CPC salient points

• Muscle strength testing and grading

  1. Performed symmetrically, simultaneously asking the patient to push against resistance (usually start with arms then legs)

  2. Scale: 0/5 = No muscle twitch with attempted movement

  3. 1/5 = The muscle can be seen to twitch but no movement at the joint is seen

  4. 2/5 = Movement occurs in the horizontal plane but not against gravity

  5. 3/5 = Movement against gravity but not resistance

  6. 4/5 = Movement against some resistance

  7. 5/5 = Movement against full resistance
• First Aid Review


  • Shock section
  • Amputation section
  • Triage section
• Shock management


  1. A-B-C's: airway; breathing; circulation

  2. Causes of shock

  3. Major types of shocks- hypovolemic; cardiogenic; anaphylactic; fainting
• Amputation management


  1. Manage A-B-C's & call 9-1-1

  2. Apply direct pressure to stump

  3. Wrap body part in a dry, clean cloth

  4. Place wrapped part into a plastic bag and seal

  5. Place sealed bag into icy cold water

  6. DO NOT PUT AMPUTATED PART DIRECTLY INTO WATER OR ON ICE
• Triage


  The action of sorting victims of disaster in order to determine who needs immediate care and transportation to the hospital, or could be delayed
• Disaster


  Any situation that taxes emergency resources
• Screening for possible newborn sepsis

  1. Mother should undergo speculum exam during 34-36 weeks of gestation, that includes a group B beta (GBS) to assess maternal colonization

  2. Treat with intrapartum antibiotic prophylaxis (IAP) during labor

  3. Most common organism causing newborn sepsis is GROUP B STREPTOCOCCUS

  4. Another common etiologic agent for neonatal sepsis is ECOLI

  5. Evaluate for sepsis to newborns who appear ill or asymptomatic newborns with high risk factors, start antibiotic treatment until the test result comes back
• APGAR scoring


  1. Perform 1-5 mins (immediately) after delivery

  2. 5 categories, each category scored 0,1,2, add all up

  3. APGAR total score 2 or less = newborn in poor condition; 3-7 = in fair condition; 8 or higher = in good condition
• Comprehensive history


  • Full maternal / Family/ Prenatal histories
  • Cardiorespiratory exam component should always be prepared to perform when opportunity arises to assess congenital heart defect
• Skin findings on newborns

  • Central cyanosis
  • Acrocyanosis
  • Ecchymosis
  • Pallor
  • Jaundice
  • Vernix caseosa
  • Lanugo
  • Milia
  • Mongolian spots
  • Nevus simplex
  • Port-wine stains
• Asymmetric tonic neck reflex

  1. Newborn supine - rotate the head to one side - extremities on chin side extend while those on the occiput side flex

  2. Persistence after 6months - may indicate cerebral palsy
• Moro reflex with palmar grasp response


  1. Place doctor's thumb pads into each of newborn's palms, palming grasping tests for palmar grasp response

  2. Place supporting fingers behind the baby's hand, then lift the hands upward until the thorax barely lifts, and the head begins to flex but does not leave the table

  3. Suddenly release the hands imitating a fall

  4. Normal response = symmetrical; extension of the back, extension and abduction of the arms, and fanning of the digits, followed by flexion and adduction of the arms, and closing of the fingers as in a motion of trying to cling; the baby may cry as part of reflex

  5. Persistence after 6months - may indicate cerebral palsy or peripheral nerve injury
• Plantar grasp reflex


  1. Tap the plantar surfaces of the feet, the feet should grasp

  2. Persistence of grasp reflexes after 1 year seen in birth injury and developmental delay
• Babinski reflex


  1. Stroke the bottom of each foot from the heel, laterally along the side and across the ball of the foot

  2. Normal = A positive Babinski reflex should be seen, with extension and fanning of the toes
• Walking reflex

  1. Lift the baby with the thumbs over the anterior chest, hands under each axilla, and fingers wrapped around the back

  2. Hold the baby over the table and lower until the feet are just above it

  3. Touch the feet lightly to the table

  4. Normal = the baby attempts to walk across the surface
• Placing reaction


  1. Holding the infant upright and touching the anterior distal tibia against the edge of the table should cause the infant to lift the foot, flexing the hip and knee as if attempting to step up onto the table surface

  2. Absence at birth may indicate brain damage
• Caput succedaneum


  Swelling that crosses suture lines, caused by edema related to the presenting part of the head at delivery and self-resolves

  
• Cephalohematoma


  An area of subperiosteal bleeding that stops at suture lines, the collection of blood will be reabsorbed but takes several weeks or more
• The main difference between caput succedaneum and cephalohematoma is that caput succedaneum is caused by scalp swelling due to pressure, while cephalohematoma is caused by bleeding under the scalp

  
• The testicles should be fully descended into the scrotum by the age of 1 year
• Undescended testicles increase the risk of developing testicular cancer, and referral to a specialist should be made
• Newborn vital signs


  • Temperature
  • Pulse
  • Respiration
  • Heart rate
  • Blood pressure
  • Weight
  • Length
  • Head circumference
• Blood pressure is not typically measured in the newborn unless cardiovascular or renal abnormalities are suspected
• Preeclampsia: BP>140/90 diagnosed after 20 weeks gestational age along with proteinuria
• Chronic hypertension: BP>140/90 prior to 20 weeks gestational age
• Tanner staging - Femalepubic hair

  • Stage 1 - prepubertal with no pubic hair
  • Stage 2 - sparse, straight hair along the lateral vulva
  • Stage 3 - hair is darker, coarser, and curlier, extending over the mid-pubis
  • Stage 4 - hair is adult-like in appearance but does not extend over to the thighs
  • Stage 5 - hair is adult in appearance, extending from thigh to thigh
• Tanner staging - Malegenitalia

  • Stage 1 - testes are small
  • Stage 2 - testes begin to enlarge, with scrotum becoming pendulous
  • Stage 3- penis begins to lengthen, testes continue to enlarge, scrotum thickens
  • Stage 4 - penis begins to widen, testes continue to enlarge
  • Stage 5- penis and testes attain mature adult size
• Male pubic hair Tanner stages

  • Stage 1- prepubertal, with no pubic hair
  • Stage 2 - sparse, straight pubic hair along the base of the penis
  • Stage 3 - hair is darker, coarser, and curlier, extending over the mid-pubis
  • Stage 4 - hair is adult-like in appearance but does not extend to thighs
  • Stage 5 - hair is adult in appearance, extending from thigh to thigh
• Grading deep tendon reflexes

  1. 0/4 = no response

  2. 1/4 = diminished response

  3. 2/4 = normal

  4. 3/4 = somewhat increased

  5. 4/4 = greatly increased, clonus
• Primary deep tendon reflexes

  • Biceps
  • Brachioradialis
  • Triceps
  • Patellar
  • Ankle (Achilles tendon)
• Assessing Achilles reflex


  1. Have the patient seated on the table

  2. Dorsiflex the ankle and strike the Achilles tendon

  3. Normal: plantar flexion reflex

  4. Check bilaterally
• Clonus


  Involuntary contractions and relaxations of a muscle when a reflex is assessed, tested by rapidly dorsiflexing the foot at the ankle and maintaining a light upward pressure on the sole, indicates upper motor neuron lesions involving descending motor pathways
• Cranial nerves


  • I - Olfactory
  • II - Optic
  • III - Oculomotor
  • IV - Trochlear
  • V - Trigeminal
  • VI - Abducens
  • VII - Facial
  • VIII - Vestibulocochlear
  • IX - Glossopharyngeal
  • X - Vagus
  • XI - Accessory
  • XII - Hypoglossal
• Testing cranial nerve I (olfactory)

  1. Have the patient occlude one naris and close their eye

  2. Have the patient sense two distinct smells and identify them (don't use noxious stimuli)

  3. Repeat the other side
• Testing cranial nerve II (optic)

  1. Have the patient read the handheld or wall visual acuity chart with each eye closed

  2. Document visual acuity as 20/20 OD, 20/30 OS (OD=right, OS= left, OU= bilateral)

  3. Cover right eye, patient covers left eye, test peripheral fields from 3 ft away on the same eye level

  
• CN 1


  Olfactory nerve
• Olfactory nerve

  • Sensory nerve
  • Tested upon complaint of smell or frontal lobe disorder is suspected
• Steps for CNII test

  1. Have the pt occlude one naris and close their eye

  2. Have the pt sense two distinct smells and identify them (DON'T USE noxious stimuli)

  3. Repeat the other side
• CN II

  Optic nerve
• Optic nerve

  • Sensory nerve
  • Note that for pupillary reaction test, light sensing is by CNII; pupil constriction is by CNIII