Eight Senses Assessment - page 3
everyone seems to enjoy these "games". once again it is a no blame no shame game. you have been on the holiday of your life camping out on a deserted remote national park. you have a mobile... Read More
Jun 20, '03He is either A)intoxicated, B) fumigated (carbob monoxide posioning or C) a combo of both and then there is D) Ate something toxic (ie wild mushroom)
Jun 21, '03Sorry for the delay but I was on night duty and like to try and keep the limited working neurones for work.
Okay - lets look at assessment of the unconscious patient in a non=hosptial setting and see if we can tease it out further than the traditional ABC's
Most of you will be aware that the traditional "shake and shout" has been replaced with "squeeze and shout". Do you think this is wise? In truth how would you check wakefulness?
Firstly lets revist the airway. To truly protect the airway we need three intact mechanisms. How are we going to assess for them?
Breathing - looking at a chest what does the following data indicate? snoring - tracheal tug slight intercostal recession on inspiration. You support his head and look further - you notice he has a beard and there is some yellow staining aroung the witer hairs of the beard. There is brown staining on the first snd second fingers. What other respriatory signs might I check for given these facts? When checking his breathing what parameters am I looking for?
Circulation - what can we truly determine form just taking a pulse? What might I see that would indicate hypothermia?
Would I be able to tell how long the person had been lying in the one postion?
Neuro assessment - beyond checking for pupil reponses can we determine more? How do I tell if the patient has altered limb power. Would this patient score an automatic 3 on the Glasgow coma scale.
We are looking for poisoning here so what other clues are we going to be looking for? What is a common reaction to ingestion of a poisonous substance? Can we group symptoms so that we can decide what type of thing has caused the poisoning. i.e. If say this poor unfortunate has botulism poisoning from his own cooking then he will be showing symptoms of a neuromuscular blockade.
The object here is to have fun and learn or is it to learn and have fun? Never mind!! If you don't want to answer all parts of the post above then pick one section i.e. assessment of airway or examination of neurological response. This isn't an examination and no one person will be completely "right" not even me!!
Turn about is fair play too so if you have some aspect of assessment you want to challenge me on - go ahead!!! Again it is all about learning form each other.
Jun 21, '03Yellow staining of whiskers and fingers indicative of smoking evidenced by nicotine staining of beard and fingers. Assess lungs, cardiac status for s/sx MI, COPD, emphysema (sp). In assessesing for airway look for the rise and fall of the chest, feel around the mouth or nose for air movement listen for unusual breath sounds. Geeck for rate rhythm and depth of inspiration, the trachael tug is evidence of an occluded airway. Enough for now I have to go think about the rest.
Jun 21, '03GCS:E1 v1 m1 so yes a three would be generous.
Barrel chest indicates COPD/emphysema
Fever, increased rate of breathing,
Nailbeds could be bluish/cyanosis, tips clubbed, splinter hemorrhages,
Lividity/blood pooling indicates being on one side length of time.
skin Fever, hot, cool, moist dry, turgor
Posturing/ decorticate: Flexion of arms
Hyperextension legs |decerebrate Arms and legs extended
uncontrollable muscle twitches, pinpoint pupils,eyes tearing? dry? convulsions, unconsciousness.
Jun 21, '03Fantastic replies and just what I am looking for. I guess part of this is to assess the abnormal, not as many books do assess the normal.
You are correct tracheal tug is can mean upper airway obstruction and suggests that although this guy is moving air the airway may not be a clear as we would wish. The other times I have seen tracheal tug is when the patient is "gulping" air. Rapid intakes of breath and is usually a sign of immanent failure.
All for now I'll be back later.
Jun 21, '03hmmmmm hypothermia and circulation? Delayed capillary refill time. if severe enough there may be lack of deep tendon reflexs and comapossible v-fib followed by" ta duh" cardiac arrest.......