No. Typically a rapid physical exam is done because of an unreliable (eg unconscious patient) or significant mechanism of injury (trauma). Head trauma can cause bleeding from the ears, nose, and mouth, cerebrospinal fluid discharge, and unequal pupils. They could have a pericardial tamponade causing jugular venous distention and muffled heart sounds. They could have unilateral chest wall movement, jugular venous distention, tracheal deviation, unilateral dimished breath sounds if they have a tension pneumothorax. Those are examples. There are many things to look for than just "DCAPBTLS".So Rapid Medical Assessment is just looking for DCAPBTLS?
What's RMS? I am not familiar with that acronym. Their chief complain is none if they are unresponsive. You'd document it as "The patient is unable to give a chief complaint because they are unresponsive". You could say their chief complain is "altered mental status" or "unresponsive", but the first way I mentioned it "Unable to give one because of XYZ" is probably most appropriate.If patient is unresponsive then is obtaining chief complaint possible ONLY through Rapid Medical Assessment? If so then just focusing on his chief complaint doesn't seem to make sense since I'll check his whole body anyway during RMS.
It's a full head to toe. You check everything. A rapid physical exam is a full head to toe without checking the distal extremities.And what's the Detailed Assessment?
Does is mean that the only difference between Rapid Medical Assessment (Rapid Physical Exam) and Detailed Assessment is not checking extremities below the knee and elbow? (I'm not trying to sound like smartarse). Sorry for having such a trouble understanding it. Today my brain accepts only KISS information.Head, Eyes, Ears, Nose, and Throat (HEENT): Look for head and facial symmetry, check for blood when palpating, Battle's sign/Racoon eyes, sclera white, pupils 4 mm equal, reactive, round to light 2 mm, and accommodate (look up accommodate, people usually don't know what this is and don't assess it, but they still say it), check for injury or debris in the eyes, contact lenses, cataracts, do they follow movement equally, moist or dry, nystagmus, nasal flaring, singed nares, foreign objects, blood, cerebral spinal fluid (CSF) in nose or ears, burn around mouth (I forget how to word this all of the sudden, what people usually say at least), symmetry of the tongue (are the making an O sign or Q sign? Just kidding... a little), bit tongue, foreign objects or blood in the mouth, oral hydration, and if teeth are intact.
Neck: Trachea midline, subcutaneous emphysema, stoma, medic alert tag, JVD, accessory muscle use (platysmal indrawing or strenocleidomastoid), neck veins distending.
Chest: Supraclavicular indrawing, intercostal retraction, pacemaker/AICD, nitropatch, equal rise and fall, assess breath sounds (bare minimum 2 breadths midclavicular from clavicle and about 6th intercostal space (ICS) midaxillary is what I was taught), excessive chest movement, subcutaneous emphysema also.
Abdomen: Distention. Is it soft and non tender? Pulsating mass (I was told not to touch it if it's pulsating). Palpate in the 4 quadrants or 9 regions (learn the 9 regions if you don't know it, it'll help you relay more exactly where the pain is and better form a differential diagnosis (DDx), which isn't the final diagnosis (Dx) doctors make and not the whole "we don't diagnose" thing). I hear Cullen's sign thrown around and McBurney's point mentioned sometimes.
Pelvis: Urinary/Fecal incontinence, priapism, rectal or vaginal bleeding if applicable.
Extremities: Check for track marks, and assess CMSTP: capillary refill, motor, sensory, temperature, pulse. I've seen a lot of variations of CMSTP e.g. CMS, PMS, etc. A lot of times, C is circulation instead. Look for medical alert tags on wrist and feet. Check for pedal edema at the feet. Sometimes I hear clubbed fingers tossed in. You can toss in equal grip test too and pronator drift if you suspect stroke (palm face up when you have them hold up their hand)s in front of them for 10 seconds and their eyes closed).
Posterior: Symmetry and sacral edema. Breath sounds paravertebral from above the scapula, mid scalpula, and below it I think is the easiest way for me describe it, not over the bone.
Some may disagree with me but if they're unresponsive that can kinda be inferred as their chief complaint... As far as documentation goes the only difference would be "Upon arrival we find an unconscious xx year old male..." vs. "Upon are we find a xx year old male complaining of xxx..."Thanks for you time Aprz. You've made it much clear. However, I still have some questions. Since Focused Exam FOCUSES on patient's chief complaint how am I going to obtain chief complaint from unresponsive patient? In other words, does Focused Assessment for Unresponsive Patient make any sense? Btw, I made RMS abbreviation from Rapid Medical Assessment to not keep repeating (yeah it should've been RMA, sorry for that).
Does is mean that the only difference between Rapid Medical Assessment (Rapid Physical Exam) and Detailed Assessment is not checking extremities below the knee and elbow? (I'm not trying to sound like smartarse). Sorry for having such a trouble understanding it. Today my brain accepts only KISS information.