Emir Rasyid Hafiz

712016047
Ankle and foot examination
 Before starting
 Introduce yourself to the patient, and confirm his name
and date of birth.
 Explain the examination and obtain his consent.
 Ask him to undress from the waist downwards.
 Ensure that he is comfortable.
 The examination
 The patient is standing.
 Look
 General inspection: posture, symmetry, and any obvious deformities.
Look for clues such as walking aids and abnormal wear on shoes. Ask
the patient to turn around.
 Gait: observe from front and back. Pay particular attention to height
of step, ankle movement, and foot strike. Ask the patient to stand on
his tiptoes and then on his heels.

 Ask the patient to lie on the couch.

 Skin: colour, sinuses, scars, corns, calluses, ulcers, bunions (big toe),
Tailor’s bunion/bunionette (little toe).
 Shape: alignment, pes planus (flat foot), pes cavus (arched foot),
deformities of the toes (hallux valgus, claw, hammer, and mallet
toes).
 Position: varus or valgus hindfoot deformity.
 Feel
 Ask about any pain.
 Skin: temperature (compare both sides), abnormal
thickening on the soles of the feet.
 Pulses: dorsalis pedis, posterior tibial.
 Bone and joints: palpate the joint margin, forefoot
(metatarsals and metatarso phalangeal joints) and hind
foot, and localise any tenderness. Remember to keep
looking at the patient’s face.

 Move (active and passive)

 Look for restriction of the normal range of movement.
Ask the patient to report any pain.
merasakan
 tanya mengenai nyeri
 kulit: suhu(membanding kedua sisi), apakah tdpt
penebalan pd telapak kaki yg tdk normal pd kaki
 pulsasi: arteri dorsalis pedis, posterior tibia.
 tulang dan sendi: palpasi tepi sendi, sendi kaki
depan/anterior (sendi metatarsal,
metatarsophalangeal) dan sendi kaki blkng/posterior,
lokalisasi nyeri. ingat untuk melihat mimik wajah
pasien saat memeriksa lokalisasi nyeri.
 Ankle joint
 Hold the heel in the left hand and the fore foot in the
right hand.
 Plantarflex the foot (normal range 40 degrees).
 Dorsiflex the foot (normal range 25 degrees).
 Compare range of movement to that in the other foot.
 Subtalar joint
 Hold the heel in the left hand and the forefoot in the
right hand, as above, with the ankle fixed at 90 degrees.
 Invert the foot (normal range 30 degrees).
 Evert the foot (normal range 15 degrees).
 Compare the range of movement to that in the other
foot.
pemeriksaan sendi pergelangan kaki
 tangan kiri memegang tumit pasien dan tangan kanan pemeriksa
memegang kaki depan.
 plantaflexi pd kaki (nilai normalnya 40 derajat)
 dorsoflexi pd kaki (nilai normalnya 25 derajat)
 bandingkan nilai dr pergerakan/derajat pd satu kaki dan kaki yg
lain.
pemeriksaan sendi subtalar
 tangan kiri memegang tumit dan tangan kanan memegang
bagian dpn kaki(jari2 kaki), seperti pemeriksaan diatas, dengan
pergelangan kaki pada posisi 90 derajat.
 inversi (normalnya 30 derjat)
 eversi (normal 15 derjart)
 bandingkan nilai pergerakan/derajat antara satu kaki dengan kaki
yg lain.
 Midtarsal joint
 Hold the heel in the left hand and the forefoot in the
right hand.
 Flex, extend, invert, and evert the forefoot.
 Toes
 Flex and extend each toe in turn. If there is any
tenderness, try to localise it to a particular joint.
 Ask the patient to lie prone.
 Look for any scars and for wasting of the calves.
 Palpate the calf muscle and the Achilles tendon.
 Simmond’s test: squeeze the calf – if the foot
plantarflexes, the Achilles tendon is intact.
sendi midtarsal
 tangan kiri memegang tumit dan tangan kanan memegang
jari2 kaki.
 lakukan fleksi, ekstensi, inversi, dan eversi pd jari2 kaki.
 jari kaki
 fleksi dan ekstensi masing2 jari kaki secara bergantian. jika
tdpt nyeri tekan, coba lokalisasi bagian sendi tsb.
 minta pasien untuk berbaring dgn posisi pronasi(tengkurap)
 lihatapakah ada bekas luka/tdk, dan kapalan/penebalan kulit.
 palpasi otot betis dan tendon achilles.
 test simmond: menekan betis -jika kaki dlm posisi
plantafleksi, tendon achilles normal.
 After the examination
 State that you would also like to examine the vascular
and neurological systems of the lower limbs.
 If appropriate, indicate that you would order some tests,
e.g. foot and ankle X-ray (AP and lateral), FBC, ESR,
bone profile, rheumatoid factor, etc.
 Thank the patient.
 Offer to help him put his socks and shoes back on.
 Ensure that he is comfortable.
 Summarise your findings and offer a differential
diagnosis.
setelah pemeriksaan
 setelah pemeriksaan, anda hrus juga memeriksa sisten
pembuluh darah dan saraf pd ekstremitas bawah.
 jika tdk normal, indikasi utk pemeriksaan lanjutan. contoh:
xray pd kaki dan pergelangan kaki(posisi AP dan lateral),
FBC, ESR, profile tulang, faktor rheumatoid, dll.
 terimakasih kpd pasien
 meminta pasien utk menggerakan kaki ke dpn dan blkng
 memastikan apakah pasien nyaman
 simpulkan hasil yg didptkan dan menentukan diagnosis
bandingnya
 DD: osteoarthritis.......
 Adult Basic Life Support
 Make sure you, the victim,
and any bystanders are
safe.
 Check the victim for a
response. Gently shake
his shoulders and ask
loudly, “Are you all right?”
bantuan hidup dasar pd orang
dewasa
 pastikan posisi pasien, penolong dalam posisi aman
 periksa respon pasien. gerakan bahu pasien dan tanya
pasien secara kuat “ apakah kmu baik2 saja?”
 If he responds:
 Leave him in the position in which you find him provided
there is no further danger.
 Try to find out what is wrong with him and get help if needed.
 Reassess him regularly.

 If he does not respond:

 Shout for help.
 Turn him onto his back and open the airway using the head-
tilt, chin-lift technique:
 place your hand on his forehead and gently tilt his head back
 with your fingertips under the point of his chin, lift the chin to open
the airway
 holding his airway open, put your ear to his mouth. Listen, feel, and
look for breathing for no more than 10 seconds. If you have any
doubt about whether breathing is normal, assume that it is not
 jika ada respon
 biarkan posisi pasien pd saat pasien ditemukan asal kondisi pasien tdk dalam gawat darurat.
 coba untuk mencari penyebab pasien dan minta pertolongan
 nilai ulang pasien secara umum.

 jika tdk ada respon

 teriak minta tlong
 posisikan pasien dlm posisi terlentang, dan membuka jalan napas dengan metode head tilt chin
lift.
 letakkan tangan diatas dahi dan miringkan kepala pasien ke belakang dengan hati2.
 dengan ujung jari tngan anda di bawah dagu, angkat dagu utk membuka jalan naaps.
 pertahankan jalan napas, dan letakkan telinga anda ke mulut pasien. dengarkan, rasakan dan
lihat breathing kurang dr 10 detik. jika kamu ragu2 apakah breathing normal, nilai kembali
apakah normal atau tdk.
 If he is breathing normally:
 Turn him into the recovery
position.
 Call for an ambulance by
mobile phone or, if this is
not possible, send a
bystander to call.
 Check for continued
breathing.
The head-tilt, chin-lift technique
jika breathing pasien normal
 posisi kan pasien dlm posisi recovery
 hubungi ambulan atau atau jika td memungkinkan,
minta orang2 sekitar utk menghubungi ambulan.
 cek kembali breathing
 If he is not breathing - place the heel of the other hand on
normally: top of the first hand
 Ask someone to call for an - interlock the fingers of your hands
ambulance and bring an
automated external and ensure that pressure is not applied
defibrillator (AED) if on the victim’s ribs, bottom end of his
available. If you are on your chest bone, or upper abdomen
own, use your mobile phone - position yourself vertically above the
to call for an ambulance.
Leave the victim only if there victim’s chest and, with your arms
is no other way of obtaining straight, press down on the sternum 5–
help. 6 cm
- after each compression, release all
 Deliver 30 chest the pressure on the chest without
compressions followed by 2 losing contact between your hands
rescue breaths. To deliver and the sternum – repeat at a rate of
chest compressions:
about 100–120 per minute
 kneel by the side of the victim
 place the heel of one hand in - compression and release should take
the centre of the victim’s chest an equal amount of time
 To deliver rescue breaths:
 after 30 compressions, again open the airway using
head-tilt and chin-lift
 pinch the soft part of the victim’s nose closed using the
index finger and thumb of the hand on his forehead
 allow his mouth to open, but maintain chin lift
 take a normal breath and place your lips around his
mouth, making sure that you have a good seal blow
steadily into his mouth whilst watching for his chest to
rise – take about 1 second to make his chest rise
maintaining head-tilt and chin-lift, take your mouth
away from him and watch for his chest to fall
 deliver a second rescue breath and return to chest
compressions without delay
 Continue with chest compressions and rescue breaths at a
ratio of 30:2.
 Stop to re-check the victim only if he starts to show signs of
regaining consciousness, such as coughing, opening his
eyes, speaking or moving purposefully AND starts to
breathe normally
 If your rescue breaths do not make the chest rise as in
normal breathing, check the victim’s mouth and remove
any obstruction and re-check that there is adequate head-
tilt and chin-lift.
 If there is more than one person present, the person
providing chest compressions should change every 1–2
minutes with no interruption to the chest compressions.
 Continue resuscitation until qualified help arrives or until
the victim shows signs of regaining consciousness AND
starts to breathe normally or until exhaustion.
The recovery position
 Choking
 Choking is a physiological response to obstruction of
the airways by a foreign object, and can lead to
asphyxia (oxygen starvation) and brain hypoxia, and,
ultimately, loss of consciousness and death. Victims of
choking are likely to grab or point at their neck. Young
children are prone to choking on food and small
objects, so eating or playing prior to the episode is
strongly suggestive of choking. Differentials of choking
include fainting, heart attack, seizure, and other
conditions that may cause sudden respiratory distress,
cyanosis, or loss of consciousness. The first step is to
ask the victim, “Are you choking?”
 In-hospital resuscitation
 This sequence should be followed for a collapsed
patient in hospital.
 Ensure personal safety.
 Shout for help.
 Check the patient for a response – gently shake his
shoulders and loudly ask “Are you all right?”
If the patient responds:
–– urgent medical assessment is required – depending on
local protocols, this may be by the
resuscitation team
–– while awaiting the arrival of this team, assess the patient
using the ABCDE approach
–– give the patient oxygen
–– attach basic monitoring
–– obtain venous access
• If the patient does not respond:
–– turn the patient onto his back
–– open the airway using the head-tilt, chin-lift technique
Advanced Life Support
Figure 64. ECG traces of ventricular
fibrillation
and ventricular tachycardia
 Resume chest compressions immediately and perform
CPR for a further 2 minutes, during which time give
adrenaline 1 mg IV and amiodarone 300 mg IV.
 Keep on repeating this 2 minute CRP – rhythm/pulse
check – defibrillation sequence for as long as VF/VT
persists.
 Give further adrenaline 1 mg IV after alternate shocks,
i.e. after every 3–5 minutes.
 If organised electrical activity compatible with a
cardiac output is seen during a rhythm check (and not
otherwise), check for central pulse. If a pulse is
present, start post-resuscitation care. If a pulse is
absent, continue CPR and switch to the non-shockable
algorithm.