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2) intoduce yourself
3) confirm pasien detail
4) explain examination
5) gain consent
6) general inspiration
1. look around in the bed, (oksigen)
2. comfortable at rest? pain/sob
7) inspeck the hand
1. Splinter hemorrhages, ( inspeksi endocardiatis)
2. Nail clubbing, loss of schamroth is window
3. Janeway lesions, oslers nodes
4. Capillary refill time ( normal < 2 detik)
5. Radial pulse ( assess rate & rhythm)
6. Radial – radial delay ( aortic coarctation )
7. Bradical pulse
8. Collapsing pulse ( aortic regurgitation)
9. Carotid pulse, ( assess volume character )
10. Assess each side individually
11. Measure blood pleausure
12. Positions patient 45 , jugular venous pressure (jvp)
13. Hepato - jugular reflux
1. Apply pressure to the liver (ruq) ,
2. Observe for a rise in jvp,
positive result =sustained rise > 4 cm ,
14. corneal arcus / xanthelasma (hiperkolestrollameia)
15. konjungtiva pallor ( anemia)
16. angular stomatitis (iron deficiency anaemia)
17. central cyanosis (hypoksia)
close inspection
18. scars (midline sternotomy / infraclavikular
19. scars lateral thoracotomy
pallpation,
20. apex beat 5 th intercostal space / mid clavicular line
21. sternal angle (2nd rib ) 5 th intercostal space
22. thrills ( palpable murmurs)
23. heaves ( ventricular hypertropy)
auskultasi
1. aortic valve ( 2nd intercostal space right sternal edge )
2. pulmonary ( 2nd ibtercostal space left sternal edge)
3. tricuspid valve ( 5 th intercostal space left sternal edge )
4. mitral valve ( heard best at the apex )
5. switch to the bell
6. repeat auskultasion of all valves using the bell of the stesocop
7. accentuation manoeuvre ( mitral stenosis)
8. auskultasi the axila to assess for radioation of murmurs
9. accentuation manoeuvre (aortic regurgitation )
10. left sternal edge (diaphragm of stetoskop)
11. auskultasi carotis ( murmur radioatioan , bruith )
12. auskultase lung bases (pulmonary oedema)
palpate
1. palpate of sacral oedema ( right heart failure )
2. assess for pedal oedema ( right heart failure )
thanks ,
hand wash ,
to compleate the examination : 1. peripheal 2. 12 lead ecg 3. fundoscopy 4. urine
disptick , capillary blood glucose.
PEMERIKSAAN KARDIOVASKULER
1) cuci tangan
2) perkenalkan diri anda
3) konfirmasi detail pasien
4) menjelaskan pemeriksaan
5) mendapatkan persetujuan
6) inspeksi umum
1. lihat di sekitar tempat tidur, (oksigen)
2. nyaman beristirahat? sakit / terisak
7) pemeriksaan tangan
1. Hemorrhages splinter, (pemeriksaan endocardiatis)
2. Kuku clubbing/ nail clubbing finger, hilangnya schamroth adalah jendela
3. Lesi Janeway / nodus osler = membuka keuda telapak tangan
4. Waktu pengisian kapiler (normal <2 detik)
5. Pulsa Radial (nilai menilai & ritme) pemeriksaan denyut nadi radialis (ditekan)
6. Radial - radial delay (koarktasio aorta)
7. Nadi Bradical
8. Nadi kolaps (regurgitasi aorta)
9. Nadi karotis, (menilai karakter volume)
10. Menilai setiap sisi secara individual
11. Ukur tekanan darah
12. Posisi pasien 45, pengukuran dan observasi tekanan vena jugularis (jvp)
13. Hepato - jugular reflux ( palpasi )
1) Oleskan / plapasi beri tekanan tangan ke hati (ruq),
2) Amati peningkatan jvp,
Inspeksi
palpasi
auskultasi
cuci tangan ,
1) peripheal
2) 12 lead ecg
3) fundoscopy
4) urin disptick, glukosa darah kapiler.