Los 25 procedimientos indispensables que debe saber hacer todo médico

¿Es útil la exploración física? Abraham Vergase y Ralph Horwitz, profesores de medicina de la Universidad de Stanford han publicado recientemente en el BMJ un editorial ( In praise of the physical examination) en el que defienden las utilidades de explorar a los pacientes.

Stanford ha elaborado una lista de 25 procedimientos que deben ser realizados de forma efectiva por todos los estudiantes , que evite que puedan recibir su titulación ,médicos que conocen la importancia de tales técnicas, pero no saben realizarlas adecuadamente.

link: http://medicine.stanford.edu/education/stanford_25.html

Stanford 25: Fundamental, Technique-Dependent Physical Diagnosis Skills
1. Funduscopic exam, papilledema etc. using panoptic and regular ophthalmoscopes
2. Pupillary responses and relevant anatomy
3. Thyroid exam technique
4. Examination of neck veins/JVD for both level (volume) and common abnormal wave forms; tricuspid regurgitation (ventricularization of ‘v’ waves); canon ‘a’ waves, etc
5. Lung: Surface anatomy, percussion technique, finding upper border of liver dullness, finding Traube’s space
6. Evaluation of PMI, parasternal heave, and other precordial movements
7. Examination of the liver
8. Palpation, percussion of spleen
9. Evaluation of common gait abnormalities
10. The ankle jerk: if performed in a recumbent patient, one must have the right technique for each of the reflexes.
11. Stigmata of liver disease from head to foot: be able to list, identify, and demonstrate
12. Internal capsule stroke: list, identify, and demonstrate common physical findings: lower facial weakness, distal motor weakness, hyperreflexia, absent abdominal reflex on that side, abnormal plantar (Babinski) and abnormal tone, etc
13. Knee exam
14. Cardiac second sounds: splitting, wide splitting and paradoxical spitting
15. Evaluation of involuntary movements such as tremors, etc.
16. The Hand in Diagnosis: recognize clubbing, cyanosis, other common nail and hand findings
17. The Tongue in Diagnosis
18. Shoulder exam (specifically testing rotator cuff tears, ac joint, etc.)
19. Blood pressure assessment (this is more technique-driven than health care workers realize), Pulsus paradoxus assessment
20. Cervical Lymph node assessment
21. Ascites detection and abdominal Venous patterns
22. Rectal Exam
23. Evaluation of scrotal mass - differential between hydrocele, varicocele, spermatocele, testicular mass, etc.
24. Cerebellar Testing
25. Bedside Ultrasound ¿Quien se atreve a comentarlo? Venga, animos.....!