Professional Documents
Culture Documents
Palpation:
Arterial pulse: radial, carotid, measure collapsing pulse Rate (brady/tachy) 40-100 Rhythm (regular, regularly irregular, irregularly irregular) Volume (thready = shock) Character (slow rising = AS, collapsing = AR) Radial-radial/femoral delay = coarctation of aorta *Measure bp in BOTH arms for aortic dissection (examiner will stop you)* Venous pulse: JVP height and waveform (raised = fluid overload, RVF) Chest palpation: o apex beat (displaced = LVF, dilated CM) o parasternal heave: RV enlargement o thrills: palpable murmurs Diaphragm and bell at the apex Diaphragm at 4th IC space L sternal edge Diaphragm at 2nd IC space L sternal edge Diaphragm at 2nd IC space R sternal edge Bell at the apex with patient on LHS in expiration Diaphragm at 2nd IC space L sternal edge with patient sitting up in expiration Bell in the carotids
Auscultation:
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Heart sounds I + II Timing with carotid/radial to determine Added sounds: S3 = Ken-tucky; S4 = tenne-see Murmurs: o Timing, character, loudness, radiation, accentuation manoeuvres Lungs: LVF/CCF: basal coarse crackles auscultation = pulmonary oedema; stony dullness percussion = pleural effusion Oedema: RVF/CCF = pitting ankles, legs, sacrum
To complete:
Dipstick the urine (oedema, HTN) ECG, CXR Fundoscopy (HTN, Roths spots) Peripheral vascular examination (AAA) Palpate abdomen (hepatomegaly)
Cardiovascular Write up
Date and Time BP: 120/80 HR: 72 bpm, regular, N volume + character HS I + II + O, JVP o Scars, o heaves o thrills, o peripheral oedema PRINT NAME
Signature (Medical Student) ZOHA SHAIKH JAHANZAIB KHWAJA