c. Palpate firmly for
(1) Distended abdomen
(2) Guarding
(3) Local tenderness
(4) Rebound pain
10. Extremities
a. Inspect for
(1) Abnormal angulation or bone ends protruding
(2) Presence of extremity pulse
(a) Dorsalis pedis
(b) Radial
(3) Nail bed color (cyanosis)
(4) Impaired sensation
(5) Inability to move joint
(6) Lacerations or ecchymosis
(7) Needle marks or bites
b. Palpate for abnormal reaction
11. Central nervous system
a. Inspect for
(1) Mental state
(a) Consciousness
(b) Orientation
(c) Response to verbal stimu- lus and pain
(2) Gross deformities
(3) Lacerations
(4) Decerebrate posturing
(5) Decorticate posturing
b. Palpate for
(1) Tenderness
(2) Deformities
EXAMINING FOR MEDICAL PROBLEMS
A. Assess each of the following areas
1. Neck
a. Inspect for jugular vein distention
b. Auscultate trachea for adequate airflow
2. Thorax and lungs
a. Inspect for evidence of pain while breathing or moving
b. Auscultation
(1) Rales
(2) Rhonchi
(3) Wheezes
(4) Stridor
c. Palpate to determine symmetry of breathing
d. Percuss for
(1) Hemothorax
(2) Pneumothorax
3. Thorax and heart—auscultate for ab- normal heart sounds
4. Abdomen
a. Inspect for
(1) Flexion of hips to relieve pain
(2) Normal contour during breathing
(3) Distention
b. Auscultate for bowel sounds
c. Palpate for
(1) Distention
(2) Guarding
(3) Local tenderness
(4) Rebound pain
5. CNS
a. Inspect for
(1) Mental state
(2) Pupil reaction
(3) Eye movements
(4) Muscle tone
(5) Paralysis
b. Palpate for
(1) Loss of feeling
(2) Absent reflexes
(3) Muscle tone
(4) Paralysis
DEVELOPING THE MEDICAL HISTORY
The patient’s history is an important informa- tion source that will directly influence both the treatment offered by the corpsman at the accident scene and the care given in the hospital. The history is acquired at the accident scene and the care given in the hospital. The history is acquired by observing for clues and careful questioning of the patient, family, and bystanders.
A history is divided into three parts: the history of the im- mediate situation, the patient’s medical history, and the family medical history. (The family history is usually not relevant in the field with a trauma patient.) A history of the present illness is a directed history, striking a balance between allowing the patient to ramble and leading the patient. The pur- pose is to discover why you were called. In general, the following information must be gathered:
A. Gross problem identification
1. Chief complaint
2. How does the patient feel?