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DCAP-BTLS
- 1. derformity
- 2. contusions
- 3. abrasions
- 4. punctures/penetrating injuries
- 5. bruising/burns
- 6. tenderness
- 7. lacerations
- 8. swelling
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Examination Techniques
- 1. inspection
- 2. auscultation
- 3. palpation
- 4. percussion
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Areas of Exam
- 1. head
- 2. eyes
- 3. ears
- 4. nose & sinus
- 5. mouth & pharynx
- 6. face
- 7. jaw
- 8. neck
- 9. chest
- 10. abdomen
- 11. pelvis
- 12. genitalia
- 13. annus & rectum
- 14. peripheral
- 15. posterior
- 16. neurologic
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Head
- I) inspect
- 1. symmetry
- 2. obvious deformities
- 3. obvious bleeding
- 4. bruises
- 5. lice, parasites
- II) palpate
- 1. DCAP-BTLS (specifically for)
- a. deformities
- b. areas of unusual warmth
- c. point tenderness
- 2. step offs
- 3. crepitus, loose fragments
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Eyes
- I) inspect
- 1. symmetry in size, shape, contour
- 2. sclera & conjuctive for discoloration, swelling & exudates
- 3. orbits for periorbital ecchymosis "raccoon eyes"
- 4. test cranial nerves II, III, IV & VI - optic, oculomotor, trochlear & abducens
- a. pupils for equality, reactivity (CN2)
- b. test for conjugate movement & extra ocular movement
- c. test for accommodation
- d. test for ability to follow your finger in an H pattern
- e. test for peripheral vision & visual acuity (CN3, 4, 6)
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Ears
- I) inspect
- 1. deformities, lumps, lesions, erythema
- 2. drainage [a)blood b)csf c)mucus d)pus]
- 3. visualize they tympanic membrane w/ otoscope
- 4. visualize behind ear for discoloration suggestive of battlesigns
- 5. test CN VIII (vestibulocochlear nerve)
- a. hearing acuity, orientation & balance
- II) palpate
- 1. tragus & mastoid process for tenderness
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Nose & Sinus
- I) inspect
- 1. symmetry (deviation shape/color)
- 2. flaring of nostrils
- 3. blood or other drainage
- 4. nasal mucosa for evidence of drainage (note color, quantity, consistency)
- 5. II) palpate
- 1. integrity
- 2. nasal obstruction
- 3. frontal & maxillary sinuses for swelling & tenderness
- 4. ability to smell CN I (olfactory)
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Mouth & Pharynx
- I) inspect
- 1. condition/color of lips for pallor or circumoral cyanosis
- 2. oral musosa for color, turgor, lesions, nodules, fissures
- 3. buccal mucosa
- 4. tongue for malignancies & discoloration - especially sides & bottom
- 5. test CN IX & X (glossopharyngeal, vagus)
- a. ability to extend tongue & move side to side
- 6. test CN XII (hypoglossal)
- a. verbalize "aaaah" w/ tongue blade in center of tongue
- 7. note fluids or odors coming from mouth
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Face
- I) inspect
- 1. symmetry
- 2. test CN VII (facial)
- a. ability to use facial muscles equally & bilaterally (have pt smile, wrinkle forehead, clench eyes tightly)
- b. mastoid process for discoloration (battle signs)
- II) palpate
- 1. integrity/stability of bones
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Jaw
- I) inspect
- 1. symmetry, discoloration, bruising, swelling, deformity
- II) palpate
- 1. point tenderness
- 2. test CN V (trigeminal)
- a. corneal reflex, ability to clench
- 3. TMJ for equal movement w/ presure
- 4. evaluate tempormandicular joint for tenderness, swelling & range of motion
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Neck
- I) inspect
- 1. symmetry, discoloration, bruising, swelling, deformity
- 2. visible lymph nodes, surgical scars, masses
- 3. evaluate JVD at 45 degree angle
- 4. trachea deviation
- II) auscultate
- 1. carodid arteries for bruits
- III) Palpate
- 1. back of neck
- a. point tenderness
- b. crepitus
- c. step offs
- 2. lymph nodes for swelling
- 3. thyroid gland for swelling/tenderness
- 4. carodid arteries for equility (gently & separately)
- 5. test CN XI (spinal accessory)
- a. have pt shrug shoulders then turn head side to side
- 6. subcutaneous emphysema
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Chest
- I) inspect
- 1. note respiratory rate & breathing patterns
- 2. symmetrical or asymmetrical movements
- 3. structural symmetry
- 4. use of sternocleidomastoidal, suprasternal, supraclavicular & intercostal muscle use (accessory muscles)
- 5. bruising, contusions, discolorations, lacerations, punctures
- 6. skin pallor & other signs of decreased perfusion
- 7. count respiration rate & note breathing pattern
- II) auscultate
- 1. quality at 6 points of evaluation (side to side, anterior & posterior)
- 2. heart sounds (murmurs, valve noise or hyper resonance)
- a. S1 (apex of heart)
- b. S2 (base of heart)
- c. S3 (apex w/ PT on their L side)
- d. S4 (at the width (???) w/ PT on their L side)
- III) palpate
- 1. bilateral expansion
- 2. mechanical integrity (covering entire rib cage)
- 3. loose segments
- 4. crepitus
- 5. tenderness/deformity
- 6. evaluate for excursion (anterior/posterior)
- 7. evaluate for tactile fremetis
- 8. apical impulse - PMI
- IV percuss (anterior/posterior 6 points or more for resonance)
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Abdomen
- I) inspect
- 1. distension, rigidity, symmetry
- 2. guarding
- 3. discoloration, bruising, scars, stretch marks
- 4. rashes, lesions
- 5. Cullen's sign / Grey Turner's sign
- 6. ascites or other masses
- II) palpate
- 1. point tenderness all 4 quadrants & epigastric - examining area of complaint LAST
- a. using fingertips gently 1st - then deeper for rebound
- 2. regidity
- 3. superficial organs
- III) percuss (for resonance)
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Pelvis
- I) inspect
- 1. symmetry, bruising, deformities
- II) palpate (compress gently)
- 1. stability, point tenderness, crepitus
- 2. range of motion
- 3. equality of femoral pulses
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Genitalia
- I) inspect (ONLY if indicated by complaint or index of suspicion)
- 1. priapism, hemorrhage or penetrating injury
- 2. inflamation, swelling, lessions
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Anus & Rectum
- I) inspect (only if indicated by complaint or index of suspicion)
- 1. anus for hemorrhoids, lacerations
- 2. perineum for wounds, tears, punctures
- 3. hemocult if indicated
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Peripheral (all four extremities)
- I) inspect
- 1. size & symmetry
- 2. deformaties, bruising, discolorations, hemorrhage
- 3. puncture, lacerations, burns, swelling, lesions, tenderness
- 4. color of skin
- 5. nail beds & fingertips
- 2. test for range of motion passively & actively
- 3. evaluate for swelling
- II) palpate
- 1. skin temperature, moisture, turgor, edema
- 2. regidity
- 3. crepitus
- 4. capillary refill, sensory & motor sensation distally
- 5. joints
- 6. locate & compare peripheral pulses for rate & quality
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Posterior
- I) inspect (head to tow "every inch")
- 1. DCAP-DTLS
- II) palpate (head to tow "every inch")
- 1. DCAP-BTLS
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Neurologic
- I) ascertain for signs of hypoperfusion
- II) focused history for neurologic
- 1. reassess mental status
- 2. access perceptual process for coherence, hallucination, delusion or phobias
- 3. access mood & effect for depression, elation, anxiety & agitation
- 4. access intelligence for speech, level of covabulary & ability to formulate an idea (note speech patterns & use language)
- 5. access judgement for recognition of problems, denial & blame of others
- 6. access psychomotor for unusual posture or movements
- 7. assess motor tone/strength. check for pronator drift sideways or upwards.
- 8. assess cerebellum for coordination w/ rapid alternating movements & point to point testing.
- 9. test all cranial nerves
- 10. test deep tendon reflexes
- a. bicep, triceps, brahcioradialis, quadriceps, achilles, superficial abdominal & plantar
- 11. assess ability to differentiate between sharp & dull sensation scatter stimuli
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