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Head to toe (part 4)

The fourth video section covers examination of neck and upper limbs (arms and hands).
This fourth video section considers the examination of the neck, arms and hands. Whilst you are watching, think about when you might find a deviated trachea. Right, now I am going to examine your neck, ok, so I am just going to move around to the back. Could you turn to look this way for me, and then to this side. I inspect the neck for symmetry and smoothness, assess the range of motion of the neck and listen for crepitus. Any problems there? No. Just relax. Now I want you to shrug your shoulders up for me and then relax and do it again but don’t let me stop you. OK smashing.
Now I want you to push your face against my hand and turn your head towards it. Thank you. Resisted turning of the head and shoulder shrug test cranial nerve 11. Now I would like to just feel your thyroid. A thyroid gland should not be palpable except on swallow, then should be smooth to the touch. And I want you to swallow for me. The trachea should be central. Thank you, and while I am here I am going to check the glands, so we are going to start under your chin. Lymph nodes are only palpable when enlarged. And under here. Right at the back of your head and could you shrug your shoulders for me again. And then just down inside there.
That’s lovely, thank you. I just need to do one more thing on your neck, if you just lift your head a little bit for me, I’m going to feel down here it may be a little bit uncomfortable. That’s super, thank you. I am now going to examine your arms and hands. Can I see your hands please, thank you? Inspecting the hands, feeling the warmth and looking for peripheral cyanosis, palmar erythema and muscle wasting. Just check your nails.
Checking the nails for signs of splinter haemorrhages which may indicate endocarditis, koilonychia a sign of iron deficiency anaemia, Leukonychia, usually caused by injury to the nail bed but may be due to kidney failure or respiratory disease, or clubbing, a sign of cardiac respiratory or gastrointestinal disease. Can you put your fingers like that? Thank you very much. Can you make fists for me? Lovely. Now open your hands and squeeze my fingers tightly. Excellent. Now splay your fingers apart and don’t let me push them together. By demonstrating the movements as well as saying what we want, we eliminate confusion. That’s excellent. Bring your wrists back like this, don’t let me pull them down.
Bring your wrists down and don’t let me pull them up. Put your arms up like that. Now pull me towards you and push me away. Bring your arms out to the side and then down and then do it again and don’t let me stop you. Seeing the range of movements then testing the strength saves the patient from having to do each movement multiple times and allows us to assess a range of myotomes. Now I want to test for sensation of your hands and arms as we did for your face, so I want you to close your eyes. Can you feel me touching you there? Yes. Does this feel the same as this? Yeah.
Bring your hands out, keep your eyes closed. Can you feel me touching you there? Yes. Does it feel the same as there? Yes. Can you feel me touching you there? Yes. Does it feel the same as there? Yeah. Can you feel me touching you here? I can. Does it feel the same as that? Yes. Can you feel me touching you here? Uh hum. Does it feel the same as that? Yeah. Lovely, thank you. You can open your eyes. We are just going to check your pulses. I assess the radial pulse for one minute feeling the rate and quality of the pulse then compare with the other radial. I compare one to the other.
And then if you roll your arms out I am just going to check for the pulses further up. Next, I palpate each brachial pulse. If the blood pressure was lower than 80mm of mercury the radials may not be palpable. Excellent. That’s have a look at these arms and just relax your arm and let me move it around for you. That’s lovely. No problems with any of the fingers or your wrist or any of the joints? Your elbow ok? Yeah. Lovely and your shoulder? Yeah, it’s ok. No problems there? No. OK. Lovely and we will just do that with the other side. No problems with this one? No. And your shoulder. OK, that’s lovely.
Now we are going to do some observation, so I am just going to fetch the blood pressure machine. At this stage, I would go onto check the blood pressure in both arms, the temperature, the pulse oximetry, blood glucose and urinalysis, if appropriate. Let’s put this on one arm. Lovely. Relax that one down. And on one finger of your other hand. That’s lovely, rest your hand down. That’s lovely, thank you. So, what I want you to do is to close your eyes for me and put your hands out. I am going to put an object in each hand and I want you to tell me what it is, feel it with your fingers.
The ability to identify objects placed in the hand shows the patient can perceive and integrate a variety of sensory signals. It’s a coin. And in this hand? Pen. Thank you. OK, now open your eyes and now we have got one more test. I want you to put your finger out and touch my finger, then put it to your nose and touch your nose and then keep going to my finger wherever I move it as fast as you can. Lovely. Difficulty in completing this task indicates cerebella problems. And now swap hands. Lovely, thank you.
Having covered examination of the ears, nose, mouth and throat in the previous step, watch this video (4/6) where we cover examination of neck and upper limbs (arms and hands).

Your task

When might you find a deviated trachea?
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