Dr.R.K.Yadava Associate Prof.&Head Department of kayachikitsa SRM Govt.Ayu.College&Hospital, Bareilly

Transcription

1 Dr.R.K.Yadava Associate Prof.&Head Department of kayachikitsa SRM Govt.Ayu.College&Hospital, Bareilly

2 General examination is most important aspect in clinical practice. Learn the art to take detail information Practice of medicine combines both science and art. Patient doctor relationship Jnana buddhi pradipena sa vai chikitsakah (charak)

3 Interview technique What to ask about. How to ask.

4 Observation at a glance Note facial expression/appearance,built,complexion,state of clothing. Observe and define any abnormality of mental state, consciousness, gait posture and movement. Identify any abnormal sound or odour. Assess the state of hydration, nutrition and oedema. Observe any change in colour of skin and mucous membrane. Measure the height and weight.

5 Examination of vitals Pulse. Blood pressure. Respiration. Temperature.

6 The arterial pulse With each contraction, left ventricle ejects a volume of blood into the aorta and then in arterial system. The ensueing pressure wave moves rapidly through the arterial system, it is felt as the arterial pulse.

7 How to examine pulse Rate. Rhythm. Character. Volume. Radioradial and radiofemoral delay. Condition of the vessel wall.

8 Pulse rate To assess the radial pulse is frequently used. Beats per min. Count for a period of at least one min. If the pulse is irregular, count the heart rate with stethoscope. Pulse deficit = heart rate minus pulse rate. Bradicardia HR is less than 60/min Tachycardia HR is more than 100/min

9 Rhythm The normal rhythm of the heart originates from the SA node, called sinus rhythm. Seldom completely regular because HR increases during inspiration and decreases during expiration sinus arrhythmia.

10 Volume of pulse Pulse volume is decided by the amplitude by which the finger is displaced during palpation with each beat. Normally pulse is felt without lifting of the fingers. Pulse volume is said to be good or high if lifting of fingers occur. If pulse is felt with difficulty, it is said to be low volume pulse. High vol. exercise, heat, emotion, anxiety, pregnancy etc. pathological in fever, thyrotoxicosis etc.

11 Character of pulse The normal character of the pulse is fairly rapid rise, rounded peak and fairly rapid fall. The wave form consists of a percussion wave, a tidal wave, a dicrotic wave and a notch. Radiofemoral delay. Radioradial delay. Arterial wall

12 Blood pressure Pressure exerted by the intravascular blood volume laterally on the wall of vessel. Systolic BP depends on cardiac output. Diastolic BP depends on peripheral resistance. Clinically measured by a mercury sphygnomanometer.

13 Check list for measuring BP Patient relaxed, arm supported at heart level, all clothing removed from the arm. Cuff neatly applied appropriate size for arm, no leaks. Manometer well supported, upright, calibrated regularly. Doctor /student- check systolic BP by palpation. Release pressure slowly. Avoid parallax error( Eye at same level)

14 Classification of hypertension Category systolic(mm/hg) diastolic(mm/hg) Normal <120 <80 Prehtn HTN First stg Sec.stg. >160 >100

15 Respiration A process by which tissues of our body utilize oxygen for metabolic purpose and produce carbon di oxide as a result of metabolism. Normal breathing is quiet with larger inspiration than expiration. The respiratory rate is about 14-20/min. in normal adults. Difficulty in breathing is called dyspnoea.

16 Breathing pattern in respiratory disorders Pattern disorder Rapid slow breath. Restrictive lung dis. elevated hemidiaph. slow breath. Narcotic poisoning Kussmaul s breath ketoacidosis (deep&rapid) Chyne-stokes breath renal failure, RF,LVF, children. Biot s breath. Narcotic poi. Resp. dep (ataxic irregular br.) resp.dep, meningitis Deep stertorous breath ^ICP, deep coma, deep sleep (rattling noise breath.) Sighing respiration dying pts, hysteria, hyperventilation

17 Temperature /fever A protective phenomenon of body. Each of us has experienced some time in our life. Probably synonym to disease itself. The temperature is simple, objective,and accurate indicator of a physiologic state. Assists in estimating severity of an illness.

18 Disease state with fever All infections. Mechanical trauma. Many neoplastic diseases. Hematopoietic disorders. Vascular accidents. Diseases of immune mechanism. Acute metabolic disorders.

19 How to measure fever Probably everybody is aware. With the help of a thermometer- murcury/digital Normal temp degree F Hyperpyrexia - >103 deg.f In heat stroke temp. may be as much as 108 df

20 Definitions of fever Intermittent temperature falls to normal each day eg. Pyogenic infections, miliary tuberculosis. Remittent temperature falls each day but does not return to normal eg. Most of the fever. Sustained persistent elevation without significant diurnal variation eg. Untreated typhoid. Relapsing short febrile periods occur between one or several days of normal temperature. Eg. Malaria, rat bite fever,localised pyogenic infections, UTI etc.

21 conclusion Examination of the patient starts as the patient enters the room. Ends with completion of interrogation. Wise physician takes care of both rogi and roga. Be careful and sympathetic to the patient.

22 thank you