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21 Cards in this Set
- Front
- Back
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Generic approach |
Listen to intro Wash hands don gown Make sure lights are up Environment Phys exam Obs / invx Presentation |
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Environment |
Monitors - Read numbers out Ventilator - or ask for mode, io2, peep urine - ask for last 12 h hourly output Chest, abdo etc drains - ask for last 24h output Dialysis - what dose, anticoagulent, probs ECMO - VA or VV, flow rates, gas flow, probs IABP Infusions - including labels on fluid bags EVD - height and whats draining (blood) |
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Phys exam intro |
Ask examiner may I move and expose the patient Cachexia, jaundice, trauma muscle wasting chest flail scars |
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Phys exam GCS |
Open your eyes please Grab hands 'Hello open your eyes' 'Can I administer a nailbed pressure?' |
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Hand / Nail / Pulse / A-line |
Warm? Clubbing / beau / leukonykia / splinter haem / nicotine stains Hand deformities RA / OA Compare radial pulses and look at a-line trace
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Upper Limbs |
Tone Asterixis / pronator drift Lymph nodes, ACF multiple lines, fistula Scars |
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Neck |
Is there a CVP? dont look for veins Tracheostomy Lymph nodes Thyroid gland |
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Quick Cranial nerve test |
Hello whats your date of birth corneal reflex follow my finger, tell me if see double Can you feel here, here, here open eyes, clench jaw Open mouth - deviated uvula / tongue Shrug shoulders |
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Chest |
Observe and palpate quickly Auscultate apex then bases |
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Praecordium |
Briefly tap out then auscultate apex / left / right sternal edge, carotids |
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Abdomen |
Observe, 'Whats under the dressings' Palpate quadrants, liver, spleen, kidneys Percuss if ascites Auscultate |
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Groin |
Lines (Why the vascath / PICCO / groin access? PR - Melaena? tone? prostate? Pressure areas? |
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Lower Limbs |
Fully expose - remove SCDs Warm? Muscle wasting of quads Tender calfs Tone - lift briskly from knee |
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Feet |
Warm. Oedema. Neuropathic joints. Babinski Clonus
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Neuro - lower limb |
Ankle up and down. Knee flex / straight. Hip Up / down / ad / abduct |
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Neuro - Upper limb |
Wrist plantar / dorsi Elbow straight / flex Shoulder ab / adduct |
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Sensory levels arm |
* Medial forearm (T1)
* Pinky finger (C8) * Middle finger (C7) * Thumb (C6) * Lateral forearm (C5) * Posterior shoulder (C4) |
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Sensory levels leg |
* Sole of the foot (S1)
* Lateral lower leg (L5) * Medial lower leg (L4) * Medial knee (L3) * Anterior upper quads (L2) |
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Always ask for these invx |
FBC U+E (Routine bloods) ABG Urinalysis Microbiology Trop / Amylase / BNP CXR ECG |
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Case presentation |
He is suffering from ..... I think this because ...... I would like to confirm by seeing ..... Management issues are ...... I would address these by ...... |
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Case presentation if no clue |
”This is a complex case and I’m not certain of the diagnosis." "I note the following organ failures: "I have identified clinical findings which support this hypothesis: namely, "The possible aetiologies responsible for this presentation could include "In order to discriminate between these differentials, I would like to perform the following investigations: "Furthermore, I would like to enlist the help of the following specialties , for whom I will have the following specific requests/questions: |
