TROUVAILLES ET ASTUCES
Index
général
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IV. AIDE A L'EXAMEN CLINIQUE - HINTS FOR CLINICAL
EXAMINATION
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- Mouillez votre abaisse-langue! - Wet
tongue depressor
- Comment examiner un patient
chatouilleux?
- Otoscopie chez l'enfant - Ear Exam Child
Diversion
- Respire! - Take A Deep Breath
- Comment diagnostiquer une sciatique -
Testing for Lumbosacral/Sciatic Radiculopathy
- Torsion ou épididymite? - Prehn's Sign
- Profondeur du coma - Consciousness
- Détermination du niveau de conscience -
Evaluating Level of Consciousness
- Débusquer un simulateur de coma -
Identifying a Phony LOC Patient
- Aide à la mesure de la pression
artérielle - Easier blood pressure
- Comment peser un patient très lourd? -
Weighing Heavier Patients
- Où est le col? - 'Pop!' Goes The Cervix
- Comment recycler un condom - Cervical
Visualization
- Mettez-le sous microscope - Pediculosis
Pubis Diagnosis
- Surveillance d'une lésion cutanée -
Skin lesion measurement
- Mesure d'une papule
d'intradermo-réaction - Checking for Induration
- Ressortez votre diapason! - Get Out The
Tuning Fork
- Comment mesurer le foie - Finding the
Liver Margin
- Piquer-toucher - Assessing Pin-prick
Sensation
4.1 Mouillez votre abaisse-langue! - Wet tongue depressor
Most patients, especially youngsters, don't like having a
wooden tongue depressor placed in their mouth on the tongue. So,
I dip the tongue depressor briefly in a glass of water to
moisten it before using and it then "blends" right into the
tongue surface. It works great and, I suppose for very young
patients, you might even use some sugar free beverage.
Leonard R. Schaer, BA, MD, Alamo,
CA, Medscape,
3.9.99
4.2 Comment examiner un patient chatouilleux?
Demandez au patient d'appuyer légèrement avec sa main sur la
vôtre lorsque vous le palpez; cela diminuera sa sensibilité au
chatouillement.
Harry Goldstein, MD, Netanya,
Israel, Medscape,
17.9.99
4.3 Otoscopie chez l'enfant - Ear Exam Child Diversion
To distract a pediatric patient during an otoscopic exam, have
the child cover one ear with his or her hand while you shine a
light in the other ear, and challenge the patient to not "let
the light out" through the covered ear. Ask a parent to check
"if any light comes out" to divert the child's attention
further.
Joseph E. Healy, PA-C, Hartford,
Conn
4.4 Respire! - Take A Deep Breath
For a child who refuses to take a deep breath during a lung
examination, simply blow on a tissue and then ask the child to
imitate you.
ENS Robert Vincent Rodezno, USN,
PA, Havelock, NC
4.5 Comment diagnostiquer une sciatique - Testing for
lumbosacral/sciatic radiculopathy
If I suspect a lumbosacral/sciatic radiculopathy but the
standard straight leg raising test is equivocal or negative,
then I simultaneously perform foot dorsiflexion (braggard's
test) and great toe extension (Sicard's sign) along with the SLR
test. This combination of procedures will certainly bring out
any symptoms of lumbosacral/sciatic radiculopathy.
Charles A. Sallahian, DC, New
York, NY, Medscape,
17.9.99
4.6 Torsion ou épididymite? - Prehn's Sign
To differentiate between epididymitis and testicular torsion
for a patient presenting with acute testicular pain, perform the
Prehn's sign. With the patient lying in a supine position, cup
the scrotum and move it on to the abdomen. If the pain
dissipates, diagnose as epididymitis; if the pain worsens,
diagnose as testicular torsion.
Geoff Carlson, PA-S, Bellmawr, NJ
4.7 Profondeur du coma - Consciousness
Rapidly assess the level of consciousness by looking at the
eye:
Alert = Eyes opening spontaneously
Drowsy = Eyes opening on verbal commands only
Stuporous = Eyes opening on painful stimuli only
Comatose = Eyes not opening to any stimuli
Mohammed S. Akram, MD,
Poplarville
4.8 Détermination du niveau de conscience - Evaluating
Level of Consciousness
Persons presenting to emergency rooms sometimes feign loss of
consciousness. One simple and humane way to evaluate level of
consciousness is to raise and position the patient's hand
directly above his or her nose. Drop the hand. An unconscious
patient will have no self-protective mechanism intact and the
hand will strike the nose. A patient feigning unconsciousness
will deflect the hand away from the nose.
4.9 Débusquer un simulateur de coma - Identifying a Phony
LOC Patient
Patients who feign a decreased level of consciousness (LOC) may
subject themselves to painful and unnecessary testing methods
(eg, sternal rubs). To determine whether a patient is faking a
decreased LOC, lightly brush the eyelash and eyelid and wait for
the reflexive blink. Once caught "playing possum," the patient
will become more willing to interact.
Mark J. Bell, PA, Simi Valley,
Calif
4.10 Aide à la mesure de la pression artérielle - Easier
blood pressure
When taking manual manometric blood pressure in a very ill
patient or edematous patient, the auscultory systolic sound
could be too soft to be audible or too weak for palpation.
Simultaneous pulse oxymeter connection to the respective finger
allows the first detection of the pulse as the blood pressure
cuff is deflated.
Abu Dzarr, MD, Malaysia, Medscape,
17.9.99
4.11 Comment peser un patient très lourd? - Weighing
Heavier Patients
To weigh a patient who is too heavy for the standard office
scale, use two scales. Ask the patient to place one foot on each
scale and then stand still. The measurements from the two scales
added together provide an accurate weight.
Ronald A. Berry, RN, MS, FNP,
Lander, Wyo
4.12 Où est le col? - 'Pop!' Goes The Cervix
Usually a "difficult" cervix is posterior and retroflexed. When
performing a Pap smear on a patient whose cervix is difficult to
visualize, have the woman lift her hips and place her hands
under her buttocks. The cervix will quickly "pop" into view
without pain.
Barbara J. Runquist, FNP,
Phoenix, AZ
4.13 Comment recycler un condom - Cervical Visualization
If while doing a pelvic exam/pap smear you have trouble
visualizing the cervix due to lax vaginal tissues falling into
the speculum, apply a condom over the speculum, then cut the tip
off. This works especially well with a large speculum.
Elizabeth Carroll, FNP,ARNP, St.
Marys, Ga.
4.14 Mettez-le sous microscope - Pediculosis Pubis
Diagnosis
When you are trying to diagnose pediculosis pubis (phthiriasis
inguinalis) but you cannot see any nits and a Wood's lamp is
unavailable, take a piece of transparent tape and press it on
the area of suspected infestation. Then place the tape on a
slide for examination under the microscope.
Jennifer Angotti, CRNP,
Pittsburgh, Pa
4.15 Surveillance d'une lésion cutanée - Skin lesion
measurement
To observe a skin lesion over time, gently place a piece of
transparent tape over the lesion and outline its border. You can
then remove the tape and place it in the patient's chart as a
permanent and reproducible replica of the lesion's size and
shape.
Richard Moore, RPA-C, Stamford,
NY
4.16 Mesure d'une papule d'intradermo-réaction - Checking
for Induration
When evaluating a tuberculosis skin test, take a ballpoint pen
and lightly mark toward the site of injection on four sides. If
an induration is present, the pen will stop before reaching the
site. Measurement is easy from pen mark to pen mark.
Sarah Burnside, PA-C, Warsaw, Ill
4.17 Ressortez votre diapason! - Get Out The Tuning Fork
Use your tuning fork to localize a suspected fracture in a
patient presenting with an acute musculoskeletal injury. The
patient will have a heightened pain response from the vibration
of the tuning fork when placed over the fractured region.
Maria Bartley, PA-C, Chattanooga,
TN
4.18 Comment mesurer le foie - Finding the Liver Margin
When you are unable to locate the liver margin, place the
diaphragm of your stethoscope on the lowest anterior rib on the
patient's right. Beginning in the right lower quadrant, scratch
with your fingernail along the abdominal wall in the direction
of the stethoscope. When you have reached a solid viscus, the
sound will be magnified greatly. This method may also be used on
the left side to locate the spleen.
Warren J. Stoffey, MS, PA-C,
Murfreesboro, Tenn
4.19 Piquer-toucher - Assessing Pin-prick Sensation
Ever needed to assess pin-prick sensation and not had a
suitably blunted pin at hand? Hypodermic needles should never be
used, owing to the fact that they are intrinsically designed to
puncture skin. Instead, break a tongue depressor obliquely and
use the resulting sharp points to assess this modality of
sensation.
Dave Pothier, Cape Town, South
Africa
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