PHYSICAL EXAMINATION
Should be started with an overall assessment of the patient, answering the following questions:
- How does he / she look? Normal, pale, sweaty, severely unwell…
- What is the behaviour? Agitated, quiet, in agony, lying on the side…
- What is the consciousness level? Awake, asleep, sleepy, aggressive, orientated and aware, disoriented…
MONITORING OF ESSENTIAL LIFE PROCESSES
Should be checked while resting.
PULSE
Assess frequency (number of beats per minute) and rhythm to check whether it is regular or irregular.
The pulse should be checked on the palmar side of the wrist, where the radial artery is located, by placing the tips of the second and third fingers toward the base of the first finger (thumb) of the patient.
The pulse can also be checked on the carotid arteries, which are situated in the neck, on both sides of the throat, close to Adam's appple.
Picture 3-2: Checking
the radial pulse.
Picture 3-3: Checking
the carotid pulse.
Under normal conditions body temperature has a constant value between 36.5 and 37 degrees centigrade.It is measured with the "digitalis thermometer for hypothermia and hyperthermia" (DRAWER 11, First aid kits A, B and C), which should be placed under the armpit, with the sensor tip touching the skin, leaving it in place for a few minutes (follow the manufacturer's instructions regarding reading and maintenance).
If a clinical mercury thermometer is available, place it under the
armpit with the reservoir touching the skin for five minutes and read
the number reached by the column of mercury. It may also be placed in
the groin or inside natural orifices such as the mouth (under the tongue)
or the rectum (through the anus), leaving it for a shorter time, although
it is not generally used here for hygienic reasons.
In any case, these are special thermometers, with a more resistant glass
ampoule.
Picture 3-4: Different thermometers.
Before placing the mercury thermometer make sure that the column is below the 36 degrees centigrade line. If it is above this level, lower it by making fast wrist rotation movements holding the tip opposite to the thermometer's ampoule (see picture).
After use, the thermometer should be washed and disinfected with an antiseptic; for example, by dipping it in alcohol for a few minutes.
Picture 3-5: How to lower
the mercury column.
Readings should be made at least twice a day (every four hours in severe illness), always at the same hours, and should be noted down in the "temperature file sheet" (DRAWER 11, First aid kits A and B).
We must check the number of times the patient breathes per minute, considering that each breathing cycle is made up of an inspiration (air intake) and an expiration (air release). To count the respiratory frequency, check the elevation and descent thoracic movements, or place the palm of your hand on the lower ribs and count the number of times it moves up and down with the breathing.
We must also note the breathing rhythm (regular or irregular) and its amplitude (shallow or deep).
Is expressed in two figures: the maximum (systolic) and the minimum (diastolic) pressure.
Picture 3-6: Stethoscope and aneroid pressure meter.
To measure the arterial pressure use a device called aneroid pressure meter or sphygmomanometer (DRAWER 11, First aid kits A and B), which is made up of a manometer and a pneumatic cuff. We use the stethoscope (DRAWER 11, First aid kits A and B) to listen to the sounds produced by the heartbeats.
Blood pressure is measured in the Anterior elbow region, which is crossed by the humeral artery. The individual should be lying down and at rest. Adjust the cuff two fingers above the elbow, with the arm completely stretched out and supported, placing the stethoscope's bell over the flexion area (see picture 3-7). After that, close the air security valve and pump air in until the manometer shows approximately 200 mm (see picture 3-8). Then, open the valve to release the air slowly. When the first arterial beat is heard note the pressure on the manometer; this is the maximum blood pressure figure. The moment when the beat is no longer heard corresponds to the minimal pressure.
Picture 3-7: How to place
the pressure cuff and where
to place the stethoscope's bell.
Picture 3-8: Insufflated
blood pressure meter.
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