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A physical assessment should be a structured approach to investigating one particular body system. In the pre hospital setting the end of bed assessment is typically determined from initial contact and during the history taking (Talley and O’Conner, 2001). The patient was observed to be alert, orientated, pale in complexion without obvious signs of cyanosis or jaundice and exhibiting slight work of breathing. There was no significant odour that could be suggestive of incontinence, infection or excess diaphoresis (Fitzgerald and Tierney 1982).
Due to the similarity in many aspects of both the respiratory and cardiovascular examination it was deemed appropriate to combine them. The examination was briefly explained to the patient in order to allow informed consent. Examination of the hands and nails failed to identify any clubbing, splinter haemorrhages or other abnormal nail presentation. Bilateral pulses were checked for rate, intensity, rhythm and volume with no abnormalities identified. Purposeful examination of the face was omitted as this had been performed discreetly during the history taking and no signs of oedema or anaemia noted. Due to the environment it was not possible to examine the jugular vein for distension, a notable absence given the significance in assessing right sided cardiac dynamic (Chua Chiaco et al, 2013).
A visual inspection of the chest was performed to identify work of breathing, chest dissymmetry or bruising. The chest wall was then palpated to elicit tenderness, chest expansion or subcutaneous emphysema, indicators of chest trauma (Aghajanzadeh et al, 2015). During palpation of the chest both heaves and thrills were sought but not found. Again the environment prevented effective assessment of the apex beat however Ehara et al (2011) question the significance of this measure, a finding that opposes traditional beliefs. Percussion was performed, ensuring the intercostal space was identified. A bilaterally equal resonant percussion note was detected in all fields. Walker, Hall and Hurst(1990) suggest it is important to not only assess the note but also interpret the frequency and intensity.