Ultimate RMC #1 - Patient Assessment Tools

[Reasonable Rascal]

Okay, here we go. For those just joining us please see initial thread here for the Rulz of this game.

Patient Assessment Tools - the items you want/need to perform a thorough assessment of your patient.

We want to be accurate and thorough, because we are in this for the long haul. There is no functioning hospital in the next valley, or you cannot get to it for whatever reason (bridge washed out last fall and it's a 231 mile detour to get to it via the closest open route, and your buggy has a busted axel). You may be assessing for the presense of a greenstick fracture in a kid or diabetic neuropathy in an older person.

Remember, no grid power is available. You have batteries of course (AA, C, D, etc), and if you wish you have a generator but it isn't built to run 24/7 and it won't come close to powering a CT scanner.

I'll start with a couple basic items and let you folks jump in.
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1. Tuning fork

Used to assess bone continuity, sensitivity to vibration (neuro function) and hearing

2. Visual acuity chart

Sometimes called Sloan letters. Set up 20 feet from subject to determine relative acuity of 20/16 to 20/80.

3. Reflex hammer

Percussion of the body as well as checking reflexes. Not to be used for emergency anesthesia. :D

RR

[RESQDOC]

Patient Assessment:

1. High quality stethoscope such as Littman Master Cardiology, Cardiology II or III. While you certainly can listen to lung sounds, heart tones, bowels with your ears this is much easier with a ‘scope. Also works well with the tuning fork or 2-coin test for long bone injuries, the stethoscope head can be used as a percussion hammer, and the tubing can be used for chest tubes, etc. This is the single most important tool available. It’s invention revolutionized the art and science of diagnosis.

2. Otoscope with flashlight head, prefer the Corpsman ENT Kit, which includes eye, & ear speculum, eye staining filter, etc. Ophthalmoscope head would be good but not useful unless you know what you are looking at, so very optional. In my medical antique collection I have an otoscope that uses mirrors and an external light source like the sun or a candle. Nothing like this is currently available, but should be. The otoscope is needed for looking in whatever body cavity is in question, staining & treating eye injuries, transillum lesions/testicles, etc.

3. Glass thermometer, prefer extended range model that reads higher & lower than standard model. Drop proof case! Needed for following infectious disease, intercranial injury, hypo/hyperthermia, etc.

These three plus your eyes, ears, nose, hands, and brain will give you an excellent bedside diagnostic capability.

[rd_rnr]

I would not forget a good BP cuff.Actually,make sure that you also have a peds cuff and a large adult cuff to cover everyone that you may help.Just my 2 cents.

[walz]

I agree on the Otoscope, mine is a WelchAllyn CompacSet which is very small, has a otoscope on one end and an Ophthalmoscope (with all the typical filters) on the other that fold neatly into the case. Visual quality is as good as a full-sized unit. Has a small compartment for ear speculums on the back and uses two AA batteries. The heads also pop off to give a very bright pen-light. One small unit that serves like 3!

[Reasonable Rascal]

1. Head mirror - the old fashioned kind that reflected ambient light, was worn using a headband, and had a hole in the center to peer through. Largely replaced these days by AC powered headlamps.

2. Watch! How are you going to get accurate pulses without a watch. Some find sweep second hand watches easier to use than digitals (I don't) but a wind-up watch alleviates the problem with the battery going dead.

3. Pupil guage - I've always found it easier to have a handy guage for measuring pupil size rather than estimate.

Next player.

RR

[themadmedic]

Agree strongly with otoscope/opthmaloscope...and a stethoscope.
Would add flourescein stain to use in evaluating possible corneal abrasions, and hemoccult testing kits for use in finding blood in trauma and some medical problems...