CPH ACT 13

• Principal symptoms

  Symptoms with duration and describe the symptoms
• History taking

  1. Inquire the sequence of symptoms and events

  2. Ask leading questions in the beginning of the event
• Important points in history taking

  • Look confident
  • Greet the patient
  • Introduce yourself
  • Ask questions to find out what happened
  • Patients are comfortable
  • Confirm name, age and occupation
• Sequence in history taking

  1. Chief complaints (concise statement)

  2. Symptoms

  3. Problems and condition why visited the clinic

  4. History of present illness (when was she feeling well, what happened, describe the symptoms in chronological order)

  5. Past history (past illness, operations, medications, hospitalization, family history, personnel and social history)
• Chest pain

  • Site of pain, onset, acute or gradual
  • Character: feeling pressure, dull, stabbing or shooting
  • Radiation
  • Severity: Does it interfere with work or sleep
  • Precipitating and relieving factors
  • Associated with other symptoms
• General examination

  • General appearance (ill, alert, confused, drowsy, happy or sad, cooperative, obese, muscular, wasted, in pain or distress, alertness, mood, behavior)
  • Hands and nails
  • Radial pulse and blood pressure
  • Lymph node
  • Faces, eyes, tongue
  • Extremities
• Remember to thank the patient at the end of the examination
• Additional questions and clarification
• Vital signs

  Temperature, pulse, respiration, blood pressure (reflect body's physiological status and provide information important in evaluating homeostatic balance)
• Temperature

  • Clinically the hotness or coldness of the body
  • Balance between heat production and heat loss of the system
  • Core temperature (temperature of internal organ, 36.5 to 37.3 degrees celsius)
  • Surface temperature (temperature of the skin, subcutaneous tissue and fat cells, rises and falls in response to the environment)
• Alteration in body temperature

  • Pyrexia (temperature above 37.8 degrees celsius)
  • Hyperpyrexia (very high, more than 41 degree celsius)
  • Hypothermia (between 34 degrees celsius to 35 degrees celsius, less than 34 degrees celsius that can lead to death)
• Types of fever

  • Intermittent (alternate at a regular intervals between period of fever and normal temperature)
  • Remittent (wide range of fluctuation more than 2 degrees celsius which occurs over 24 hours period all of which are above normal)
  • Relapsing (short periods of few days are interspersed with periods of 1 or 2 days of normal temperature)
  • Constant (fluctuates minimally but always remain above normal)
• Oral temperature

  • Less than 0.65 less than rectal and 0.65 greater than axillary temperature
  • Advantages (easy access and patient comfort)
  • Disadvantages (can lead to false reading if the person has taken hot or cold drinks or food, temperature can vary: had smoke or maybe after eating, wait for 10-15 mins without eating before taking the temperature)
• Rectal temperature

  Reflects core body temperature, more accurate, most reliable, disadvantage (injury, needs privacy)
• Axillary temperature

  Recommended for infants, safe and non invasive, disadvantage (long time, less accurate because far from major blood vessels, least reliable of all sites)
• Pulse

  Wave of blood created by the contraction of left ventricle, reflects the heartbeat, regulated by the autonomic nervous system, two factors influencing (stroke volume, compliance of arterial wall)
• Peripheral pulse

  Foot and neck
• Apical pulse

  Beats per minute (BPM), pulse deficit (the difference between peripheral and apical pulse = 0)
• Palpation and auscultation of pulse

  Assessed for rate, rhythm, volume, elasticity of arterial wall
• Adult pulse

  Tachycardia (>100 BPM), bradycardia (< 60 BPM)
• Pulse sites

  • Carotid (neck)
  • Apical (infant and children below 3 yrs old, left mid clavicular line under the fourth, fifth, sixth intercostal lines)
  • Brachial (interaspect of the biceps of the arms or medially in the antecubital space)
  • Radial (located at the thumb side in the inner aspect of the wrist)
  • Femoral (located along the inguinal ligament, infants and children)
  • Popliteal (behind the knee)
  • Posterior Tibial (located in the median surface of the ankle)
  • Pedial (located at dorsum of the feet)
• Respiration

  Respiratory rate (act of breathing, the intake of oxygen and removal of CO2), ventilation (movement of air in and out of the lungs), hyperventilation (slow or shallow respiration)
• Types of breathing

  • Costal (thoracic, movement of the chest upward and downward)
  • Diaphragmatic (abdominal, contraction of diaphragm and observed by the movement of abdomen, children)
• Factors affecting respiration

  • Age (normal growth of infancy to adulthood = larger lung capacity, increased lung capacity = decreased respiration rate at sufficient)
  • Medication (narcotics = increased respiration rate and depth)
  • Stress (strong emotions = increased respiration rate and depth)
  • Exercise (increased respiration rate and depth)
  • Altitude (increased rate and depth)
  • Gender
• Respiration rate

  Normal health adult = 15-20/min, measured in full minute, decreasing age = increased respiration rate, eupnea (normal breathing rate and depth), bradypnea (slow respiration), tachypnea (fast respiration), apnea (temporary stop of breathing)
• Blood pressure

  Force exerted by the blood against the walls of the arteries, expressed in mmHg, systolic pressure (maximum pressure against the wall of the vessel following ventricular contraction), diastolic pressure (minimum pressure of the blood against the walls of following closure of aortic valve), normal value: 120/80 mmHg
• Sites of blood pressure measurement

  • Upper arm (brachial artery)
  • Thigh (popliteal artery)
  • Forearm (radial artery)
  • Leg (posterior tibial or dorsal pedis)
• Equipment for blood pressure measurement

  Sphygmomanometer and stethoscope, blood pressure cuff sizes, parts of stethoscope
• Procedure for blood pressure measurement

  1. Explain the procedure to the patient

  2. Make sure that the client has not smoked or ingested caffeine within 30 mins prior to measurement

  3. Position the patient on lying or sitting

  4. Ensure that sphygmomanometer is at the level of the heart and palm facing upwards

  5. Apply cuff securely around the arm 2.5cm above the antecubital space/fossa

  6. At the level of the heart palpate the pulse (brachial or radial)

  7. Inflate the cuff until radial pulse can no longer be felt (estimation of systolic pressure)

  8. Inflate the cuff 30mmHg higher than the estimated systolic pressure

  9. Position stethoscope over the brachial artery

  10. Deflate the cuff 2-4 mmHg per second

  11. The first pulse heart is the systolic reading

  12. Continue to deflate until there is a change in tone to a muffled beat, last beat is the diastolic reading

  13. Deflate and remove the cuff

  14. Record the systolic and diastolic pressure

  15. Return all equipment
• First aid


  Immediate care after an accident or illness prior to the arrival of expert
• First aid does not take the place of proper medical treatment, but it can save a person's life
• Three P's of first aid

  • Preserve life
  • Prevent worsening
  • Promote recovery
• Preserve life


  1. Carry out emergency first aid procedures

  2. Preserve own life (never put yourself or others in danger)

  3. If situation is too dangerous, stay back and call for professional help
• Prevent worsening


  1. Prevent further injuries

  2. Make area safe

  3. Dress wounds

  4. Support fracture

  5. Remove casualty from danger
• Promote recovery


  1. Arrange prompt emergency medical help

  2. Perform simple first aid to avoid long-term risk

  3. Treat injury to resolve issue in best possible way

  4. Perform CPR

  5. Apply bandages and first aid treatment
• Roles of first aider

  • Protect from danger
  • Identify the illness or injury
  • Decide on priorities of care
  • Ensure dignity of the patient
  • Transport as appropriate
  • Good communication skills
  • Good documentation
• Types of danger


  • Environmental danger (chemicals, broken glass, falling masonry, broken glasses, moving cars)
  • Human danger (danger from people on the scene, health workers - body fluids can carry infection and disease and cross contamination)
• Principles of first aid


  • First, do no harm
  • First aid is not an exact science and is open to error
  • First aid is about putting first things first
  • Safety is of utmost importance in first aid
• Principle 1 - First, do no harm


  • Know what to do but what not to do
  • Provide comfort and assurance to the casualty
  • Do not use treatments you are not sure about
  • Provide treatments most likely to benefit the casualty
• Principle 2 - First aid is not an exact science and is open to error


  • Great variations in terms of methods and practices
  • Casualty may not respond as you hope no matter how hard you try
  • Don't feel bad if the casualty doesn't respond