Is FirstAid CS "wrong"?

[LouisianaDoctor]

Hi all,

I have some doubts about First Aid Step 2CS. It seems that it wants you to always do some unnecessary physical exam stuff, or stuff that is not realistic in the context of Step 2 CS.

Case #18. Patient has migraine headaches, and is currently experiencing one. BP 135/80, other VS WNL.

They want you to perform:
- Full HEENT
- Neck exam
- Listen to lungs
- Listen to heart
- Mental status
- Full neuro (CNs, motor, and DTRs) [I guess no sensation]

Your lucky to have 3-4 minutes for the physical exam portion. I can do cranial nerves in about 50 seconds if I'm hauling butt. Full neuro including mental status, maybe 3:00 minutes, but probably longer. How are you supposed to cram a full HEENT in there, along with the cumbersome heart and lungs?

Also, first aid tells you to do a funduscopic exam on this patient.... Who is photophobic and has a migraine.

If I was doing a "focused" physical, I'd do this:

- CN 2-12
- Motor strength
- DTRs
- Listen to the heart

...

Also, the standard Step 2 CS rumor is that you are supposed to listen to heart and lungs on every patient. But I've been hearing differently. Ie, a patient comes in with absolutely normal vitals, and they have knee pain, then you would not listen to heart and lungs. Absolutely unnecessary. Unless, of course, they have a history of HTN or other heart or lung problems. Anyone else playing the game that way?

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[kryptik]

Some of the physical exams in FA are excessive, it tries to be complete, you can skip non essential physicals and do just fine. The best part of FA is the DD and PN.

This is what worked for me: examine the system related to the CC. Cardiopulmonary for every case. if u have time after that you can do extra, but I just concluded, counseled and stepped out to finish my note.

 

[PokerDoc]

First aid isnt wrong as it is extensive. Remember, you can only list 5 DDx and plans for each case.. in FA some cases have 8, 9, 10 in their list.

I'll admit I did cheat sometimes on a plan line by writing Rectal exam, stool occult blood and hem. check all on one line.