Competency Evaluation Checklist 23-24 Performance Skills Checklist 25-39
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Baseline Vitals &
Baseline Vitals and Sample History Company Drill Instructor Guide Session Reference: 1 Topic: Baseline Vitals and Sample History Company Drill Level of Instruction: 2 Time Required: Three Hours Materials Blood Pressure cuff & stethoscope Pen light Clock or wrist watch with second hand Writing paper Writing pencil Personal protective equipment: gloves References Brady Emergency Care, 11th Edition, The Maryland Medical Protocols for Emergency Medical Services Providers, Effective July 1, 2011, Maryland Institute for Emergency Medical Services Systems Preparation Motivation The Baseline Vitals and SAMPLE History are part of the essential information necessary to obtain and document in order to give a patient the best possible care in the field. This information can alert the provider to call for additional resources if necessary and can give those accepting care of the patient at the next level of patient care a good idea of what may be going on inside the patient’s body. Objective (SPO) 1-1: Given a live victim; blood pressure cuff; stethoscope; pencil; paper; pen light; clock or wrist watch, the student will be able to demonstrate, from memory and without assistance, the proper procedures in obtaining a set of Baseline Vitals, to include: pulse, respirations, skin color, skin temperature and condition, pupil appearance, blood pressure and be able to document the same at a practical station, as governed by The Maryland Medical Protocols for Emergency Medical Services Providers, Effective January 1, 2002 and the Brady Emergency Care, 7th Edition, EMT-Basic National Standard Curriculum. The student will also be able to score a 70% or above on a written exam. -
ABCDE Approach
The ABCDE and SAMPLE History Approach Basic Emergency Care Course Objectives • List the hazards that must be considered when approaching an ill or injured person • List the elements to approaching an ill or injured person safely • List the components of the systematic ABCDE approach to emergency patients • Assess an airway • Explain when to use airway devices • Explain when advanced airway management is needed • Assess breathing • Explain when to assist breathing • Assess fluid status (circulation) • Provide appropriate fluid resuscitation • Describe the critical ABCDE actions • List the elements of a SAMPLE history • Perform a relevant SAMPLE history. Essential skills • Assessing ABCDE • Needle-decompression for tension • Cervical spine immobilization pneumothorax • • Full spine immobilization Three-sided dressing for chest wound • • Head-tilt and chin-life/jaw thrust Intravenous (IV) line placement • • Airway suctioning IV fluid resuscitation • • Management of choking Direct pressure/ deep wound packing for haemorrhage control • Recovery position • Tourniquet for haemorrhage control • Nasopharyngeal (NPA) and oropharyngeal • airway (OPA) placement Pelvic binding • • Bag-valve-mask ventilation Wound management • • Skin pinch test Fracture immobilization • • AVPU (alert, voice, pain, unresponsive) Snake bite management assessment • Glucose administration Why the ABCDE approach? • Approach every patient in a systematic way • Recognize life-threatening conditions early • DO most critical interventions first - fix problems before moving on -
HEENT EXAMINIATION ______HEENT Exam Exam Overview
HEENT EXAMINIATION ____________________________________________________________ HEENT Exam Exam Overview I. Head A. Visual inspection B. Palpation of scalp II. Eyes A. Visual Acuity B. Visual Fields C. Extraocular Movements/Near Response D. Inspection of sclera & conjunctiva E. Pupils F. Ophthalmoscopy III. Ears A. External Inspection B. Otoscopy C. Hearing Acuity D. Weber/Rinne IV. Nose A. External Inspection B. Speculum/otoscope C. Sinus areas V. Throat/Mouth A. Mouth Examination B. Pharynx Examination C. Bimanual Palpation VI. Neck A. Lymph nodes B. Thyroid gland 29 HEENT EXAMINIATION ____________________________________________________________ HEENT Terms Acuity – (ehk-yu-eh-tee) sharpness, clearness, and distinctness of perception or vision. Accommodation - adjustment, especially of the eye for seeing objects at various distances. Miosis – (mi-o-siss) constriction of the pupil of the eye, resulting from a normal response to an increase in light or caused by certain drugs or pathological conditions. Conjunctiva – (kon-junk-ti-veh) the mucous membrane lining the inner surfaces of the eyelids and anterior part of the sclera. Sclera – (sklehr-eh) the tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea. Cornea – (kor-nee-eh) clear, bowl-shaped structure at the front of the eye. It is located in front of the colored part of the eye (iris). The cornea lets light into the eye and partially focuses it. Glaucoma – (glaw-ko-ma) any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision. Conductive hearing loss - a hearing impairment of the outer or middle ear, which is due to abnormalities or damage within the conductive pathways leading to the inner ear. -
Diagnostic Significance of Apgar Score in Perinatal Asphyxia
wjpmr, 2020,6(11), 178-182 SJIF Impact Factor: 5.922 WORLD JOURNAL OF PHARMACEUTICAL Research Article Manoj et al. World Journal of Pharmaceutical and Medical Research AND MEDICAL RESEARCH ISSN 2455-3301 www.wjpmr.com Wjpmr DIAGNOSTIC SIGNIFICANCE OF APGAR SCORE IN PERINATAL ASPHYXIA A. Manoj*1, B. Vishnu Bhat2, C. Venkatesh2 and Z. Bobby3 Department of Anatomy1, Paediatrics2 and Biochemistry3 Jawaharlal Institute of Post Graduate Medical Education and Research (An Institution of National Importance -Govt. of India Ministry of Health and Family Welfare), Pondicherry, India. *Corresponding Author: A. Manoj Department of Anatomy, Government Medical College Thrissur-680596, under Directorate of Medical Education, Health and Family welfare of Government of Kerala; India. Article Received on 02/09/2020 Article Revised on 23/09/2020 Article Accepted on 13/10/2020 ABSTRACT This case control study was conducted to evaluate the clinical status of infant for recruitment of babies with Perinatal asphyxia and without Asphyxia. 80 cases and 60 healthy controls were participated. Apgar score of cases at 1minutes, 5 minutes and 10 minutes of cases were <3 in 60, 11, and 6 babies, 4-6 in 20, 55 and 30 babies and 6-7 in 0,14 and 11 babies respectively. Whereas, in controls Apgar score >7 at 1 and 5 minutes were seen in 56 and 60 babies respectively which indicated that they are healthy new born. The mean and SD of Apgar score in cases was significantly lower (4.9±1.624) against (8.633 ±0.6040) among controls. Male babies 52(65%) were more affected than female 28 (34.9%). -
Clinical Handbook Health Care for Children Subjected to Violence Or Sexual Abuse
KINGDOM OF CAMBODIA NATION RELIGION KING MINISTRY OF HEALTH CLINICAL HANDBOOK HEALTH CARE FOR CHILDREN SUBJECTED TO VIOLENCE OR SEXUAL ABUSE 2017 PREFACE Violence against children is a serious public health concern and a human rights violation with consequences that impact their lives in various ways. Violence and sexual abuse suffered in childhood adversely affects the body as well as the mind, which can lead to a broad range of behavioral, psychological and physical problems that persist into adulthood. Healthcare practitioners play a significantly important role in prevention and response to violence against children. They are often the first or only point of reference for children who have experienced violence, detecting abuse and providing immediate and longer-term care and support to children and families. In 2015, the Ministry of Health developed “the National Guidelines for Management of Violence Against Women and Children in the Health Sector”, which provides health care centers and referral hospitals with an overview of prevention and response in the health sector to violence against women and children. This “Clinical Handbook on Health Care for Children Subjected to Violence or Sexual Abuse” elaborates on knowledge and skills required to implement the National Guidelines. It aims to serve as a guide to ensure a prompt and adequate response to child victims of violence or sexual abuse for all healthcare practitioners. It provides further guidance on first line support, medical treatment, psychosocial support, and referral to key social and legal protection services. It can be also used as a resource manual for capacity development and training. Phnom Penh, 30th January 2017 Prof. -
CASE REPORT 48-Year-Old Man
THE PATIENT CASE REPORT 48-year-old man SIGNS & SYMPTOMS – Acute hearing loss, tinnitus, and fullness in the left ear Dennerd Ovando, MD; J. Walter Kutz, MD; Weber test lateralized to the – Sergio Huerta, MD right ear Department of Surgery (Drs. Ovando and Huerta) – Positive Rinne test and and Department of normal tympanometry Otolaryngology (Dr. Kutz), UT Southwestern Medical Center, Dallas; VA North Texas Health Care System, Dallas (Dr. Huerta) Sergio.Huerta@ THE CASE UTSouthwestern.edu The authors reported no A healthy 48-year-old man presented to our otolaryngology clinic with a 2-hour history of potential conflict of interest hearing loss, tinnitus, and fullness in the left ear. He denied any vertigo, nausea, vomiting, relevant to this article. otalgia, or otorrhea. He had noticed signs of a possible upper respiratory infection, including a sore throat and headache, the day before his symptoms started. His medical history was unremarkable. He denied any history of otologic surgery, trauma, or vision problems, and he was not taking any medications. The patient was afebrile on physical examination with a heart rate of 48 beats/min and blood pressure of 117/68 mm Hg. A Weber test performed using a 512-Hz tuning fork lateral- ized to the right ear. A Rinne test showed air conduction was louder than bone conduction in the affected left ear—a normal finding. Tympanometry and otoscopic examination showed the bilateral tympanic membranes were normal. THE DIAGNOSIS Pure tone audiometry showed severe sensorineural hearing loss in the left ear and a poor speech discrimination score. The Weber test confirmed the hearing loss was sensorineu- ral and not conductive, ruling out a middle ear effusion. -
Bates' Pocket Guide to Physical Examination and History Taking
Lynn S. Bickley, MD, FACP Clinical Professor of Internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics Chief, Division of General Pediatrics University of Rochester School of Medicine and Dentistry Rochester, New York Acquisitions Editor: Elizabeth Nieginski/Susan Rhyner Product Manager: Annette Ferran Editorial Assistant: Ashley Fischer Design Coordinator: Joan Wendt Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Indexer: Angie Allen Prepress Vendor: Aptara, Inc. 7th Edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1995, 1991 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Bickley, Lynn S. Bates’ pocket guide to physical examination and history taking / Lynn S. -
Current Audiometric Tests for the Detection of Functional Hearing Loss
CURRENT AUDIOMETRIC TESTS FOR THE DETECTION OF FUNCTIONAL HEARING LOSS by JOAN PHYLLIS COOPER X^^ Be A., Union College, 1965 A MASTER'S REPORT submitted in partial fulfillment of the J requirements for the degree MASTER OF ARTS Department of Speech KANSAS STATE UNIVERSITY Manhattan, Kansas 1963 Approved by: Ma j or ? ro re s s or . bo 11 C6£ TABLE OF CONTENTS Chapter Page I , Introduction .••••••••••••••••••«••• • • • 1 Definitions ....?................«« •••••••• 2 II. Tests for Functional Hearing Loss 4 General Behavior in the Clinical Evaluation 4 The Ear, Nose, and Throat Examination 9 Pure-tone Audiometry 12 Saucer-shaped Audiograms 14 False-alarm Responses During Pure-tone Audiometry ...................... c 17 Inappropriate Lateralization ,« 17 Bone Conduction Audiometry 20 Speech Audiometry ••••••••••••••••• • 22 Speech Discrimination ••••••••••• 22 Speech Reception Threshold ........ ............... 23 Errors During Measurement of Spondee Threshold ... 2 3 Inappropriate Lateralization 26 Pure-tone Stenger Test 26 Modified (Speech) Stenger Test 29 Doerf ler-Stewart Test 30 Lombard Test ............ o 36 De layed Auditory Feedback ., 39 Psychogalvanic Skin Resistance Test 45 Modification of EDR Test , . .. 50 Bekesy Type V Tracing ......... o ..... ....... ... s ...... 51 c ^ . iii Chapter Page ( II. Rainville Test 5S Sensorineural Acuity Level Test ..... 59 Lipreading Test .....«•..•.<.«•......,....•............ 61 The Variable Intensity Pulse Count Method 62 Rapid Random Loudness Judgments ..................... c 63 Middle Ear -
Vital Signs and SAMPLE History
CHAPTER 9 Vital Signs and SAMPLE History Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Overall Assessment Scheme Scene SizeSize--UpUp Initial Assessment Trauma Medical Physical Exam SAMPLE History Vital Signs & Physical Exam SAMPLE History & Vital Signs HOSP Detailed Ongoing Physical Exam Assessment Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Baseline Vital Signs Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Baseline Vital Signs Pulse Respirations Skin Pupils Blood Pressure Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pulse Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pulse Rate Adults generally 60-100/minute. Tachycardia is pulse more than 100/minute. Bradycardia is pulse less than 60/minute. More than 120 or less than 50 may be a critical finding. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pulse Quality Strong or weak Regular or irregular Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If you cannot feel a radial or brachial pulse, check the carotid pulse. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respirations Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Quality Normal Shallow Labored Noisy Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. -
Copyrighted Material
Index Page numbers in italics denote fi gures, anion gap 263 Baker’s cyst 100, 104 those in bold denote tables. ankle swelling 195–8 bamboo spine 189 ankle-brachial pressure index 70–1 basal cell carcinoma 77 abdominal aortic aneurysm 145 ankylosing spondylitis 179, 189 basic life support 282–5 abdominal distension 143–7, 145 antalgic gait 25, 42, 94 Behçet’s disease 181 abdominal examination 10–19 anti-tuberculosis drugs 223 benign paroxysmal positional vertigo abdominal masses 17–18, 17 antiepileptics 223 173 abdominal pain 137–42 antihypertensives 223 benign prostatic hypertrophy 57 acute 138 anxiety berry aneurysm 33 chronic 139 faintness 175 biceps tendonitis 81 investigations 139–40 palpitations 120 bleeding diathesis 149 origin of 140–1, 141 tremor 169 blood gas analysis see arterial blood gas abducens nerve 34 aortic dissection 116 analysis abscess 193 aortic regurgitation 3 Boerhaave’s syndrome 149 breast 54 aortic stenosis 3 Bouchard’s nodes 90 perianal 57 aorto-enteric fi stula 149 bowel cancer see colorectal cancer acidosis apex beat 4 bowel obstruction 144, 146 metabolic 263, 265 Apley’s test 102 brachial plexus 85 respiratory 264 apologising 237 brain natriuretic peptide 6 acoustic neuroma 34, 175 appendicectomy 218 breaking bad news 208–10 acquired immunodefi ciency syndrome apraxic gait 25 SPIKES framework 209 see HIV/AIDS arterial blood gas analysis 262–6, 264–5 breast abscess 54 acromioclavicular joint arterial examination 68–72 breast examination 53–5 arthritis 81 arterial ulcer 70 description of lumps 55, 55 Scarf test -
Primary Care Assessment of Suspected Stroke-TIA Pathway
Primary Care Assessment of Rapid onset of new neurological deficit or symptom Suspected Stroke/TIA Rapid means over seconds or minutes, or rarely, hours Exclude/ treat Click for hypoglycaemia more info Perform face, arm, speech test (FAST) • Has the person’s face fallen on one side? Can they smile? • Can they raise both arms and keep them there? • Is their speech slurred? FAST positive FAST negative See pathway Negative, but history Primary Care Risk of FAST positive now Stratification of Suspected resolved TIA Upper or Lower Motor Neurone Sparing of the forehead, and possibly maintenance of spontaneous smiling = UMN Quick assessment Facial nerve weakness lesion. Lower Motor Neurone Leg weakness YES for other neurological only? Whole of one side affected, including the facial weakness forehead = LMN lesion. This could be caused by a deficit brainstem stroke in which case it would be Diplopia squint 3rd, 4th, accompanied by other signs such as tremor, 6th ataxia, vertigo and horizontal gaze palsy Weakness 11th of Rapid onset of other shoulder elevation, NO Upper Motor Neurone motor symptoms or Other cranial nerves ninging of scapula, (sparing of forehead) signs weakness of head turning See pathway Deviation of tongue or Management of uvula 12th nerve Suspected Stroke Numbness or altered Exclude peripheral nerve sensation or dermatomal pattern Rapid onset sensory Click for more symptoms or signs info Sensory inattention Comprehension difficulties may be for the spoken or written word or for both or for one language only Speech difficulties -
Examples of Questions for the Exam
MedIS exam 2013 Course title: Nervesystemet og bevægeapparatet II - MedIS Programme: Bachelor in education Semester: 5. semester Exam date: 21-1-12 Time: 9:00 - 12:00 Evaluation form 7-point scale – External censur Important information: Remember to bring your student identification card Remember to put your student number – not your name and cpr no – on all sheets that you hand in for evaluation Remember to hand in the assignment if you leave the exam before it has ended No written aid is allowed Quicktionary pen is allowed Your paper must be handed in on paper in hand written form The study board/the university cannot be held liable if any problems should occur regarding the electronic aid during the examination It will be considered cheating or attempting to cheat if the technical equipment of the student is communicating or trying to communicate with other equipment not relevant to the exam, without an explicit permission. Before the beginning of the exam, the student should make sure that all communication devices in the equipment at the exam are turned off. Communication is not allowed The exam consists of a mixture of multiple choice questions and essay questions. The total amount of questions is 36. The total amount of points is 60. This lists the grades corresponding to the points: 12 (passed): 56-60 points 10 (passed): 51-55.5 points 07 (passed): 46-50.5 points 04 (passed): 41-45.5 points 02 (passed): 36-40.5 points 00 (failed): 18-35.5 points -2 (failed): 0-17.5 points 1 1.