CS physical exam

[drcushing]

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questions about how thorough we need to do the exam.
for lung exam: would 4 points on the back enough? or has to be 6 on back and 2 anterior + 1 right basolateral?
for heart: 4 areas about 5 seconds on each spot?
for abd: listen for bowel sound on one area only? check liver/spleen always?
what do you guys think? any comments would be appreciated.

 

[kaboodle]

Chest: 6 points on the back, 4 on the front.
Heart: Just listen to the 4 valve areas.
Abd: Listen to all 4 quadrants.

At all auscultation points: Listen for 3 seconds each (count to 3).

BUT: Depending on what the pt comes in for you may need to do more.

Check out Kaplan complex cases for CS or go to a review course. The book is great, as is 1st aid, but the course was AWESOME!!

 

[Law2Doc]

questions about how thorough we need to do the exam.
for lung exam: would 4 points on the back enough? or has to be 6 on back and 2 anterior + 1 right basolateral?
for heart: 4 areas about 5 seconds on each spot?
for abd: listen for bowel sound on one area only? check liver/spleen always?
what do you guys think? any comments would be appreciated.

You need to try to do the exam correctly for the body part at issue -- you are given points for doing the exam the way the SP has been taught is the proper way for that scenario. So that means listening to 6 spots on the back and 2 on the front for a lung exam, even if you might do less in real life. And it means listening for bowel sounds in all 4 quadrants even if in real life you might quit once you heard them in 1. And yes, for abdominal complaints, you would look, auscultate, palpate and percuss. The targeted exam doesn't mean using shortcuts so much as it means doing the complete exam for a targeted part of the body. So for an abdominal issue, you might do the abdominal exam in detail, and maybe briefly do a listen to the heart and lungs. For a breathing issue, you do a complete lung exam, and maybe quickly check out the heart, abdomen. But your "grade" is going to be to do the exam the SP has been told you should be doing, in its entirety.

So yes, you will lose points if it doesn't appear you are doing what they have been told is the right approach. It thus helps to "narrate" as you are going through the exam -- "I'm going to listen to your belly. Now I'm going to push on your belly, tell me if it feels tender. Now I'm going to tap on your belly to check out your liver/spleen". etc. That way when they grade whether you did X, Y and Z, you will get the points, even if perhaps you didn't do it perfectly. It's not a test of whether you come to the right conclusion, or find the necessary findings. It's a test of form over substance -- you have to do the exam in a seemingly precise and professional manner, with the right amount of bedside manner.