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TROUVAILLES ET ASTUCES
Index général IV. AIDE A L'EXAMEN CLINIQUE - HINTS FOR CLINICAL EXAMINATION
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 spontaneouslyDrowsy = Eyes opening on verbal commands onlyStuporous = Eyes opening on painful stimuli onlyComatose = 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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