Name: why physical exams still matter
Uploaded: 2023-04-30T06:35:19.000Z
Duration: 5 min 21 s
Channel: JoVE

K12 Standards

new-york-state-science-learning-standards

New York State Science Learning Standards

High School

Life Science

Structure and Function

HS-LS1-3.

General Approach to the Physical Exam

1. antes de encuentro de pacientes
<ol>
	<li>Preparar la sala de examen para el paciente por desinfectar las superficies tocadas por el paciente anterior (p. ej., mesa de examen); Esto normalmente se hace por personal de apoyo.</li>
	<li>Desinfectar cualquier equipo va a utilizar durante el encuentro (e.g., estetoscopio, martillo de reflejo).</li>
	<li>Lávese las manos con agua y jabón o solución desinfectante tópica.</li>
	<li>Determinar si las precauciones de control de infecciones específicas se necesitan para encontrar la clínica (por ejemplo, precauciones de contacto) y obtener el equipo de protección necesario.</li>
	<li>Trate de calmar su propia ansiedad, como el paciente puede sentirse vulnerable debido a la enfermedad. El paciente es probable que sienta mucho más cómodo si aparece tranquilo.</li>
</ol>
2. entrar en la habitación
<ol>
	<li>Llamar a la puerta y pedir permiso para entrar.</li>
	<li>Introducir usted mismo y su papel.</li>
</ol>
3. paciente privacidad
<ol>
	<li>Pedir a familiares que han acompañado a la paciente a salir de la habitación. Esto proporciona una oportunidad importante para hablar con el paciente solamente. Las peticiones de pacientes que miembros de la familia siguen siendo presente generalmente deben ser respetadas.</li>
	<li>Asegúrese de que las cortinas de la sala de examen se dibujan y las puertas están cerradas.</li>
	<li>Determinar si un acompañante estará presente durante el examen, el cual está bien si el paciente o el proveedor se siente necesario. Esto se realiza en forma estándar para los exámenes de mama genitourinaria y rectal femenina.</li>
</ol>
4. considerar el enfoque
<ol>
	<li>Determinar qué aspectos del examen va a realizar. Esto puede ir desde una evaluación integral, como se puede hacer durante una visita preventiva, para un examen más preciso basado en quejas de los pacientes y su suspicacia clínica para enfermedades específicas.</li>
	<li>Si centrado o completa, el examen debe realizarse de una manera deliberada, activa, constante atención a lo que se busca, en lugar de únicamente un proceso de memorización automática. Alcanzar el estado en que uno es capaz de concentrarse en los resultados, en lugar de sólo el proceso, requiere mucha práctica.</li>
	<li>Planificar la secuencia de la examinación para optimizar la eficiencia y la comodidad del paciente. Usted debe esforzarse por minimizar el reposicionamiento paciente agrupando juntos de maniobras que deben realizarse en una posición en particular. Es útil tener un plan en mente antes de comenzar el examen.</li>
</ol>
5. paciente vestimenta
<ol>
	<li>Asegúrese de que el paciente se viste adecuadamente para el examen previsto. Si es necesario, proveer del paciente una bata y cuelgue.</li>
</ol>
6. otras consideraciones ambientales
<ol>
	<li>Ajuste la altura de la mesa la silla y el examen como sea necesario para optimizar su capacidad para realizar maniobras.</li>
	<li>Ajustar la iluminación y ambiente ruido como capaz.</li>
	<li>El enfoque convencional para el examen coloca el examinador lado derecho del paciente.</li>
</ol>
7. componentes del examen
<ol>
	<li>El examen físico se subdivide en los siguientes componentes regionales, anatómico: encuesta general; signos vitales; cabeza, ojos, oídos, nariz, garganta (HEENT); cuello; pecho; cardiovascular; parte posterior; abdomen; extremidades; neurológica; músculo-esquelético; piel; mama; génito-urinario; rectal; los ganglios linfáticos; estado mental. Hay traslapo substancial entre los componentes.</li>
	<li>Cada examen componente consiste en maniobras que emplean las técnicas de inspección, percusión, palpación y auscultación, cada una de ellas es explorada en detalle en los videos separados. Nuevas modalidades, como la cabecera ultrasonido diagnóstico, se incorporan cada vez más en el examen físico.</li>
	<li>Pedir permiso del paciente para continuar con el examen y en puntos de transición importantes durante el examen (por ejemplo, "ahora que he explicado lo que voy a hacer, ¿puedo empezar el examen?" y "A continuación, me gustaría examinar tu corazón.").</li>
</ol>
8. clínica razonamiento
<ol>
	<li>El examinador debe pesar activamente cómo la presencia o ausencia de resultados particular afecta la probabilidad de enfermedad. Los clínicos experimentados para ello en tiempo real durante el examen.</li>
	<li>Modificar el plan inicial de enfoque basado en los hallazgos encontrados durante el examen. Por ejemplo, mientras que uno puede haber sólo planeaba realizar simple auscultación de los pulmones, la presencia de los ruidos respiratorios disminuidos en un área dada puede incitar al examinador de utilizar técnicas especializadas (e.g., egophony, vocal fremitus).</li>
	<li>La consolidación de la información obtenida durante la historia (los síntomas) y físico (signos) informa los pasos a seguir en la gestión. Tratamiento se puede iniciar si la probabilidad de una determinada enfermedad es lo suficientemente alta, o pruebas adicionales pueden ser solicitados en forma deliberada y racional.</li>
</ol>
9. terminando el examen
<ol>
	<li>Haga que el paciente en ropa regular en la conclusión del examen.</li>
	<li>Es ideal esperar hasta que el paciente se viste otra vez antes de ofrecer sus consejos y opiniones.</li>
</ol>

Este video demuestra el papel que juega el examen físico en el paciente moderno y ha revisado algunos pasos críticos para asegurar el examen se lleva a cabo en forma segura y sensible. Importantes pasos preparatorios antes de la examinación ayudan a reducir el riesgo de infección, así como la ansiedad del paciente y proveedor. Garantizando la privacidad del paciente y usando vestidos y cortinas de una manera sensible también hacen los pacientes se sienten más cómodos. Un enfoque deliberado para el examen que se basa en e...

abordaje general para la exploración física

Fuente: Jaideep S. Talwalkar, MD, medicina interna y Pediatría, Facultad de medicina de Yale, New Haven, CT
El examen del cuerpo es fundamental para la práctica de la medicina. Desde el imperio romano, los médicos han descrito la relación entre alteraciones en la función de partes específicas del cuerpo y Estados de enfermedad específica y han buscado más conocimiento científico para mejorar el diagnóstico de cabecera. Sin embargo, en esta edad moderna de creciente tecnología en diagnóstico médico, es importante considerar el papel que desempeña hoy la examinación física. Es erróneo creer que el examen físico tiene todas las respuestas, y mucho se ha escrito sobre la cuestionable utilidad de ciertas maniobras previamente llevó a cabo en alta estima. Igualmente es un error sugerir que el examen físico poco papel en el encuentro paciente moderno.
El examen físico sigue siendo una valiosa herramienta de diagnóstico; Hay muchos diagnósticos que sólo se pueden hacer por la examinación física. Un diagnóstico realizado por los laboratorios o la proyección de imagen se realiza raramente en ausencia de hallazgos detectables en la cabecera. Como el proveedor lleva a cabo una historia y física, son activamente generando y probando hipótesis para explicar la condición del paciente. La información que uno recoge no puede reemplazar la necesidad de ensayos, pero contar con hipótesis firmes permite el proveedor ordenar exámenes de manera más sensata y más preguntas de las pruebas. Esto, a su vez, tiene el potencial para reducir el riesgo para el paciente y ahorrar coste para el sistema de salud. Por último, el examen físico juega un papel crítico en la relación terapéutica. Al participar en el ritual ancestral de la examinación física, el clínico tiene la oportunidad de desarrollar rapport (demostrando atención y sensibilidad) y promover la curación a través de la utilización deliberada y responsable del tacto.

Abordaje general para la exploración física

Source: Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
The examination of the body is fundamental to ...

El examen físico ha sido fundamental para la práctica de la medicina durante siglos. A pesar de los avances sustanciales en la instrumentación médica, el examen físico sigue siendo una valiosa herramienta de diagnóstico y no se puede exagerar su importancia. A medida que los médicos evalúan la historia clínica y realizan un examen físico, recopilan información que conduce a una hipótesis firme, lo que promueve un enfoque más juicioso para ordenar las pruebas y el análisis de esas pruebas. Esto, a su vez, tiene el potencial de reducir el riesgo para el paciente y los costos de atención médica. Este video ilustrará algunos de los pasos importantes que todo médico debe tomar para garantizar que el examen físico se lleve a cabo de manera segura y sensible. Un examen físico puede ser completo o específico, pero los pasos generales antes y durante cada examen siguen siendo los mismos. Repasemos estos pasos en detalle. En primer lugar, la sala de examen debe estar preparada para el paciente desinfectando las superficies que se utilizarán durante el examen. Además, el médico debe desinfectar el equipo, como el estetoscopio o el martillo de reflejos, que se pueden utilizar durante el examen. Antes de cada examen, lávese las manos con agua y jabón o aplique una solución desinfectante tópica. Si el paciente padece una infección específica conocida, se deben tomar precauciones de control mediante la obtención del equipo de protección necesario. Asegúrese de que los puños de los guantes cubran la bata para que no quede expuesta la piel. Una vez que el paciente esté sentado en la habitación, llame a la puerta y pídale permiso para ingresar a la habitación. Preséntate a ti mismo y a tu rol. Solicite a los familiares o amigos que hayan acompañado al paciente que salgan de la habitación. Esto proporciona una oportunidad importante para hablar con el paciente a solas. Asegúrese de que las cortinas de la sala de examen estén echadas y las puertas cerradas. Al hablar con el paciente, se deben hacer observaciones generales con respecto a la salud del paciente. Estos incluyen la consistencia de la apariencia con la edad indicada, la salud general, el estado de alerta, el afecto, el contenido y la organización del pensamiento y la percepción. Después de esta conversación inicial, determine qué aspectos del examen son necesarios. Asegúrese de que el paciente esté vestido adecuadamente para el examen planificado. Si es necesario, proporcione al paciente una bata y un paño y dele algo de tiempo para cambiarse. Después de un tiempo, llame a la puerta y pida permiso al paciente para entrar en la habitación. Solicitar al paciente que ocupe la mesa de exploración. Ajuste la parte posterior de la mesa de examen según sea necesario para optimizar su capacidad para realizar maniobras. El examen físico se puede subdividir en los siguientes componentes: encuesta general, medición de signos vitales, examen del funcionamiento neurológico y del estado mental, examen de la cabeza, ojos, oídos, nariz, garganta, tórax, pulmones, ganglios linfáticos, cardiovascular, abdomen, musculoesquelético, piel, genitourinario y rectal. Un acompañante puede ser necesario si se va a realizar un examen sensible como exámenes genitourinarios, rectales o de mama. Explique al paciente el examen físico que se va a realizar y pídale permiso para continuar con el examen. "Ahora que he explicado lo que voy a hacer, ¿puedo continuar con el examen?" Cada examen consiste en maniobras que emplean las técnicas de inspección, percusión, palpación y auscultación, cada una de las cuales se explora en detalle en videos separados de esta colección. Debe esforzarse por minimizar el reposicionamiento del paciente agrupando las maniobras que deben realizarse en una posición en particular. Una vez finalizado el examen, solicite al paciente que vuelva a ponerse ropa normal. Lo óptimo es esperar a que el paciente se vuelva a vestir antes de ofrecer consejos y opiniones. Posteriormente, sopesando cómo la presencia o ausencia de hallazgos particulares afecta la probabilidad de enfermedad y consolidando la información obtenida de la historia clínica y el examen físico del paciente, se puede decidir iniciar una terapia u ordenar pruebas adicionales de manera deliberada y juiciosa. Acaba de ver el video de JoVE sobre el enfoque general del examen físico. Este video revisó la importancia del examen físico en el encuentro con el paciente moderno y demostró algunos pasos críticos para garantizar que el examen se lleve a cabo de manera segura y sensible. Los pasos preparatorios importantes antes del examen ayudan a reducir el riesgo de infección, y un enfoque organizado de las maniobras que se realizan minimiza la necesidad de reposicionar al paciente innecesariamente. Dado el énfasis reciente en la contención de los costos médicos, la seguridad del paciente y el acceso a los servicios, el examen físico sigue siendo barato, ampliamente disponible y conlleva poco riesgo de efectos adversos. Como siempre, ¡gracias por mirar!

Education

Educación

JoVE Science Education

Clinical Skills

Habilidades Clínicas

Physical Examinations I

Exámenes físicos I

why physical exams still matter

Physical examination remains an important part of medicine. Doctors have used the body exam for centuries to connect changes in body function with disease. Even with modern imaging and lab tests, the bedside exam still helps clinicians understand what may be happening in the patient.

Physical examination is not a replacement for tests, and it does not answer every question. Some maneuvers that were once highly valued may have limited usefulness. Still, many conditions can only be found through physical examination, and diagnoses made with labs or imaging usually begin with findings from the bedside.

As a provider performs the history and physical, they form and check ideas, or hypotheses, about the patient’s condition. These ideas help guide which tests to order and which questions to ask next. That can make testing more focused, reduce risk for the patient, and help lower health care costs.

The physical exam also supports the therapeutic relationship. By using careful and respectful touch, the clinician can show attention and sensitivity. This process can build rapport and may help promote healing during the patient encounter.

Why Physical Exams Still Matter

general approach to the physical exam

Physical examination remains an important part of medicine. Doctors have used the body exam for centuries to connect changes in body function with disease. Even with modern imaging and lab tests, the bedside exam still helps clinicians understand what may be happening in the patient. Physical examination is not a replacement for tests, and it does not answer every question. Some maneuvers that were once highly valued may have limited usefulness. Still, many conditions can only be found through...

observation and inspection

Clinical Observation in Physical Exam

Clinical observation is the starting point of a physical examination and begins at the first contact with a patient. Observation is a broad term for using the senses carefully to gather information. Inspection is a narrower term. It refers to what can be seen with the eyes, especially on the surface of the body, rather than to behavior. Skilled clinicians use more than sight when they examine a patient. They also rely on touch, through palpation and percussion, and on hearing, through...

palpation

How Hand Position Guides Palpation

Palpation uses touch to collect diagnostic information during the physical exam. It is one of the ways a healthcare provider uses the senses to learn more about a patient. The part of the hand used for palpation changes depending on the body area being examined. Finger pads are best for fine detail. Their dense sensory nerves help the examiner feel small features, such as the borders of masses or lymph nodes. The back of the hand, also called the dorsal surface, gives a rough sense of relative...

percussion

Clinical Percussion and Body Sound

Clinical percussion uses tapping to create sound and help assess what lies beneath the body surface. It is a simple bedside technique that depends on the way sound changes when it travels through different tissues. The method began with Leopold Auenbrugger, an Austrian inn-keeper's son, who found that tapping beer barrels could help him take inventory. He later applied the same idea to patients in Vienna and published the first description of its diagnostic use in 1761. Jean-Nicolas Corvisart...

auscultation

Stethoscope Sounds in Clinical Exam

Auscultation is a clinical exam method that lets a provider listen to sounds inside the body. Doctors use it to gather important diagnostic information from the chest, heart, abdomen, and blood vessels. For many years, auscultation meant immediate auscultation. In that method, the examiner placed an ear directly on the patient's skin. This approach was used for centuries, but it became less useful in nineteenth-century France because of social norms and poor diagnostic yield. René Laënnec...

proper adjustment of patient attire during the physical exam

proper-adjustment-of-patient-attire-during-the-physical-exam

Draping for a Better Physical Exam

Draping is an important part of a careful physical exam. It helps the provider examine the right body area while also protecting patient modesty. Good draping takes practice because the examiner must balance exposure with comfort. Correct technique also improves the accuracy of the exam. Skin lesions can be missed if inspection is done through clothing. Lung crackles may be reported by mistake when the chest is examined through a T-shirt, and subtle heart findings can be missed when...

blood pressure measurement

Manual Blood Pressure Reading Steps

Blood pressure reading uses an indirect method to measure the pressure of blood against vessel walls. Blood pressure, or BP, is a vital sign that is checked routinely in hospital and outpatient settings. It is one of the most common medical assessments performed around the world. The indirect method is non-invasive, safe, and easily reproducible, so it is used most often. BP can be measured automatically by oscillometry or manually by auscultation. Auscultation uses a sphygmomanometer, which...

measuring vital signs

Vital Sign Ranges and Patient Status

Vital signs are objective measurements that show a patient’s clinical status. The commonly accepted vital signs are blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. In many practices, pain is also treated as the sixth vital sign and is documented with the others. Pain is different from the other vital signs because it is a subjective measurement. That means the pain scale can vary from one patient to another. A vital signs assessment includes heart rate, blood...

respiratory exam i: inspection and palpation

respiratory-exam-i-inspection-and-palpation

Checking Breathing Distress by Exam

Respiratory exam starts with looking for breathing distress and feeling the chest. Shortness of breath is a common reason for both outpatient and inpatient evaluation. Early inspection can reveal fast breathing or cyanosis, which is a bluish color change that can signal low oxygen. If a patient shows respiratory distress, the situation needs urgent attention and oxygen therapy. In many cases, careful clinical examination can help identify lung problems without relying only on tests. This is...

respiratory exam ii: percussion and auscultation

respiratory-exam-ii-percussion-and-auscultation

Respiratory Exam: Lung Sounds and Percussion

Respiratory exam skills include percussion and auscultation of the lungs. These techniques help identify lung problems during a physical exam. Percussion uses tapping to assess the chest, and auscultation uses a stethoscope to listen for breath sounds. Percussion is a useful skill that is often skipped in routine clinical practice. When it is done correctly, it can help a physician detect underlying lung pathology. Auscultation can also give an almost immediate clue to several acute pulmonary...

cardiac exam i: inspection and palpation

Cardiac Exam I: Checking the Chest First

Cardiac exam inspection and palpation are the first steps in a careful heart assessment. These steps help a physician gather useful information before using a stethoscope. They are part of the core examination performed when a patient is first seen. Heart and circulatory disorders are common reasons for hospital admission. They can include conditions such as myocardial infarction and congestive heart failure. Because of this, learning a complete cardiac examination is important for any...

cardiac exam ii: auscultation

Listening for Normal and Abnormal Heart Sounds

Heart auscultation uses a stethoscope to listen to heart sounds and check for normal and abnormal patterns. For physicians, knowing how to hear these sounds and tell them apart is an essential skill. The sound heard at each spot on the chest relates to the closing of specific heart valves. The heart has two main sounds, called S1 and S2. S1 happens when the mitral and tricuspid valves, which are the atrioventricular valves, close after blood enters the ventricles. This marks the start of...

cardiac exam iii: abnormal heart sounds

Heart Murmurs and Gallop Sounds

Heart murmurs and gallop sounds are abnormal heart sounds that can be heard during auscultation, or listening to the heart with a stethoscope. A good understanding of normal heart sounds is the first step in telling normal sounds apart from abnormal ones. Murmurs usually have a swishing quality and point to turbulent blood flow across a heart valve. Murmurs can happen because a valve is too narrow, which is called stenosis, or because blood leaks backward across the valve, which is called...

peripheral vascular exam

Assessing PAD and Venous Signs

Peripheral vascular disease can affect blood flow in the arms and legs, and careful exam steps help reveal signs of disease. Peripheral artery disease (PAD) is linked to cardiovascular and cerebrovascular complications. Risk factors include diabetes, hyperlipidemia, hypertension, and tobacco use. Symptoms may appear as limb claudication, which is cramp-like muscle pain that gets worse with activity and better with rest. Chronic venous insufficiency (CVI) can cause lower extremity swelling,...

peripheral vascular exam using a continuous wave doppler

peripheral-vascular-exam-using-a-continuous-wave-doppler

Bedside Doppler for Leg Blood Flow Checks

Peripheral vascular disease affects the arteries and veins outside the heart, and it is common in older adults. History and physical exam can suggest the diagnosis, but Doppler ultrasound is now a routine part of the bedside vascular exam. This lesson focuses on bedside assessment of peripheral arterial disease and chronic venous insufficiency with a handheld continuous wave Doppler. A handheld Doppler is a simple tool that sends and receives ultrasound at the same time. It detects changes in...

physical examinations i

Esta colección proporciona una base para realizar la exploración física; con técnicas que van desde la medición de la presión arterial o signos vitales, hasta la exploración pulmonar y cardiovascular.

Learn why the physical exam remains a key part of medicine, from bedside diagnosis and hypothesis testing to building patient trust and rapport.

Why Physical Exams Still Matter | JoVE K12

Jaideep Talwalkar

Internal Medicine

Yale School of Medicine

Overview

General Steps During Any Physical Examination

Summary

Characteristics of Life

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In molecular biology, ligation refers to the joining of two DNA fragments through the formation of a phosphodiester bond.  An enzyme known as a ligase ...

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Explant Culture for Developmental Studies

Explant culture is a technique in which living cells or tissues are removed from an embryo for continued development outside of the organism. This ex vivo ...

DNA Methylation Analysis

Methylation at CpG dinucleotides is a chemical modification of DNA hypothesized to play important roles in regulating gene expression. In particular, the ...

Expression Profiling with Microarrays

Microarrays are important tools for profiling gene expression, and are based on complementary binding between probes that are attached to glass chips and ...

Density Gradient Ultracentrifugation

Density gradient ultracentrifugation is a common technique used to isolate and purify biomolecules and cell structures. This technique exploits the fact ...

F&#246;rster Resonance Energy Transfer (FRET)

F&#246;rster resonance energy transfer (FRET) is a phenomenon used to investigate close-range biochemical interactions. In FRET, a donor photoluminescent ...

detecting-environmental-microorganisms-with-polymerase-chain-reaction

Detecting Environmental Microorganisms with the Polymerase Chain Reaction and Gel Electrophoresis

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - Arizona University
Demonstrating Author: Bradley Schmitz
Polymerase chain reaction (PCR) is ...

Gel Purification

Gel purification is used to recover DNA fragments after electrophoretic separation. DNA recovery from an agarose gel includes three basic steps: binding, ...

Detecting Reactive Oxygen Species

Reactive oxygen species are chemically active, oxygen-derived molecules capable of oxidizing other molecules. Because of their reactive nature, there are ...

Gene Silencing with Morpholinos

Morpholino-mediated gene silencing is a common technique used to study roles of specific genes during development. Morpholinos inhibit gene expression by ...

development-and-reproduction-of-the-laboratory-mouse

Development and Reproduction of the Laboratory Mouse

Successful breeding of the laboratory mouse (Mus musculus) is critical to the establishment and maintenance of a productive animal colony. Additionally, ...

Construct an explanation based on evidence for how the structure of DNA determines the structure of proteins which carry out the essential functions of life through systems of specialized cells.

HS-LS1-1.

Why Physical Exams Still Matter

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