Physical Assessment - DCAP BTLS

RoadZOmbie

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Hello everyone!!

I need a bit of help here. Can anyone help me understand exactly what to look for other than DCAP BTLS in each part of the body? Like when assessing the head I'm checking for DCAP BTLS, Battles Sign, CSF bleeding etc etc. Then what to look for in the neck, chest etc. Thanks!!
 
Um, that is an enormous amount of information. Maybe look into getting a good physical exam text book and studying that?
 
If it doesn't look normal, you probably found it.


Neck-- JVD, tracheal deviation
Chest-- flail segment

Crepitus, petechia, other skin things. (Legit medical term-- "skin things")... really just way too much to put in to here.
 
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As has been said, covering such a topic is way too much for a forum.

My one recommendation is to make the most of your time in clinicals and such and listen to breath sounds, palpate abdomens, get as much hands on time as you possibly can... in the hospital you might actually the chance to actually place your stethoscope on someone's chest and have an MD tell you "this is what rales sound like..."

Even if you don't get to hear/see/touch abnormal... the more you start learning what's normal... the easier it is to recognize what's not normal. You may not even initially be able to understand what is going on... but at least you'll get that "hmm something's wrong here" sensation.

Take blood pressures and listen to breath sounds and such outside of class too, as much as you can. On your grandma too... I feel like a common problem people face coming out in to the real world is they get so used to taking blood pressure and such on their healthy, young classmates they get all fumble-f***** when they have to take a BP on an older lady with skinny arms and lots of extra skin for the first time in the field.
 
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Doesn't the EMT-B text book explain all this?
 
Thanks for the info. The book explains most of it but just wanted to get some feedback on what if any tips you used to help you remember what to look for.
 
Shoot, we have to do 30 hours of clinical. Once a week, 3 hours a session.
 
If you have the patient trauma assessment sheet that is used for the practical NREMT, It lists the highlights that should be assessed.


Your basically just looking for DCAP-BTLS. The mnemonic is used to help identify what to look for. Your essentially just palpating the various regions of the body. Starting with the head, you palpate the scalp and facial areas, note any CSF or drainage, moving on to the neck looking for JVD/Tracheal Deviation/Subcutaneous emphysema, step offs of the spine, etc. Moving on to the chest- Auscultating/palpating, then to the abdomen, pelvis, extremities, etc.
 
My advice is not to "look" for anything but see what is there, when you start "looking" for only certian things you run the risk of excluding what is important because it wasn't on your list of things to look for.
 
http://www.amazon.com/Physical-Examination-Extremities-Stanley-Hoppenfeld/dp/0838578535I'm a fan of the Hoppenfeld book myself, but it only deals with ortho stuff. It does, however, provide a good understanding about what the structures are that you're palpating during the exam. The one BIG problem with that book is that it introduces special tests that are beyond the scope of prehospital providers. I can't imagine a Paramedic needing to do a Lachman's or check for GH joint instability in the normal course of work. ;)

DCAP-BTLS is simply a "device" to remind you about what you're looking for during that trauma exam. While I forget the specifics of the mnemonic, I check for all those things when I examine someone. I use my eyes, ears, hands...

Once you get used to doing that exam, it only takes a couple minutes at most to do it. I found that verbalizing everything I'm doing actually slows me way down. It takes me about a minute to do it that way. If I'm not verbalizing and just "doing", it only takes me about 30 seconds to do. It's not that I'm just speedy at it, it's that I've done a LOT of them over the past 18-20 years. I know what I'm "looking" for and I have a pattern that I follow EVERY time I do it. It's close to, not exactly, the same sequence you're learning.

For purposes of testing, VERBALIZE the steps as you're doing them and verbalize during the skills test. Your proctor NEEDS to hear you say what you're checking for, otherwise your proctor won't know that...
 
My advice is not to "look" for anything but see what is there, when you start "looking" for only certian things you run the risk of excluding what is important because it wasn't on your list of things to look for.

That leaves too many occult findings unchecked in my not always humble opinon.

I like exam by regional anatomy or system based, depending on the complaint.
 
Had a ganda at Bates a while back. Twas alright. It definitely had some gems (I particularly liked the stuff about pulse quality), but it was in amongst what seemed like an awful lot of fairly useless chatter.

Any other PE and Hx books I wanna look at while we've got a new thread open about the topic?
 
Ok, Here ya go. Hope this helps.

D- Deformity
C- Contusions
A- Abrasions
P- Punctures

B-Burns
T-Tenderness
L-Lacerations
S-Swelling

Head and Face:

Observe and palpate skull (anterior and posterior) and face for DCAP-BTLS;
Check eyes for equality, responsiveness of pupils, movement and size of
pupils, foreign bodies, discoloration, contact lenses or prosthetic eyes;
Check nose and ears for foreign bodies, fluid or blood;
Recheck mouth for potential airway obstructions (swelling, dentures, bleeding,loose or avulsed teeth, vomit, absent or present gag reflex) and odors, altered voice or speech patterns and evidence of dehydration.

Neck:

Observe and palpate for DCAP-BTLS, jugular vein distension, use of neck
muscles for breathing, tracheal tugging, tracheal shift, stoma and medical
information medallions.

Chest:

Observe and palpate for DCAP-BTLS, scars, implanted devices such as
pacemakers and indwelling IV/arterial catheters, medication patches, chest wallmovement, asymmetry and accessory muscle use in breathing;

Have patient take a deep breath if possible and observe and palpate for signs
of discomfort, asymmetry and air leak from any wound.

Abdomen:
Observe and palpate for DCAP-BTLS, scars and distention;
Palpation should occur in all four quadrants taking special note of tenderness,
masses and rigidity.

Pelvis/Genital-Urinary:

Generally, a patient’s genital area should not be exposed and examined unless
the assessment of this body region is required due to the patient’s condition,
such as trauma to the region, active labor or suspected/knownbleeding.When
possible have an EMT of the same gender as the patient perform evaluations ofthe pelvis/genital area.

Observe and palpate for DCAP-BTLS, asymmetry, sacral edema and as
indicated for other abnormalities; Palpate and gently compress lateral pelvic rims and symphysis pubis for tenderness, crepitus or instability; Palpate for bilateral femoral masses, if warranted.

Shoulder and Upper Extremities:

Observe and palpate for DCAP-BTLS, asymmetry, skin color, capillary refill,
edema, medical information bracelet, and equality of distal pulses;
Assess sensory and motor function as indicated

Lower Extremities:

Observe and palpate for DCAP-BTLS, asymmetry, skin color, capillary refill,
edema and equality of distal pulses;
Assess sensory and motor function as indicated.

Back:

Observe and palpate for DCAP-BTLS, asymmetry and sacral edema.


A lot of information to read over however do not skip any of these as most proctors will deduct a point on you examif you do.
 
I hate when people quote protocol books like scripture. Protocol books are not textbooks or even really books at all

In medic school our instructors worked in 4 different counties hince 4 different protocols. These protocols rarely matched what was in our textbook. Our instructors read and studied their protocols, they did not read our textbook. This made for a aggravating time in paramedic school. they could not agree on anything, and you one answer could be praised by two instructors, scorned by all the others.

this is why L4L is so mad at the world. paramedic school scarred him for life.
 
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