Basics of Physical examination Measuring Vital signs

Transcription

1 Basics of Physical examination Measuring Vital signs

2 Agenda Alterations in body temperature Body weight measurement Pulse and Bp ECG

3 Normal temperature: Body Temperature. Basics Meas. in - axillary 36,5 C 8-10 min - oral 37,0 C ± 0,5 C 4-5 min - rectal 37.5 C 1-2 min Circumstances: - norm. room temperature - no cold or hot drinks/food -patient is in relaxed position, (No shivering) Diurnál rithm. -Highest in the afternoon - lowest at night Subfebrile: C (axillar) Hyperpyrexia: 41,0 C above (rectal)) Hypothermia: under 35 C (rectal)

4 Indications of measuring body temperature Rutine. Complaints: Feeling cold, Goosebumps, Shivering Night sweats. Malaise, headache, pain in the muscles and joints Suspision on physical exam Warm skin, tachicardia ect... Detect illness. Monitor whether or not treatment is working.

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6 Continuous Fever The temperature remains above normal throughout the day and does not fluctuate more than 1 degree Celsius in 24 hours. This type of fever occurs in lobar pneumonia, typhoid, urinary tract infection, infective endocarditis, brucellosis, typhus etc.

7 Remittent Fever The temperature remains above normal throughout the day and fluctuates more than 2 degree Celsius in 24 hours. This type of fever is most common in practice.

8 Intermittent Fever The temperature is present only for some hours in a day and remains to normal for the remaining hours. When the spike occurs daily, it is quotidian, when every alternate day, it tertian and when every third day, it is quartan. Intermittent fever is seen in malaria, kala-azar, pyemia, septicemia etc.

9 Hectic or Septic Fever The temperature variation between peak and nadir is very large and exceeds 5 degree Celsius. This type of fever occur in septicemia.

10 Relapsing Fever Febrile episodes are separated by intervals of normal temperature. The fever when occur may last from 2-9 days and then temperature gets normal. The fever may relapse after a period of few days repeating same cycle. It is typically seen in Borrelia infections.

11 Causes of high body temperature A: Exsess heat Heat stroke B: Impaired Colling Neuroleptic malignant sysndrome Malignant hyperthyrmia Serotonin syndrome C: Modified Thermostat (Inflamation)

12 Causes of Fever (cont.) Infection bacterial, viral, rickettsial, fungal or parasitic Neoplasms Hypernephroma, lymphoproliferative malignancies, carcinoma of pancreas, lung and bone. Vascular Causes Acute myocardial infarction, pulmonary embolism. Pontine hemorrhage Trauma A massive crush injury may lead to pyrexia. Immunological Diseases Systmic lupus erythematosus, rheumatoid arthritis Metabolic dieses Gout, porphyria, acidosis, dehydration, hemolytic crisis. Endocrine Thyrotoxicosis

13 FUO Fever higher than 38.3 C (101 F) on several occasions Persisting without diagnosis for at least 3 weeks At least 1 week's investigation in hospital 3 outpatient visits or 3 days in the hospital without elucidation of a cause or 1 week of "intelligent and invasive" ambulatory investigation.

14 Body Weight

15 BMI BMI=Kg/m2 <16, severely wasted. <17 significantly underweight <18.5 are considered underweight; Values of are normal; , overweight; 30-40, obese >40 extreme obese.

16 Why? Body weight influences pronnes to diseases. Medicin dosage Nutritional treatement Fluid, ion intake Ventillation Weight change might indicate certain diseases (i.e. IWL, IWG) Treatement effectiveness may be monitored via body weight measurement.

17 Cachexia Significant Involuntary weight loss: 5% weight loss in 30 d 10% weight loss in 180 d Body mass index <21 25% of food left uneaten after 7 d Change in fit of clothing Change in appetite, smell, or taste a profound and marked state of constitutional disorder; general ill health and malnutrition.

18 Anorexia (loss of appetite), Sarcopenia (loss of muscle mass), Cachexia weight loss loss of muscle adipose tissue anorexia weakness Dehydration.

19 Obesity

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21 Examining the Pulse

22 Indications for checking the pulse Routine. ER situations. Palpitation. Chest pain. Intermittent Clauditation. Acute pain in lower or upper extremities.

23 Where to check?

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30 What to look for? Is there a pulse? What is the frequence? Is it regular? Is it Strong/week?

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32 Top reasons for absent pulse Asystolia VF Tamponade Shock Aortic dissection Embolism Chronic art. Stenosis/Perif. Vasc. Disease Surgical removal of the artery Morbid obesity

33 Acute embolisation

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36 Aortic dissection

37 Coarctation of the aorta

38 ECG

39 ECG leads

40 ECG examinations Routine resting 12 lead ECG Exercise ECG (stress test) Holter ECG Event/loop Recording. ECG Carotid sinus massage

41 Indications for doing an ECG Screening Suspicion of myocardial injury, ischemia, prior infarction, electrolyte abnormalities, drug toxicities, Pacemakers implanted defibrillators To check effectiveness of therapy Complaints Palpitation Chest pain Dyspnoe Dizziness Loss of conciousness Phisical findigs Unconciousness Pulse abnormality Tachy/bradicardia/asystolia Cyanosis Low/high BP Murmur over the heart

42 The 12 lead Normal ECG

43 Holter ECG

44 CHS

45 Stress ECG

46 Absent pulse, Caused by: Asystole

47 Absent pulse, Caused by: V-Fib

48 Irregular pulse caused by: Atrial fibrillation

49 Arrythmic tachycard pulse caused by A-fib

50 Regular tachycardia caused by paroxismal supraventricular tachycardia (PSVT)

51 Bradycardia

52 Ischaemia

53 Pulmonary embolism