate compensate sufficiently to maintain adequate perfusion perfusion
HypertensionHypertension::– BP significantly higher than the normal rangeBP significantly higher than the normal range
HypotensionHypotension: : – BP significantly lower than the normal rangeBP significantly lower than the normal range– Critical hypotension: BP is no longer able to Critical hypotension: BP is no longer able to
compensate sufficiently to maintain adequate compensate sufficiently to maintain adequate perfusion perfusion
HypertensionHypertension::– BP significantly higher than the normal rangeBP significantly higher than the normal range
Level of ConsciousnessLevel of Consciousness
AA - - AAlertlert
VV - Responsive to - Responsive to
VVerbal stimuluserbal stimulus
PP - Responsive to - Responsive to PPainain
UU - - UUnresponsivenresponsive
AA - - AAlertlert
VV - Responsive to - Responsive to
VVerbal stimuluserbal stimulus
PP - Responsive to - Responsive to PPainain
UU - - UUnresponsivenresponsive
Pupil AssessmentPupil Assessment
PP - - PPupilsupils
EE - - EEqualqual
AA - - AAndnd
RR - - RRoundound
RR - - RRegular in sizeegular in size
LL - React to - React to LLightight
PP - - PPupilsupils
EE - - EEqualqual
AA - - AAndnd
RR - - RRoundound
RR - - RRegular in sizeegular in size
LL - React to - React to LLightight
Abnormal Pupil ReactionsAbnormal Pupil Reactions
Reassessment of Vital SignsReassessment of Vital Signs
The vital signs you obtain serve two The vital signs you obtain serve two important functions:important functions:
– First set establishes a baseline of respiratory First set establishes a baseline of respiratory and cardiovascular system statusand cardiovascular system status
– Serves as a key baseline Serves as a key baseline
The vital signs you obtain serve two The vital signs you obtain serve two important functions:important functions:
– First set establishes a baseline of respiratory First set establishes a baseline of respiratory and cardiovascular system statusand cardiovascular system status
– Serves as a key baseline Serves as a key baseline
Reassessment of Vital SignsReassessment of Vital Signs
Reassess Reassess stablestable patients every patients every 1515 minutes. minutes.
Reassess Reassess unstableunstable patients every patients every 55 minutes. minutes.
Reassess/record Reassess/record VS after all medical VS after all medical interventions. interventions.
Reassess Reassess stablestable patients every patients every 1515 minutes. minutes.
Reassess Reassess unstableunstable patients every patients every 55 minutes. minutes.
Reassess/record Reassess/record VS after all medical VS after all medical interventions. interventions.
EENT Disorders EENT Disorders
Eyes, Ears, Nose, and Throat disorders Eyes, Ears, Nose, and Throat disorders are commonly found during sick call and are commonly found during sick call and in the field, and medical personnel need in the field, and medical personnel need to be able to accurately assess patients to be able to accurately assess patients as well as treat them.as well as treat them.
Eyes, Ears, Nose, and Throat disorders Eyes, Ears, Nose, and Throat disorders are commonly found during sick call and are commonly found during sick call and in the field, and medical personnel need in the field, and medical personnel need to be able to accurately assess patients to be able to accurately assess patients as well as treat them.as well as treat them.
Lacrimal Glands
Sclera
1.
Pupil
Structures of the EyeIris
2.
3. 4.
6
5
7
8 9
10
Eye AnatomyEye Anatomy
ConjunctivaConjunctiva
ScleraSclera
RetinaRetina
Cornea Cornea . .
LensLens
IrisIris
PupilPupil
Lacrimal Lacrimal GlandsGlands
ConjunctivaConjunctiva
ScleraSclera
RetinaRetina
Cornea Cornea . .
LensLens
IrisIris
PupilPupil
Lacrimal Lacrimal GlandsGlands
Mucus membrane that lines the eyelidMucus membrane that lines the eyelid
White of the eyeWhite of the eye
Contains rods and conesContains rods and cones
Tough and Transparent Covers Pupil Tough and Transparent Covers Pupil and Irisand Iris
Adjusts focus of eyeAdjusts focus of eye
Controls light entering eyeControls light entering eye
Window of the eyeWindow of the eye
Moistens the eyeMoistens the eye
Assessment of Ocular ComplaintsAssessment of Ocular Complaints
Gathering the Patient’s History
MOI? Blunt trauma or penetrating trauma?
Glasses or contact lenses?
Eye disease or previous trauma/surgery?
Pain? Loss of Vision? One eye or both?
Gathering the Patient’s History
MOI? Blunt trauma or penetrating trauma?
Glasses or contact lenses?
Eye disease or previous trauma/surgery?
Pain? Loss of Vision? One eye or both?
Soldier vs crowbar Soldier vs aluminum shard
Assessment of Ocular ComplaintsAssessment of Ocular Complaints
Physical Examination
Visual Acuity Screening
What is one tool used to assess visual acuity?
Snellen Visual Acuity Test
You should complete a visual acuity screening on all patient’s with an ocular complaint except…
Ocular Burns
Physical Examination
Visual Acuity Screening
What is one tool used to assess visual acuity?
Snellen Visual Acuity Test
You should complete a visual acuity screening on all patient’s with an ocular complaint except…
Ocular Burns
Discuss: Discuss: Indication, Purpose and Procedure Indication, Purpose and Procedure for the for the
Snellen Visual Acuity Snellen Visual Acuity TestTest
Gross Vision ExaminationGross Vision ExaminationVisual Acuity testing can be conducted even
when equipment, lighting, space and environment are not “ideal”.
What other ways can vision be measured?
Near Card or Printed Material
Counting Fingers
Light / Dark Distinction
Visual Acuity testing can be conducted even when equipment, lighting, space and
environment are not “ideal”.
What other ways can vision be measured?
Near Card or Printed Material
Counting Fingers
Light / Dark Distinction
Near CardNear Card
What abnormalities do you see?What abnormalities do you see?
BLOOD IN THE ANTERIOR CHAMBERBLOOD IN THE ANTERIOR CHAMBER
What abnormalities do you see?What abnormalities do you see?
RED CONJUNCTIVA AND SCLERARED CONJUNCTIVA AND SCLERA
What abnormalities do you see?What abnormalities do you see?
UNEQUAL PUPILSUNEQUAL PUPILS
What abnormalities do you see?What abnormalities do you see?
LACERATION TO THE EYE LIDLACERATION TO THE EYE LID
Assessment of Ocular ComplaintsAssessment of Ocular Complaints
Physical Examination Con’t.
You have gathered a history and completed a visual acuity test.
What other parts of the eye should be assessed?
Eyelids – Conjunctiva – Sclera – Pupils
Note any abnormalities, drainage or bleeding
Physical Examination Con’t.
You have gathered a history and completed a visual acuity test.
What other parts of the eye should be assessed?
Eyelids – Conjunctiva – Sclera – Pupils
Note any abnormalities, drainage or bleeding
Eye ComplaintsEye Complaints
Loss of Vision
Eye Pain with Decrease in Vision
History of Trauma
What should you do with a patient that presents with a red flag?
Refer to medical officer
Loss of Vision
Eye Pain with Decrease in Vision
History of Trauma
What should you do with a patient that presents with a red flag?
Refer to medical officer
RED FLAGS
Common Eye ComplaintsCommon Eye Complaints
What is Red Eye?
A sign of many possible eye problems.
What are the possible causes of Red Eye?
Infection, Allergies, Drugs, Chemical Exposure, Trauma, Systematic Disease
What causes the “red” appearance?
Vascular dilation & engorgement of the sclera and conjunctiva.
What is Red Eye?
A sign of many possible eye problems.
What are the possible causes of Red Eye?
Infection, Allergies, Drugs, Chemical Exposure, Trauma, Systematic Disease
What causes the “red” appearance?
Vascular dilation & engorgement of the sclera and conjunctiva.
Red Eye Due to Infection
Red Eye Due to Chemical Burns
Examples of “Red Eye”Examples of “Red Eye”
What is the most common cause of red eye?Conjunctivitis
What is conjunctivitis?The sclera and conjunctivae are reddened. Clear watery (viral or allergy) or purulent (bacterial) discharge.
What are some of the Chief Complaints?
What is the most common cause of red eye?Conjunctivitis
What is conjunctivitis?The sclera and conjunctivae are reddened. Clear watery (viral or allergy) or purulent (bacterial) discharge.
What are some of the Chief Complaints?
Common Eye ComplaintsCommon Eye Complaints
• Eye Discharge
• Blurry Vision
• Grittiness
• Redness
• Burning
• Sneezing and Nasal Discharge(Allergic Conjunctivitis)
Bacterial ConjunctivitisBacterial Conjunctivitis
Usually starts in one eye, may spread to other eye
Sclera and conjunctivae are commonly reddened with a purulent (pus-like) discharge
Viral ConjunctivitisViral Conjunctivitis
Usually starts in one eye, may spread to other eye
Sclera and conjunctivae are commonly reddened with a clear, watery discharge
Check on your learning…Check on your learning…
When recording distant vision visual acuity, what does each number mean?
Distance away from Chart
Distance normal eye can read the line
What is the procedure for examining the conjunctiva? Normal findings?
Ask patient to look upward - you pull lower lid downward
Normal: Pink to dark pink color
Abnormal: erythema (redness) or exudates (pus)
When recording distant vision visual acuity, what does each number mean?
Distance away from Chart
Distance normal eye can read the line
What is the procedure for examining the conjunctiva? Normal findings?
Ask patient to look upward - you pull lower lid downward
Normal: Pink to dark pink color
Abnormal: erythema (redness) or exudates (pus)
20 200
Check on your learning…Check on your learning…Abbreviations for:
Right Eye
Left Eye
Both Eyes
What are the Red Flags of Eye Complaints?Loss of Vision
Eye Pain with Decrease in Vision
History of Trauma
Abbreviations for:
Right Eye
Left Eye
Both Eyes
What are the Red Flags of Eye Complaints?Loss of Vision
Eye Pain with Decrease in Vision
History of Trauma
O.D.
O.S.
O.U.
Structures of the EarStructures of the Ear
1
2
34
6
5
7
8
Ossicles of the Middle EarOssicles of the Middle Ear
Stapes
Incus (Anvil)
Malleus (Hammer)
The Eustachian TubeThe Eustachian Tube
Ear AnatomyEar Anatomy
Pinna (Auricle)
Eustachian Tube
External Auditory Canal (EAC)
Tympanic Membrane (TM)
Pinna (Auricle)
Eustachian Tube
External Auditory Canal (EAC)
Tympanic Membrane (TM)
External part of ear collects External part of ear collects fluid waves and directs into fluid waves and directs into the earthe ear
Drain middle ear into the Drain middle ear into the nasopharynxnasopharynx
Pathway from the external ear Pathway from the external ear to the tympanic membraneto the tympanic membrane
Ear Drum. Thin translucent Ear Drum. Thin translucent membranemembrane
Physical Exam of the EarPhysical Exam of the Ear
The AuricleInspect
Palpate
Inspect this patient.
What should be noted?
The AuricleInspect
Palpate
Inspect this patient.
What should be noted?
Physical Exam of the EarPhysical Exam of the Ear
External Auditory CanalInspect for discharge
What do you see in each of
these EACs?
External Auditory CanalInspect for discharge
What do you see in each of
these EACs?
Can you do any further inspection of
this ear?
What would you do next?
Physical Exam of the EarPhysical Exam of the Ear
The Otoscope
What is inspected?
EAC and TM
Use what sized speculum?
The largest the canal will
accommodate.
As you insert the speculum,
what should you look for?Discharges, Lesions, Narrowing of the EAC, Foreign
Bodies, Presence of Cerumen
The Otoscope
What is inspected?
EAC and TM
Use what sized speculum?
The largest the canal will
accommodate.
As you insert the speculum,
what should you look for?Discharges, Lesions, Narrowing of the EAC, Foreign
Bodies, Presence of Cerumen
Physical Exam of the EarPhysical Exam of the Ear
Tympanic Membrane This is what normal looks like
Tympanic Membrane This is what normal looks like
Physical Exam of the EarPhysical Exam of the Ear
Tympanic MembraneWhat abnormalities do you see?
Tympanic MembraneWhat abnormalities do you see?
Perforations Scarring
Physical Exam of the EarPhysical Exam of the EarTympanic Membrane
What abnormalities do you see?
Bubbles Air/Fluid Levels
Inner Ear ExamsInner Ear Exams
The inner ear is tested by evaluating the patient’s hearing.
What type of hearing test do you perform on the patient?
A gross hearing test.
Does the patient respond to your questions?
AND - Note patient’s balance.
The inner ear is tested by evaluating the patient’s hearing.
What type of hearing test do you perform on the patient?
A gross hearing test.
Does the patient respond to your questions?
AND - Note patient’s balance.
Ear ComplaintsEar Complaints
Fever of 101 degrees F or greater
Embedded Foreign Objects
What should you do with a patient who has a fever and complaining of ear pain?
Refer to medical officer
Fever of 101 degrees F or greater
Embedded Foreign Objects
What should you do with a patient who has a fever and complaining of ear pain?
Refer to medical officer
RED FLAGS
Common Ear ComplaintsCommon Ear Complaints
Cerumen (Ear Wax) Impaction Patient’s Chief Complaint? Hearing Loss Definition? Build up of ear wax Pain or No Pain? USUALLY pain is not present Cause? Natural by-product of the body
Ear Irrigation?Once the medic has been trained to irrigate by a medical
officer. Ear drops may be given to dissolve the wax.
Cerumen (Ear Wax) Impaction Patient’s Chief Complaint? Hearing Loss Definition? Build up of ear wax Pain or No Pain? USUALLY pain is not present Cause? Natural by-product of the body
Ear Irrigation?Once the medic has been trained to irrigate by a medical
officer. Ear drops may be given to dissolve the wax.
Otitis Externa (Swimmer’s Ear)Patient’s Chief Complaint?Pain, canal swelling, drainageDefinition?Inflammation/infection of external ear canalPain or No pain?Pain (maybe severe), increases with external ear movementCause?Bacterial or fungal (rare) infection
Medical Officer Referral?Refer. Medical Officer may recommend antibiotic/steroid
ear drops. Possibly Motrin for the pain.
Otitis Externa (Swimmer’s Ear)Patient’s Chief Complaint?Pain, canal swelling, drainageDefinition?Inflammation/infection of external ear canalPain or No pain?Pain (maybe severe), increases with external ear movementCause?Bacterial or fungal (rare) infection
Medical Officer Referral?Refer. Medical Officer may recommend antibiotic/steroid
ear drops. Possibly Motrin for the pain.
Common Ear ComplaintsCommon Ear Complaints
Common Ear ComplaintsCommon Ear ComplaintsOtitis Media
Patient’s Chief Complaint?Pain, fever, nasal congestion, cough
Definition?Middle Ear Infection
Pain or No pain?Yes and decreased hearing in affected ear
Refer?Yes.
Medical Officer may recommend antibiotics and/or decongestants.
Otitis Media
Patient’s Chief Complaint?Pain, fever, nasal congestion, cough
Definition?Middle Ear Infection
Pain or No pain?Yes and decreased hearing in affected ear
Refer?Yes.
Medical Officer may recommend antibiotics and/or decongestants.
Abnormal Foreign Body
Embedded Tic after removal by Medical Officer
Normal Tympanic MembraneNormal Tympanic Membrane
Abnormal – Ear Vs Pencil EraserAbnormal – Ear Vs Pencil Eraser
Check on your learning…Check on your learning…Patient c/o ear pain, especially upon touch.
He has a temperature of 99 degrees.
You inspect the ear and see…
What is the possible problem?
Otitis Externa
Should you irrigate?
Management?
Antibiotic/steroid ear drop
NSAID (Motrin) for the pain
Patient c/o ear pain, especially upon touch.
He has a temperature of 99 degrees.
You inspect the ear and see…
What is the possible problem?
Otitis Externa
Should you irrigate?
Management?
Antibiotic/steroid ear drop
NSAID (Motrin) for the pain
No
Check on your learning…Check on your learning…
Your patient complains of ear pain and decreased hearing. She has a fever of 102 degrees.
You inspect the ear and see…
What is the possible problem?Otitis Media
Viral or Bacteria?
Management?Refer to a Medical Officer for
oral antibiotics and decongestants.
Your patient complains of ear pain and decreased hearing. She has a fever of 102 degrees.
You inspect the ear and see…
What is the possible problem?Otitis Media
Viral or Bacteria?
Management?Refer to a Medical Officer for
oral antibiotics and decongestants.
Pus behind the ear drum
Structures of the NoseStructures of the Nose
Nare
Frontal
Maxilla
1
2
3
Structures of the SinuesStructures of the Sinues
1
2
3
Physical Exam of the NosePhysical Exam of the NoseInspect for Shape, Size, Symmetry, Color,
Presence of Deformities or Lesions.
Palpate for Tenderness, Swelling, Masses.
What do you see?
Inspect for Shape, Size, Symmetry, Color, Presence of Deformities or Lesions.
Palpate for Tenderness, Swelling, Masses.
What do you see?
Physical Exams of the Sinuses Physical Exams of the Sinuses
Which two sinuses are accessible for physical examination?
Maxillary and Frontal
Inspect for swelling
Palpate for tenderness
Which two sinuses are accessible for physical examination?
Maxillary and Frontal
Inspect for swelling
Palpate for tenderness
Sinus ComplaintsSinus Complaints
Fever of 101 degrees F or greater
What should you do with a patient who has a fever and complains of sinus pain?
Refer to a medical officer
Fever of 101 degrees F or greater
What should you do with a patient who has a fever and complains of sinus pain?
Refer to a medical officer
RED FLAGS
Common Complaints of the NoseCommon Complaints of the Nose
Epistaxis (ep-uh-stak-sis) Commonly known as?
Nosebleed
What are some common causes?External Trauma, Nose Picking,
Infection from Plucking Hairs, Vigorous Nose Blowing, Drying of Nasal Mucosa
Chronic nose bleeds could be early signs of what?
Hypertension (high blood pressure) or Blood Clotting Disorder
Epistaxis (ep-uh-stak-sis) Commonly known as?
Nosebleed
What are some common causes?External Trauma, Nose Picking,
Infection from Plucking Hairs, Vigorous Nose Blowing, Drying of Nasal Mucosa
Chronic nose bleeds could be early signs of what?
Hypertension (high blood pressure) or Blood Clotting Disorder
Epistaxis (ep-uh-stak-sis)What is your first priority?
Stop the Bleeding
Most cases should be treated how?Patient should sit up, lean forward, tip head down
Pinch entire nose firmly (10-15 min)
What if this doesn’t work?Use a vasoconstrictive spray (Afrin or NeoSynephrine)
If the patient has a history of nosebleeds, what else should be asked about?
Family History Medications (Aspirin, NSAIDs) History of Chronic Illnesses
Epistaxis (ep-uh-stak-sis)What is your first priority?
Stop the Bleeding
Most cases should be treated how?Patient should sit up, lean forward, tip head down
Pinch entire nose firmly (10-15 min)
What if this doesn’t work?Use a vasoconstrictive spray (Afrin or NeoSynephrine)
If the patient has a history of nosebleeds, what else should be asked about?
Family History Medications (Aspirin, NSAIDs) History of Chronic Illnesses
Common Complaints of the NoseCommon Complaints of the Nose
If yes, REFER
Common Complaints of the NoseCommon Complaints of the Nose
Allergies (Allergic Rhinitis or Hay Fever)What is Rhinitis?
Inflammation of the nasal membranes
Once the sensitized immune system releases histamines what symptoms are caused?
Itching, Swelling of Tissues, Mucus Production, Hives, Rashes
What is used to treat minor and severe nasal congestion?
Minor – Decongestant Severe – Nasal Decongestion Spray (Afrin)
Afrin use should not exceed 3 days
Allergies (Allergic Rhinitis or Hay Fever)What is Rhinitis?
Inflammation of the nasal membranes
Once the sensitized immune system releases histamines what symptoms are caused?
Itching, Swelling of Tissues, Mucus Production, Hives, Rashes
What is used to treat minor and severe nasal congestion?
Minor – Decongestant Severe – Nasal Decongestion Spray (Afrin)
Afrin use should not exceed 3 days
Common Sinus ComplaintsCommon Sinus Complaints
What causes sinus complaints?
Anything that interferes with airflow into the sinuses or mucus flow out
What could interfere with air or mucus flow?
Swelling Tissue, Tumors, Thickening of Mucus, Damage to Cilia
What causes sinus complaints?
Anything that interferes with airflow into the sinuses or mucus flow out
What could interfere with air or mucus flow?
Swelling Tissue, Tumors, Thickening of Mucus, Damage to Cilia
Common Sinus ComplaintsCommon Sinus Complaints
Acute Sinusitis
Definition?Inflammation/infection of paranasal sinuses
Bacterial – Viral – Allergic
Acute Sinusitis
Definition?Inflammation/infection of paranasal sinuses
Bacterial – Viral – Allergic
Common Sinus ComplaintsCommon Sinus Complaints
Acute Sinusitis (con’t.)
Patient’s Chief Complaint?Headache, Facial Tenderness, Fever (few), Nasal Discharge and Stuffiness, Sore Throat, Cough,
Itchy Eyes*, Sneezing*
*Allergic Sinusitis
Should this patient be referred to a medical officer?Yes
How should the patient be managed?Antibiotics and decongestants.
Patient should be educated to avoid antihistamines.
Acute Sinusitis (con’t.)
Patient’s Chief Complaint?Headache, Facial Tenderness, Fever (few), Nasal Discharge and Stuffiness, Sore Throat, Cough,
Itchy Eyes*, Sneezing*
*Allergic Sinusitis
Should this patient be referred to a medical officer?Yes
How should the patient be managed?Antibiotics and decongestants.
Patient should be educated to avoid antihistamines.
Check on your learning…Check on your learning…
A Soldier comes to you complaining of a nosebleed. What is your first priority?
What is the initial procedure?
A Soldier comes to you complaining of a nosebleed. What is your first priority?
What is the initial procedure?
Stop the Bleeding
Patient should sit up, lean forward, tip head down
Pinch entire nose firmly (10-15 min)
Check on your learning…Check on your learning…
Where should treatment for Allergic Rhinitis be aimed?
What is Sinusitis?
Where should treatment for Allergic Rhinitis be aimed?
What is Sinusitis?
Identification and avoidance Identification and avoidance of the offending allergen. of the offending allergen.
Inflammation/infection of the paranasal sinuses.Inflammation/infection of the paranasal sinuses.
Structures of the MouthStructures of the Mouth
Lips
Tongue
UvulaTonsils
Soft Palate
Hard Palate
TeethGums
1
2
3
4
5
6
7
8
Examination of the MouthExamination of the Mouth
LipsInspect and palpate for symmetry, color, edema
and abnormalities.
What do you see?
Examination of the Mouth Examination of the Mouth What is the procedure for examining the mucosa, teeth
and gums?
Patient is instructed to:Remove Dental Appliances Open MouthStick Out Tongue Say “Aaahhh”
Inspect with a Light and Tongue Depressor
WHAT ARE YOU LOOKING FOR?
Mouth and Throat ComplaintsMouth and Throat Complaints
RED FLAGS
Difficulty Breathing
Difficulty Swallowing
Fever of 101 degrees F or greater
Tonsillar Exudates
If a patient displays any of these signs or symptoms, what should you do?
Refer to a medical officer
Common Complaints of the ThroatCommon Complaints of the Throat
Upper Respiratory InfectionDefinition?
Acute viral infection of the upper airway
Patient’s Chief Complaints?
Sore Throat, Nasal Congestion/Discharge
Low-Grade Fever, Sinus Pressure
Signs and Symptoms
Sore Throat and/or Cough (Both productive or not/clear or purulent)
Upper Respiratory InfectionDefinition?
Acute viral infection of the upper airway
Patient’s Chief Complaints?
Sore Throat, Nasal Congestion/Discharge
Low-Grade Fever, Sinus Pressure
Signs and Symptoms
Sore Throat and/or Cough (Both productive or not/clear or purulent)
Upper Respiratory InfectionPhysical Examination
How will the Pharynx look?Slightly reddened and mucous streaked
Lungs?Clear
Vital Signs?Normal
(possible low-grade fever)
Upper Respiratory InfectionPhysical Examination
How will the Pharynx look?Slightly reddened and mucous streaked
Lungs?Clear
Vital Signs?Normal
(possible low-grade fever)
Common Complaints of the ThroatCommon Complaints of the Throat
Upper Respiratory Infection
Treatment is based on symptoms.Cough Suppressants, Decongestants,
Throat Lozenges,
Acetaminophen for fever and body aches
Are antibiotics indicated?
No
Upper Respiratory Infection
Treatment is based on symptoms.Cough Suppressants, Decongestants,
Throat Lozenges,
Acetaminophen for fever and body aches
Are antibiotics indicated?
No
Common Complaints of the ThroatCommon Complaints of the Throat
Streptococcal Pharyngitis (Strep)Definition?Infection of the Posterior Pharynx and/or Tonsils
Common Cause?Group A Streptococcus bacteria
Patient’s Chief Complaint?Sore Throat, Fever
Signs / Symptoms?Sudden Onset of Severe Sore Throat, Fever,
Tender/Swollen Neck Glands, Exudate (pus) on Reddened Tonsils and Pharynx
Streptococcal Pharyngitis (Strep)Definition?Infection of the Posterior Pharynx and/or Tonsils
Common Cause?Group A Streptococcus bacteria
Patient’s Chief Complaint?Sore Throat, Fever
Signs / Symptoms?Sudden Onset of Severe Sore Throat, Fever,
Tender/Swollen Neck Glands, Exudate (pus) on Reddened Tonsils and Pharynx
Common Complaints of the ThroatCommon Complaints of the Throat
Streptococcal Pharyngitis (Strep)
Referral to a Medical Officer?
Yes
Management?
Antibiotics (Penicillin)
Streptococcal Pharyngitis (Strep)
Referral to a Medical Officer?
Yes
Management?
Antibiotics (Penicillin)
Common Complaints of the ThroatCommon Complaints of the Throat
Peri-tonsillar Abscess (PTA)Definition?
Bacterial infection of the tonsils.
Spreads into a cellulitis and abscess.
Common Cause?Complication of Strep
Chief Complaint?Severe Sore Throat, Pain/Difficulty Swallowing
Peri-tonsillar Abscess (PTA)Definition?
Bacterial infection of the tonsils.
Spreads into a cellulitis and abscess.
Common Cause?Complication of Strep
Chief Complaint?Severe Sore Throat, Pain/Difficulty Swallowing
Common Complaints of the Throat
Signs / Symptoms?Trismus*, Fever
(*difficulty opening the mouth)
Management?Surgical Drainage
Antibiotics
Referral?Immediate referral.
This is a surgical emergency
Signs / Symptoms?Trismus*, Fever
(*difficulty opening the mouth)
Management?Surgical Drainage
Antibiotics
Referral?Immediate referral.
This is a surgical emergency
Common Complaints of the ThroatCommon Complaints of the Throat
Peri-tonsillar Abscess (PTA)
Usually affects one side
Mononucleosis (Mono)
Definition and Cause?
Viral infection
Chief Complaint?
Sore Throat, Fatigue
Signs / Symptoms?
Lymph Node Enlargement
Abdominal Pain
Mononucleosis (Mono)
Definition and Cause?
Viral infection
Chief Complaint?
Sore Throat, Fatigue
Signs / Symptoms?
Lymph Node Enlargement
Abdominal Pain
Common Complaints of the ThroatCommon Complaints of the Throat
Infected Tonsils
Uvula
10 year old with massive tonsillar enlargement from Mono
Mononucleosis (Mono)Management?
Blood test (to confirm Mono)
Throat Culture (to rule out strep)
No contact sports/activity for a min. of 30 days
Treat the symptoms:
throat lozenges, acetaminophen, decongestants,
oral steroids
Referral?Yes
Mononucleosis (Mono)Management?
Blood test (to confirm Mono)
Throat Culture (to rule out strep)
No contact sports/activity for a min. of 30 days
Treat the symptoms:
throat lozenges, acetaminophen, decongestants,
oral steroids
Referral?Yes
Common Complaints of the ThroatCommon Complaints of the Throat
Checking on your learning…Checking on your learning…
What are the RED FLAGSRED FLAGS of Throat Complaints?
Difficulty Breathing
Difficulty Swallowing
Fever of 101 degrees F
Tonsillar Exudates
What are the RED FLAGSRED FLAGS of Throat Complaints?
Difficulty Breathing
Difficulty Swallowing
Fever of 101 degrees F
Tonsillar Exudates
Checking on your learning…Checking on your learning…
Your patient complains of a sore throat and
difficulty swallowing.You complete a physical
exam of the patient and note he has a fever and see the following when you inspect his mouth.
What do you think the problem may be?
Would you refer this patient and why?
Your patient complains of a sore throat and
difficulty swallowing.You complete a physical
exam of the patient and note he has a fever and see the following when you inspect his mouth.
What do you think the problem may be?
Would you refer this patient and why? Yes – PTAs commonly require
surgical drainage and antibiotics
Peri-tonsillar Abscess (PTA)
SummarySummary
What are the RED FLAGSRED FLAGS of Ocular Complaints?
Loss of Vision
Eye Pain with Decrease in Vision
History of Trauma
Common Ocular Complaints?Red Eye
Conjunctivitis
What are the RED FLAGSRED FLAGS of Ocular Complaints?
Loss of Vision
Eye Pain with Decrease in Vision
History of Trauma
Common Ocular Complaints?Red Eye
Conjunctivitis
SummarySummary
What are the RED FLAGSRED FLAGS of Ear Complaints?
Fever of 101 degrees F or greater
Embedded Foreign Objects
Common Ear Complaints?Cerumen Impaction
Otitis Externa (Swimmers’ Ear)
Otitis Media
What are the RED FLAGSRED FLAGS of Ear Complaints?
Fever of 101 degrees F or greater
Embedded Foreign Objects
Common Ear Complaints?Cerumen Impaction
Otitis Externa (Swimmers’ Ear)
Otitis Media
SummarySummary
What are the RED FLAGSRED FLAGS of Sinus Complaints?
Fever of 101 degrees F or greater
Common Nose and Sinus Complaints?Epistaxis
Allergies (Allergic Rhinitis or Hay Fever)
Acute Sinusitis
What are the RED FLAGSRED FLAGS of Sinus Complaints?
Fever of 101 degrees F or greater
Common Nose and Sinus Complaints?Epistaxis
Allergies (Allergic Rhinitis or Hay Fever)
Acute Sinusitis
SummarySummary
What are the RED FLAGSRED FLAGS of Mouth Complaints?
Difficulty BreathingDifficulty Swallowing
Fever of 101 degrees F or greaterTonsillar Exudates
Common Complaints of the Mouth and Throat?
URI MonoStrep PTA
What are the RED FLAGSRED FLAGS of Mouth Complaints?
Difficulty BreathingDifficulty Swallowing
Fever of 101 degrees F or greaterTonsillar Exudates
Common Complaints of the Mouth and Throat?
URI MonoStrep PTA
Questions?Questions?Questions?Questions?