OSCE - MSK - 3 page doc incl. a practice \"script\" for Musculoskeletal OSCE, hits all desired PDF

Preview

Summary

3 page doc incl. a practice "script" for Musculoskeletal OSCE, hits all desired mark points....

Description

OSCE MSK -

HELLO MY NAME IS BEN, I AM A STUDENT PARAMEDIC AND I HAVE BEEN ASKED TO TAKE A MUSCULOSKELETAL EXAMINATION ON YOU. - WHAT THIS WILL INCLUDE IS ME HAVING A LOOK AT YOUR LEGS, HAVING A LOOK AND FEEL OF YOUR JOINTS AND GIVING YOU SOME MOVEMENTS TO PERFORM, I MAY NEED TO ROLL YOUR LEG SLEEVES UP AT SOME POINT. IS THIS OK WITH YOU? o IF AT ANY POINT YOU FEEL UNCOMFORTABLE OR IN PAIN, LET ME KNOW AND WE CAN STOP. - WASH HANDS - RESPONSE - THE PATIENT IS ALERT, GCS OF 15 AND IS RESPONDING TO ME - I CANNOT SEE ANY CATASTROPHIC HAEMORRHAGE - THE PATIENT IS MAINTAINING THEIR OWN AIRWAY - THERE DOESN’T SEEM TO BE ANY MECHONISM OF INJURY SO NO C-SPINE INJURY - THE PATIENT IS BREATHING AT A NORMAL RATE AND RHYTHM, NO USE OF THE ACCESSORY MUSCLES - THE PATIENT LOOKS WELL PERFUSED ARE YOU IN ANY PAIN AT THE MOMENT? - DO YOU HAVE ANY STIFFNESS IN YOUR MUSCLES/JOINTS - CAN YOU WALK TO THE DOOR AND BACK - CAN YOU WALK UP AND DOWN STAIRS - DO YOU HAVE A HISTORY OF FALLS - HAVE YOU HAD ANY PREVIOUS INJURIES OR FRACTURES - DO YOU HAVE ANY ILLNESSES SUCH AS OSTEOARTHRITIS, RHEUMATOID ARTHRITIS, OSTEOPOROSIS, CANCER I AM NOW GOING TO BEGIN THE ASSESSMENT - I AM GOING TO ASSESS YOUR KNEE. FIRST I AM GOING TO LOOK ABOVE AT YOUR HIP JOINT AND THEN BELOW AT YOUR ANKLE - I AM GOING TO ASSESS FOR SHAPE, SYMMETRY, SCARS OR SWELLINGS - I AM LOOKING FOR COLOUR - IF IT IS RED OR BRUISED - I AM LOOKING FOR ANY MUSCLE SPASMS OR TREMORS - I LOOKING AT THE SKIN INTEGRITY I AM NOW GOING TO LOOK AT YOUR KNEE - I AM GOING TO LOOK AT THE POSTERIOR, LATERAL AND ANTERIOR. - DO YOU NORMALLY USE ANY WALKING AIDS TO GET AROUND. - PLEASE CAN YOU STAND UP. - PLEASE CAN YOU WALK OVER TO THE WALL AND BACK FOR ME o I CAN SEE THAT THE PATIENT IS DEMONSTRATING A NORMAL HEEL STRIKE/TOE OFF GAIT, EACH STEP IS OF NORMAL HEIGHT, THE GAIT IS BOTH SMOOTH AND SYMMETRICAL AND THERE ARE NO ABNORMALITIES SUCH AS ANTALGIA, WADDLING OR BROAD BASED. - PLEASE CAN YOU WALK OVER TO THE WALL ON YOUR TOES AND COME BACK ON YOUR HEELS I AM GOING TO FEEL NOW. - LET ME KNOW IF AT ANY POINT YOU FEEL ANY PAIN - I AM GOING TO PALPATE THE TISSUE OVER THE HIP -

o I AM PALPATING FOR TENDERNESS AND WARMTH - THIS WILL SHOW INFLAMMATION OR INFECTION - I AM GOING TO PALPATE DOWN THE TOP OF FEMUR AND DOWN THE SIDES ASSESSING FOR PAIN - I AM GOING TO STOP ABOUT 6CM ABOVE THE KNEE - I AM GOING TO MOVE DOWN TO THE ANKLE - I AM GOING TO ASSESS THE TEMPERATURE AND COMPARE WITH THE OTHER LEG - I AM GOING TO ASSESS POSTERIOR TIBIAL PULSE AND DORSALIS PEDIS PULSE IN INJURED LEG - I AM GOING TO PALPATE THE ACHILLES TENDON o BRING THEIR KNEE UP TO THEIR CHEST IF THERE IS NO PAIN o I AM GOING TO NOTE FOR ANY TENDERNESS OR SWELLING - TENDONITIS o IF I FIND ANY GAPS IN THE TENDON THIS CAN SUGGEST A RUPTURE - I AM GOING TO PALPATE THE JOINTS AND BONES o SQUEEZE THE MTP JOINTS - METATARSOPHALANGEAL JOINTS - FOOT  LOOK AT PATIENTS FACE FOR DISCOMFORT o METATARSAL AND TARSAL BONES o TARSAL JOINT o ANKLE JOINT - BASE OF ANKLE o SUBTALAR JOINT - BEHIND ANKLE o CALCANEUM - BASE OF HEEL o MEDIAL/LATERAL MALLEOLI - FRONT OF ANKLE o DISTAL FIBULA - OUTSIDE OF ANKLE - I WILL PALPATE UP THE SHIN, UNTIL ABOUT 6CM FROM BASE OF KNEE I AM GOING TO PALPATE THE KNEE - I AM GOING TO ASSESS FOR TEMPERATURE AND COMPARE TO THE OTHER SIDE - I AM GOING TO PALPATE DOWN THE QUADRACEPS TENDON - TENDONITIS IF TENDER - I AM GOING TO PALPATE THE PATELLA - PALPATE MEDIAL, LATERAL FOR TENDERNESS STABILISE ONE SIDE AND PALPATE THE OTHER SIDE WITH FINGERTIPS PATELLOFEMORAL ARTHRITIS/INJURY IF TENDER - I AM GOING TO GET THE PATIENT TO BEND THEIR KNEE TO 90º o I AM GOING TO PALPATE THE: o PATELLA TENDON - BELOW PATELLA o TIBIAL TUBEROSITY - BONEY KNOB BELOW KNEE CAP o JOINT LINE - MEDIAL - LATERAL o HEAD OF THE FIBULA o COLLATERAL LIGAMENTS - UNDERNEATH PATELLA o POPLITEAL FOSSA - BACK OF KNEE - COLLECTION OF FLUID - I AM NOW GOING TO MOVE THE JOINTS - I AM GOING TO BEGIN WITH MOVEMENTS TO ASSESS FOR PAIN, STARTING FROM THE HIP. - CAN YOU PLEASE LIFT YOUR LEG IN THE AIR - CAN YOU PLEASE DO THE SAME WITH THE OTHER LEG - CAN YOU PLEASE CROSS YOUR LEFT LEG OVER YOUR RIGHT LEG, AND NOW BRING IT AWAY FROM YOUR RIGHT LEG - CAN YOU PLEASE DO THE SAME WITH YOUR OTHER LEG

- I AM NOW GOING TO MOVE ON TO MOVEMENTS OF THE ANKLE - CAN YOU PLEASE POINT YOUR TOES TOWARDS ME PLEASE - AND NOW TOWARDS THE CEILING - CAN YOU CURL YOU TOES UP PLEASE - NOW CAN YOU POINT YOUR TOES TOWARDS YOUR HEAD - CAN YOU MOVE YOUR FEET TO POINT THEM INWARDS PLEASE - AND POINT THEM OUT - NOW I WILL MOVE ON TO MOVEMENT OF THE KNEE - CAN YOU PLEASE MOVE YOUR HEEL AS CLOSE TO YOUR BOTTOM AS YOU CAN - CAN YOU STRAIGHTEN OUT YOUR KNEE AS BEST YOU CAN - AND CAN YOU DO THE SAME WITH THE OTHER KNEE PLEASE. THESE RESULTS LOOK FINE, I AM NOW GOING TO MOVE ON TO PASSIVE AND RESITANCE MOVEMENTS FOR THIS I WILL ASK YOU TO PERFORM THE SAME MOVEMENTS BUT I WILL GUIDE YOU FOR THE PASSIVE MOVEMENTS AND I WILL PROVIDE RESISTANCE FOR THE RESISTANCE MOVEMENTS. THANK YOU FOR ALLOWING ME TO PERFORM A MUSCULOSKELETAL ASSESSMENT ON YOU. I HAVE NOT FOUND ANY ABNORMALITIES OR ANYTHING UNEXPECTED. I AM HOWEVER GOING TO TAKE SOME OBSERVATIONS. I WOULD LIKE TO TAKE YOUR: - HR - RR - SPO2 - ECG 12 LEAD - ANOTHER BP - TEMP - BM AND PUPIL SIZE+REACTION I AM GOING TO WASH MY HANDS AGAIN, DOCUMENT MY FINDINGS, AND CASCADE TO A MORE SENIOR HCP....