• Emergency Medicine Physical Diagnosis

    Emergency Medicine Physical Diagnosis

THE PEDIATRIC EXAMINATION PART 2: DISTRACTION AND PLAY

In the previous post we talked about using proper greetings and explanation to win rapport and trust. We talked about a 16 month old with scalp pain that could not be localized. Often efforts at rapport and trust do not work. What do you do next? For straightforward presentations there is nothing wrong with physical … Continue reading

THE PEDIATRIC EXAMINATION PART 1: RESPECT AND EXPLANATION

A 16 month old presented with pain in the scalp. The examiner was not able to localize it further because the child was uncooperative and crying. What now? The first part of pediatric examination is not general inspection “well developed and well nourished.” It is to win rapport and trust. Some of what I say … Continue reading

DELIRIUM: COUNTING MONTHS BACKWARD

An elderly patient is brought by family for confusion. You wonder whether this is delirium, or whether dementia may have developed. As covered in a previous post, dementia is defined by a deficit in memory as well as one other cognitive function. You can easily test for 3 item recall and clock drawing. But for … Continue reading

IDENTIFYING AND ADDRESSING PATIENT CONCERNS: AGENDA SETTING

It is possible to adequately address a chief complaint but not identify or meet the patient’s concerns. Agenda setting is defined as that process of the medical encounter where the doctor and patient agree on the plan for the visit. If agenda setting is not done, it defaults to whatever the doctor thinks is needed, … Continue reading

CELLULITIS: DON’T JUST LOOK – FEEL!

  Cellulitis, when you think about it, is probably not the most helpful term. Literally, it means “infection of cells.” What cells? The anatomical area is actually the dermis, as well as the subcutaneous tissue.   A patient presenting with “dermitis” has a lesion that is clearly confined to the skin. A patient presenting with … Continue reading

ORBITAL COMPARTMENT SYNDROME: CHECK FOR AFFERENT PUPILLARY DEFECT

A patient presents in a coma after head and face injury. You note proptosis and the CT shows retroorbital hematoma. You wonder whether you should decompress this. Normally we based decompression on visual acuity but that is not available in the comatose patient. What can we do?   Afferent pupillary defect (swinging flashlight test) may … Continue reading

BEDSIDE DIAGNOSIS OF COAGULOPATHY

A patient presents found in the rural backcountry after a motor vehicle accident. She has a grade V liver laceration and is not stable for transfer. Your general surgeon is getting ready to take her to the operating room for damage control laparatomy and packing. You notice she is oozing from her central line site. … Continue reading

GAIT ASSESSMENT: WALK THE WALK  

A mother brings her 2 year old child in for a limp. The student believes the patient has ankle pain because she cried when she grabbed the ankle. After that she cried with everything. After calming the child down you watch her walk and it is abnormal but you wonder how to interpret this.   … Continue reading

SCAPHOID FRACTURE: CHECK BOTH SIDES, LOCALIZE IT

A patient presents with wrist pain after a fall. X-rays are negative. You palpate the snuffbox and there is mild tenderness.  One dominant current practice is to apply a thumb spica splint in all such cases but you suspect this causes too many patients to be immobilized. Can the physical examination help?   There actually … Continue reading

HIP REDUCTION: LATERAL APPROACH USES GRAVITY TO HELP

[Although technically not physical diagnosis, some bedside procedures rely on discerning anatomical and physiological clues at the bedside, and thus are bedside skills] A patient presents after a hip injury with a right lower extremity that is flexed, adducted, and internally rotated. You suspect hip dislocation and confirm it quickly with x-rays. You attempt reduction … Continue reading

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