- WIPE, blah blah 🙂
- “Take vital signs”
- Position: from the front: 45°, from the back: sitting
- Proper exposure: from the waist up
- General inspection of the pt and surroundings “not connected to IV lines, feeding tubes, oxygen, inhalers”
- Peripheral signs:
- Nails:
- Capillary refill
- Clubbing
- Cyanosis
- Koilonychia
- Splinter hemorrhage
- Arms:
- Tremor
- Pulse
- BP
- Mouth:
- Central cyanosis
- Dry mucous membrane
- Dental hygiene
- Neck:
- JVP
- Nails:
- Chest inspection:
- Symmetry
- Scars, skin changes\discoloration, rashes
- Chest deformities: pectus carinatum\excavatum barrel chest, kyphosis, scoliosis, Harrison sulcus in pediatric pts
- Visible pulsations
- Dilated veins
- Measure RR
- Palpation: (ask pt if they have any pain?)
- Neck:
- Tracheal deviation
- Lymph nodes
- Chest expansion
- Tactile vocal fremitus (ask pt to say 99)
- Apex beat
- Neck:
- Percussion:
- Over the clavicles for lungs’ apices
- Over the chest for lung zones
- Auscultation: (don’t forget to auscultate over the supraclavicular fossa for the lungs’ apices)
- “Good bilateral air entry, normal vesicular breath sounds, no added sounds”
- Vocal resonance (ask pt to say 99)
- To complete:
- ENT exam
- Cardiovascular exam
- Differential diagnosis of tracheal deviation?
- Towards: atelectasis, pleural fibrosis, pneumonectomy, lung agenesis/aplasia
- Away: pneumothorax, pleural effusion, tumors
- Differential diagnosis of finger clubbing?
- Respiratory: lung ca, bronchiectasis, CF, sardoidosis, interstitial lung ds
- Cardiac: cyanotic congenital heart ds, infective endocarditis
- GI: cirrhosis, IBD, celiac