Precordium Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: 45°
  • Proper exposure: from the waist up
  • General inspection of the pt and surroundings

 

  • Peripheral signs:
    • Nails:
      • Capillary refill
      • Clubbing
      • Cyanosis
      • Koilonychia
      • Splinter hemorrhage
    • Palms:
      • Osler nodes
      • Janeway lesions
    • Pulse:
      • Radial
      • Radio-radial delay
      • Radio-femora delay
      • Collapsing pulse
    • Arms:
      • Tremor
      • BP
      • Xanthomata on elbows
    • Eyes:
      • Pallor
      • Xanthelesma
      • Corneal arcus
    • Mouth:
      • Central cyanosis
      • Dry mucous membrane
      • Dental hygiene
    • Neck:
      • Carotid pulse: palpate one side at a time
      • JVP: ask pt to turn their head, hepato-jugular reflux
  • Chest inspection:
    • Scars, skin changes\discoloration
    • Chest deformities
    • Visible pulsations
    • Dilated veins
    • Devices
  • Palpation: (ask pt if they have any pain?)
    • Apex beat (left 5th intercostal space): comment on location and character
    • Thrills + heaves (left parasternal heave = RVH)
  • Auscultation: (while palpating the carotid to determine S1):
    • 4 valve areas: “normal S1, S2, no added sounds, no murmurs”
    • Accentuation menoevres:
      • Mitral stenosis: ask pt to turn to the left, hold expiration, listen over the mitral area (bell)
      • Aortic regurgitation: ask pt to bend forwards, hold expiration, listen over the aortic area
    • Mention that you will listen for the radiation if there’s a murmur
  • From the back:
    • Listen to lung bases for pulmonary edema
    • Asses sacral and LL edema
  • To complete:
    • Peripheral vascular exam
    • Abdominal exam
    • 12-lead ECG
    • Fundoscopy

 


 cvs 5

  • Right sided murmurs (tricuspid + pulmonary) -> increase in intensity w\ inspiration
  • Left sided murmurs (mitral + aortic) -> increase in intensity w\ expiration (except MVP and HOCM)

 

 


Download the PDF version: here

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