I'm doctor Zakowski. Today we're going to conduct
the complete physical exam, and Steve is our patient today. I'll start with an introduction, and I'll talk as
we're going along about what I'm doing and why I'm doing it to help you better understand all the parts
of the physical exam. First, I'll begin with
the introduction. I'm going to demonstrate
it as though I were a student and how you should introduce yourself to the
patient at the beginning. Hi. I'm Lauri Zakowski. Hi, I'm Steve Clark. Is that okay if
I call you, Steve? Please do. I'm a medical student today, and I'm going to conduct
the complete physical exam, and then doctor Smith will
come in and talk with you and conduct parts of the exam
also. Is that okay with you? Certainly. All right. Now,
to begin, first, I'm going to just make sure
that you're comfortable. Is everything here all right in terms of warmth? Are
you warm enough? I'm fine. And I have the
door shut here, so nobody should come in. Good. A. Now I'm going to wash
my hands first as I start. It's perfectly acceptable to use alcohol hand wash
or soap and water, whichever is easiest for you. As you start with
alcohol handwash, your hands are usually a
little bit cold and wet and you can apologize to
the patient if that's true. Now, first, I'm going to
just take a look at you in terms of looking first
at skin of the face, looking at general appearance, seeing if there's
any signs of anxiety or depression,
facial expressions. Also looking at general
hygiene is very helpful. That can indicate
that there may be a problem with the
environment at home or again, may relate back to mental
health issues also. I've looked generally,
Steve looks comfortable. He said he's
comfortable. So move ahead into the physical exam. Starting first with vital signs. I'm going to check pulse. I'm going to check
here just on one side. I have my two fingers, my first and second finger here, press just above the thumb here and I can feel
a radial pulse. And as I'm checking that, I'm going to count for 30 seconds, and I'm watching my watch here. And after 30 seconds
have elapsed, the number that I have,
I multiply by two, and that will give me his pulse. Now as I just complete that, I will also check
respiratory rate. And this is either
visualization, watching Steve's
chest rise and fall, and counting respirations that
way again for 30 seconds, again, multiplying by two. I sometimes will leave
my hand right on his wrist as though I'm
checking his pulse because it's very easy for someone to be distracted by me checking the respiratory rate and
they may increase or decrease their respiratory rate unconsciously as I'm watching. Just watch there.
And then I'll report to the physician what the respiratory rate
and the pulse are. So next, I'm going to
check the blood pressure. This involves several
steps and I'll explain what I'm doing
as I'm going along. First, if you look at the
blood pressure cuff here, there's a mark here that says
where the artery should go. This is where the
brachial artery should sit just under
the blood pressure cuff. The cuff also towards
the end has a range. This is the size that says that it'll fit on
this person's arm. There's larger and smaller
blood pressure cuffs and we'll know once we
put it on Steve's arm, whether it's too big
or not big enough. First, I'll locate on his arm where the
brachial artery is. Always sits here on the
medial aspect of his arm. It's a fairly good pulse. If you can't feel
it, have the patient bend his arm just a little
bit more until you find it. Then put the blood
pressure cuff right over that spot where the
brachial is fairly close. It doesn't have
to be right over, but as long as
it's in that area. Then wrap it around
fairly firmly. And you see here, the range shows that the end of
your blood pressure cuff where the Valcro is attaching is in the
appropriate range here. Now, the next step that
I'll do is the ball here, when I squeeze the ball, it pumps air into the
blood pressure cuff. There's a screw
here that turns to the right that'll not let
air escape from this area. As I squeeze the ball,
the air goes here, but does not escape. And then once I turn
the screw to the left, then it'll let air escape out
of the blood pressure cuff. My first step will
be to pump air in, and then of course, I'll
be letting air out. I'll be using my
stethoscope in order to hear the turbulence of flow
through the blood vessel. That turbulence is what
measures the blood pressure. When the blood first begins
to flow through the artery, and I can hear that turbulence
with my stethoscope. I hear a pumping sound, of course, sounds like
the heart pumping. That's the systolic pressure. Then as I let the blood
pressure cuff down, that sound of the heart
pumping will disappear. That's the diastolic pressure. That's what the artery is
pressing up against the heart. Now, so I'll listen with my
stethoscope in a moment. So I'm getting everything ready here because what
I want to do is pump up the cuff until the pulse disappears
under my fingers. Once that happens, then I'll start listening with
my stethoscope. So I have everything ready here, so I don't need to
fumble around too much. Now what I will do. First turn this. Put my hand right over the brachial artery. Make sure the screw is
turned to the right. Not too tight, I want to be
able to loosen it again. So I turn it just till it's just tight enough that
air won't leak out. Then I'll watch my
monitor on the back wall. As soon as the pulse disappears, I'll go up about 20 or 30 millimeters of
mercury above that. Then I'll put my stethoscope
in the same place my hand was and loosen the screw here so that there's about
two to 3 millimeters of mercury let out per pulsation. And I heard the blood
pressure first at about 130, I heard pulse, and it
disappeared at about 88. Now I'm letting the
screw down all the way to let all the air out
of the blood pressure cuff. So his blood pressure
is about 130 over 88. Now, I'll take this off again. And that concludes
the vital signs.