GENERAL
1. mental status
2. oxygenation/vitals
3. Assess skin color/lip cyanosis
4. cap refill/nicotine nails
5. extremity swelling/rubror/dolor
6. breathing
7. body habitus
PULSES
1. Inspect neck for pulsations
2. Palpate carotids and feel for thrills/(might as well listen for bruits here)
3. Watch int jugular pressure wave (if poss) while palpating carotid pulse) and determine JVD.
4. If suspect CHF, check hepatojugular reflex
5. Check radials, femorals, dp/tp pulses
6. Bilateral upper extremity BPs..if suspect AAA, lower extremity BP
CARDIAC INSPECTION/PALPATION
Make sure you have tangential light
Aortic area – observe for pulsation (aortic aneurysm/htn)
Palpate for thrill (AS)
Pulmonic area– observe for pulsation (represents increased pressure or flow thru PA)
Palpate for thrill (Pulmonic Stenosis)
RV area (substernal; along LSB) – look for lift (anemia, anxiety, hyperthyroid
Fever, pregnancy….i.e. high output states)
Sustained lift w RV enlargement
Palp for thrill (VSD)
LV area (mitral area; 5th IC space, mid-clavicular line)
- Locate apical impulse; assess its size
* if > 1 finger, c/w LVH/vent aneurysm, etc.
*displaced upward in pregnancy
*increased amplitude in high output states.
*Feel for extra impulses that could coincide with S3 and S4
Epigastrum - note any pulsations
Palpate pulsation: if pulsations thrust downward, could be due to RV enlargement; whereas, Ao pulsations thrust outward.
CARDIAC AUSCULTATION
Start at base or apex: and identify:
1. Rate
2. Rhythm
3. Diaphragm
a. Good for high pitched sounds
b. S1S2 – listen for splitting
c. Murmurs, esp of AR, TR, MR(radiates into the axilla too) and VSD; AS & PS are of medium pitch; note them too.(can also hear equally well w bell)
d. Listen for pericardial friction rubs
4. Bell
a. Good for low-pitched sounds
b. S3S4
c. Listen for rumbling diastolic murmur of MS & opening snap
5. Special Maneuvers
a. Sit up and lean forward – brings out AS and AR murmurs
b. Exhale completely and hold breath – adds to above.
c. Roll onto left side and find apical impulse. Listen with bell to hear S3, S4 and murmur of MS
|
Topic Tags: 
