ch02b - Chapter 2, Part 2 The Musculoskeletal System...

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Unformatted text preview: Chapter 2, Part 2 The Musculoskeletal System Bledsoe et al., Paramedic Care Principles & Topics Techniques of Inspection, Palpation, Auscultation, and Percussion Evaluation of Mental Status Examination of the Body Regions Special Considerations Bledsoe et al., Paramedic Care Principles & Musculoskeletal System Consists of 206 bones and associated muscles, tendons, ligaments, and cartilage Bledsoe et al., Paramedic Care Principles & Interaction of Bone, Muscle, and Tendon Bledsoe et al., Paramedic Care Principles & Types of Joints Bledsoe et al., Paramedic Care Principles & A Synovial Joint Bledsoe et al., Paramedic Care Principles & General Approach History Inspection Range of motion (ROM) Palpation Muscular and neurological exams Bledsoe et al., Paramedic Care Principles & History An accurate history is essential. How symptoms started (mechanism of injury)? Duration of complaint? Location, nature of pain, or symptoms? Exacerbating or relieving maneuvers? Bledsoe et al., Paramedic Care Principles & General Inspection Observe how the patient moves as he goes into the room or moves to stretcher. General appearance. Body proportions. Bledsoe et al., Paramedic Care Principles & Examination of the Musculoskeletal System Observe, inspect, and palpate the joints, structure, and movement. Note: – – – – – Pain Swelling Deformity Symmetry Tissue changes – Compare strength – Range of motion – Crepitus Bledsoe et al., Paramedic Care Principles & Range of Motion (Active) Have patient position the joints. Watch for decreased or increased movement of the joint compared to the other side as well as the norm. Watch for pain with movement. Listen for crepitus or “popping.” Watch for abnormal movements. Bledsoe et al., Paramedic Care Principles & Range of Motion (Passive) Next position the joints passively, comparing the end points to the active. Note any decrease or increase in movement. Note pain with the movement. Listen for crepitus or “popping.” Bledsoe et al., Paramedic Care Principles & Palpation Palpate for swelling. Palpate for warmth. Palpate each area of the structure in turn, evaluating for pain and abnormalities as compared to the other side. Bledsoe et al., Paramedic Care Principles & The Extremities A complete examination of the extremities includes wrists and hands, elbows, shoulders, ankles and feet, knees, and hips. Bledsoe et al., Paramedic Care Principles & Bones and Joints of the Hand and Wrist Bledsoe et al., Paramedic Care Principles & Muscles of the Arm Bledsoe et al., Paramedic Care Principles & The Elbow Bledsoe et al., Paramedic Care Principles & Elbow Flexors Bledsoe et al., Paramedic Care Principles & Examining the Wrist and Hand Bledsoe et al., Paramedic Care Principles & Wrist and Hand Inspect for swelling or deformities. Palpate: anatomic snuff box, volar and dorsal aspects of the wrist, all joints of the fingers. Asses flexion, extension, ulnar and radial deviation of the wrist. Have patient make a fist and extend and spread the fingers. Bledsoe et al., Paramedic Care Principles & Nerves of the Hand Ulnar Radial Median Palmar branch of the median Bledsoe et al., Paramedic Care Principles & Palpate the DIP joint. Bledsoe et al., Paramedic Care Principles & Palpate the MCP. Bledsoe et al., Paramedic Care Principles & Palpate the wrist. Bledsoe et al., Paramedic Care Principles & Assess wrist flexion and extension. Bledsoe et al., Paramedic Care Principles & Test for carpal tunnel syndrome. Bledsoe et al., Paramedic Care Principles & Examining the Elbow Bledsoe et al., Paramedic Care Principles & The Elbow Palpation: lateral and medial epicondyles, olecranon, radial head, groove on either side of the olecranon. Inspect the carrying angle, and any nodules or swelling. Bledsoe et al., Paramedic Care Principles & Palpate the lateral and medial epicondyles. Bledsoe et al., Paramedic Care Principles & Assess elbow flexion and extension. Bledsoe et al., Paramedic Care Principles & Assess supination and pronation of the wrist. Bledsoe et al., Paramedic Care Principles & Elbow Extensors Bledsoe et al., Paramedic Care Principles & Pronator-Supinator Muscles Bledsoe et al., Paramedic Care Principles & Examining the Shoulder Bledsoe et al., Paramedic Care Principles & The Shoulder Joints of the shoulder – Glenohumeral – Sternoclavicular – Acromioclavicular Bledsoe et al., Paramedic Care Principles & The Shoulder Girdle Bledsoe et al., Paramedic Care Principles & Shoulder Girdle Ligaments Bledsoe et al., Paramedic Care Principles & Shoulder Muscles Rotator cuff: – – – – Supraspinatus Infraspinatus Teres minor Subscapularis Bledsoe et al., Paramedic Care Principles & Shoulder Exam Inspection Palpation Passive range of motion Active range of motion – Appley scratch test for internal/external rotation Impingement signs Biceps tendonitis/crossarm adduction/apprehension Neck exam: compression test Adson’s manuever Bledsoe et al., Paramedic Care Principles & Shoulder Palpation of the shoulder includes: Have patient place each hand: – Sternoclavicular joint – Acromioclavicular joint – Subacromial area – Bicipital groove – Muscles of the scapula – Behind head (external rotation and abduction) – Up the small of the back (internal rotation) Bledsoe et al., Paramedic Care Principles & Palpate the shoulder with your fingertips. Bledsoe et al., Paramedic Care Principles & Assess shoulder flexion and extension. Bledsoe et al., Paramedic Care Principles & Assess shoulder abduction and adduction. Bledsoe et al., Paramedic Care Principles & Assess internal and external shoulder rotation. Bledsoe et al., Paramedic Care Principles & Bones of the Foot Bledsoe et al., Paramedic Care Principles & The Plantar Flexors Bledsoe et al., Paramedic Care Principles & Examining the Ankle and Foot Bledsoe et al., Paramedic Care Principles & Palpate the ankle and foot. Bledsoe et al., Paramedic Care Principles & Palpate the metatarsal-phalangeal joints. Bledsoe et al., Paramedic Care Principles & Assess dorsiflexion and plantar flexion. Bledsoe et al., Paramedic Care Principles & Assess inversion and eversion of the foot. Bledsoe et al., Paramedic Care Principles & Test flexion and extension of the toes. Bledsoe et al., Paramedic Care Principles & The Knee Bledsoe et al., Paramedic Care Principles & The Knee Flexors Bledsoe et al., Paramedic Care Principles & The Knee Extensors (The vastus intermedius is behind the rectus femoris.) Bledsoe et al., Paramedic Care Principles & The Hip Joint Bledsoe et al., Paramedic Care Principles & The Hip Flexors Bledsoe et al., Paramedic Care Principles & Examining the Knee Bledsoe et al., Paramedic Care Principles & Palpate the knee. Bledsoe et al., Paramedic Care Principles & Palpate the patella. Bledsoe et al., Paramedic Care Principles & Test the collateral ligament of the knee. Bledsoe et al., Paramedic Care Principles & Test the cruciate ligaments of the knee. Bledsoe et al., Paramedic Care Principles & Assess flexion and extension. Bledsoe et al., Paramedic Care Principles & Examining the Hip Bledsoe et al., Paramedic Care Principles & Palpate the hip. Bledsoe et al., Paramedic Care Principles & Assess hip flexion with the knee flexion. Bledsoe et al., Paramedic Care Principles & Assess external and internal rotation of the hip. Bledsoe et al., Paramedic Care Principles & Assess hip abduction and adduction. Bledsoe et al., Paramedic Care Principles & The Gluteus Muscles Bledsoe et al., Paramedic Care Principles & The Spinal Column Bledsoe et al., Paramedic Care Principles & The Vertebrae Bledsoe et al., Paramedic Care Principles & Spinal Curvatures Bledsoe et al., Paramedic Care Principles & Assessing the Spine Bledsoe et al., Paramedic Care Principles & Palpate the spine. Bledsoe et al., Paramedic Care Principles & Test flexion and extension of the head and neck. Bledsoe et al., Paramedic Care Principles & Test rotation of the head and neck. Bledsoe et al., Paramedic Care Principles & Assess lateral bending of the head and neck. Bledsoe et al., Paramedic Care Principles & Assess flexion of the lower spine. Bledsoe et al., Paramedic Care Principles & Assess lateral bending of the lower spine. Bledsoe et al., Paramedic Care Principles & Assess spinal extension. Bledsoe et al., Paramedic Care Principles & Assess spinal rotation. Bledsoe et al., Paramedic Care Principles & The Peripheral Vascular System The peripheral vascular system delivers oxygenated blood to the tissues of the extremities. Bledsoe et al., Paramedic Care Principles & The Circulatory System Bledsoe et al., Paramedic Care Principles & The Lymphatic System Bledsoe et al., Paramedic Care Principles & Assessing a Peripheral Pulse Bledsoe et al., Paramedic Care Principles & Assessing the Peripheral Vascular System Bledsoe et al., Paramedic Care Principles & Palpate the radial artery. Bledsoe et al., Paramedic Care Principles & Palpate the brachial artery. Bledsoe et al., Paramedic Care Principles & Palpate and compare the femoral arteries. Bledsoe et al., Paramedic Care Principles & Palpate the popliteal pulse. Bledsoe et al., Paramedic Care Principles & Palpate the dorsalis pedis pulse. Bledsoe et al., Paramedic Care Principles & Palpate the posterior tibial pulse. Bledsoe et al., Paramedic Care Principles & Palpate for edema. Bledsoe et al., Paramedic Care Principles & Assessing for Edema Bledsoe et al., Paramedic Care Principles & Pitting Edema Scale Bledsoe et al., Paramedic Care Principles & The Nervous System A neurological exam attempts to answer the following questions: 1. Are the findings symmetrical or unilateral? 2. If unilateral, where do they originate? Bledsoe et al., Paramedic Care Principles & Five Areas of Neurological Exam Mental status and speech Cranial nerves Motor system Sensory system Reflexes Bledsoe et al., Paramedic Care Principles & The Brain Bledsoe et al., Paramedic Care Principles & The Cerebrum Bledsoe et al., Paramedic Care Principles & Posture and Behavior Bledsoe et al., Paramedic Care Principles & The Cranial Nerves Bledsoe et al., Paramedic Care Principles & The Olfactory Nerve Bledsoe et al., Paramedic Care Principles & The Optic Nerve Bledsoe et al., Paramedic Care Principles & The Oculomotor, Abducens, and Trochlear Nerves Bledsoe et al., Paramedic Care Principles & The Trigeminal Nerve Bledsoe et al., Paramedic Care Principles & The Facial Nerve Bledsoe et al., Paramedic Care Principles & The Acoustic Nerve Bledsoe et al., Paramedic Care Principles & The Glossopharyngeal Nerve Bledsoe et al., Paramedic Care Principles & The Vagus Nerve Bledsoe et al., Paramedic Care Principles & The Accessory and Hypoglossal Nerves Bledsoe et al., Paramedic Care Principles & Cranial Nerves Bledsoe et al., Paramedic Care Principles & Assessing the Cranial Nerves Bledsoe et al., Paramedic Care Principles & Test the olfactory nerve by having your patient identify common odors. Bledsoe et al., Paramedic Care Principles & Test the oculomotor, trochlear, and abducens nerves by evaluating your patient's extraocular movements. Bledsoe et al., Paramedic Care Principles & Test motor function of the trigeminal nerve by palpating the temporal and masseter muscles. Bledsoe et al., Paramedic Care Principles & Test sensory function of the trigeminal nerve with sharp and dull objects. Bledsoe et al., Paramedic Care Principles & Test the glossopharyngeal and vagus nerves with a tongue blade. Bledsoe et al., Paramedic Care Principles & Test the spinal accessory nerve by having your patient shrug her shoulders against resistance. Bledsoe et al., Paramedic Care Principles & The Peripheral Nerves Bledsoe et al., Paramedic Care Principles & Muscle Tone Bledsoe et al., Paramedic Care Principles & Muscle Strength Tests Bledsoe et al., Paramedic Care Principles & Assessing the Motor System Bledsoe et al., Paramedic Care Principles & Assess the elbow’s range of motion. Bledsoe et al., Paramedic Care Principles & Test your patient’s grip. Bledsoe et al., Paramedic Care Principles & Test arm strength. Bledsoe et al., Paramedic Care Principles & Test for pronator drift. Bledsoe et al., Paramedic Care Principles & Test for coordination with rapid alternating movements. Bledsoe et al., Paramedic Care Principles & Test coordination with point-to-point testing. Bledsoe et al., Paramedic Care Principles & Assess coordination with heel-toshin testing. Bledsoe et al., Paramedic Care Principles & Muscle Strength Scale Bledsoe et al., Paramedic Care Principles & Dermatome Chart Knowing basic landmarks enables you to locate spinal cord lesions. Bledsoe et al., Paramedic Care Principles & Test vibration sense with a tuning fork. Bledsoe et al., Paramedic Care Principles & A reflex arc depicts muscle tension over time. Bledsoe et al., Paramedic Care Principles & Reflex Scale Bledsoe et al., Paramedic Care Principles & Reflex figures show grade on a scale of 0 to 4+. Bledsoe et al., Paramedic Care Principles & Testing the Reflexes Bledsoe et al., Paramedic Care Principles & Test the biceps reflex (cervical nerves C5 and C6). Bledsoe et al., Paramedic Care Principles & Test the triceps reflex (cervical nerves C6, C7, and C8). Bledsoe et al., Paramedic Care Principles & Test the brachioradialis reflex (cervical nerves C5 and C6). Bledsoe et al., Paramedic Care Principles & Test the quadriceps reflex (lumbar nerves L2, L3, and L4). Bledsoe et al., Paramedic Care Principles & Test the Achilles reflex (sacral nerves S1 and S2). Bledsoe et al., Paramedic Care Principles & Test the plantar reflex (central nervous system). Bledsoe et al., Paramedic Care Principles & Test abdominal reflexes (thoracic nerves T8, T9, T10, T11, and T12). Bledsoe et al., Paramedic Care Principles & Pediatric Physical Exam Techniques Bledsoe et al., Paramedic Care Principles & Introduction Specific techniques same as adult – – – – Inspection Palpation Percussion Auscultation Bledsoe et al., Paramedic Care Principles & Physical Examination of Infants and Children Children are not just small adults and you cannot treat them as if they are. Different age groups have specific fears and characteristics. Position yourself at the child’s level, use a soft voice, and smile a lot. Bledsoe et al., Paramedic Care Principles & Infants (newborn to 1 year) Bledsoe et al., Paramedic Care Principles & Have parents hold young children while you examine them. Bledsoe et al., Paramedic Care Principles & Toddler (1–3 years) Bledsoe et al., Paramedic Care Principles & Preschooler (3–6 years) Bledsoe et al., Paramedic Care Principles & School Age (6–12 years) Bledsoe et al., Paramedic Care Principles & Adolescent (13–18 years) Bledsoe et al., Paramedic Care Principles & Pediatric Anatomy and Physiology Bledsoe et al., Paramedic Care Principles & Fontanelles of the Infant’s Skull Bledsoe et al., Paramedic Care Principles & General Impression Skin Respiration Hydration Mental status Cry and social interaction Psychosocial conditions – Behavior – Development – Relationship to parent and examiner and general condition Bledsoe et al., Paramedic Care Principles & Head, Eyes, and Ears Fontanelles: – Fullness – Turgor Head size and shape. Assess eyes for red light reflex. Assess hydration of the mucous membranes. Examine the tympanic membranes. Bledsoe et al., Paramedic Care Principles & Neck Short in infancy Nuchal rigidity in meningitis Clavicles – fracture Bledsoe et al., Paramedic Care Principles & Normal Vital Signs for Various Pediatric Age Groups Bledsoe et al., Paramedic Care Principles & Auscultation – Lungs Bell or diaphragm Breath sounds harsher in infants and young children Distinguish lower from transmitted upper airway sounds Abnormalities – – – – – Decreased sounds Rales Wheeze Stridor Rate Place the stethoscope along the young patient’s mid-axillary line. Bledsoe et al., Paramedic Care Principles & Auscultation – Cardiac Apical pulse S3 common Functional murmur in 1/2 to 2/3 – No cardiac symptoms – Change with position Still’s murmur louder when supine Venous hum disappears when supine – Systolic – never diastolic Bledsoe et al., Paramedic Care Principles & Perfusion Assess capillary refill. Sinus arrhythmia common. Premature ventricular contractions common. Bledsoe et al., Paramedic Care Principles & Gradually increase the pressure when palpating a young patient’s abdomen. Bledsoe et al., Paramedic Care Principles & Abdomen Warm hands; palpate gently. If abdomen tense, try flexing legs at hip. Palpate for tenderness and masses. If newborn, evaluate number of umbilical vessels. Bledsoe et al., Paramedic Care Principles & The most important characteristic of a physical assessment is thoroughness. Bledsoe et al., Paramedic Care Principles & Recording Examination Findings After you perform the history and physical examination, it is time to record the findings on your patient’s chart or permanent medical record. The patient record is only as good as the accuracy, depth, and detail you provide. Bledsoe et al., Paramedic Care Principles & Patient Screening Report (1 of 3) Bledsoe et al., Paramedic Care Principles & Patient Screening Report (2 of 3) Bledsoe et al., Paramedic Care Principles & Patient Screening Report (3 of 3) Bledsoe et al., Paramedic Care Principles & Summary Techniques of Inspection, Palpation, Auscultation, and Percussion Evaluation of Mental Status Examination of the Body Regions Special Considerations Bledsoe et al., Paramedic Care Principles & ...
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This note was uploaded on 03/25/2010 for the course PAR 100 taught by Professor Alan during the Spring '10 term at Miramar College.

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