Cardio Resp Clinical Exam

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Cardio Resp Clinical Exam

Patient to be undressed down to underwear

Look around the bed for ECG monitor, IV drip, medication, warfarin medication book, nebulizer, oxygen mask, GTN spray

General inspection of patient -> SOB, mitral flush, pallor, obesity, peripheral oedema, sternotomy scars, pacemaker, obvious deformity (barrel chest, pectus carinatum, pectus excavatum), use

of accessory muscles, asymmetry, can't hear wheeze, able to talk not

visibly breathless

Inspection of hands -> clubbing, splinter haemorrhages, tar staining

cap refill, qunicke's sign, peripheral cyanosis, janeaway lesions,

oslers nodes, peripheral cyanosis, clammy hands, fine beta agonist tremor, co2 retention tremor

Feel temperature, clammy?

Examines radial pulse, rate rhythm character.

Radio-radial delay

Offer radio-femoral delay

Ask if pain in shoulder? test for collapsing pulse- feel knocking

Check for resp rate

Inspect up arms for scars

Palpate brachial pulse rate rhythm character

Offer BP

Inspect eyes for xanthelasma, anaemia, corneal arcus, horners eye signs (ptosis, miosis, enophthalmos)

Look for mallor flush, abnormal pigmentation Addisons, asymmetrical sweating

Assess mouth for central cyanosis, hydration, stridor

Look for dental hygeine

Inspection of neck -> scars of presence of central lines, de musset's sign, corrigans sign, assess JVP, accessory muscles to breathe,

Palpate each carotid one at a time

Auscultate each carotid one at a time

Palpate trachea and note deviation, circosternal distance

Inspection of precordium -> scars, visible apex beat, visible pacemaker

Palpate precordium for heaves and thrills

Palpate apex beat, comment on its position and if it is displaced

Finger on carotid -> Auscultate 4 areas . Comment if hear murmur or normal sounds

With

bell on apex, turn to patient to left side, patient holding breath from

expiration, listen for mitral stenosis, also auscultate axilla

Aortic area- patient lean forward, holding breath from expiration, check for radiation of murmur to carotids

Chest -> Inspect for obvious deformities, scars, prominent chest wall veins

Feel for elevation, expansion

Percussion of chest

Tactile Vocal Fremitus ( increased transmission consolidation, reduced transmission in effusion) of chest

Auscultation of chest

Patient to sit forward

Inspect back for scars and symmetry

Perform lymph node exam

Palpate for sacral oedema

Feel elevation and expansion

Percuss Lung Bases

Tactile vocal fremitus

Auscultate lung bases

Look down legs for scars

Palpate ankle oedema

Also do -> chest xray, look at obs chart, Peak

flow, check sputum pot, look in notes for ABG measurements, peripheral vascular exam, perform fundoscopy, ECG , urine dip, Abdominal Exam

- Pulmonary fibrosis- fine end inspiratory crackles, decreased expansion

- Pneumonthorax- increased resonance, decreased breath sounds on auscultation

- Pleural effusion - stony dull

- COPD / asthma- wheeze

- Lobectomy- scar , percussion dull at site

- Anaemia

- Infective endocarditis

- Hyperthyroidism

- Aortic regurg -> de mussets, qunickes, bounding pulse

- Co2 retention - bounding pulse

- Aortic stenosis- slow rising anacrotic pulse

- Hypertrophic cardiomyopathy jerky pulse

- Left ventricular systolic impairment pulsus alternans

- Collapsing pulse is aortic regurg

- Mitral stenosis malor flush

- Lipid disorders

- Right ventricular hypertophy heave

- Aortic stenosis systole murmur

- Aortic regurg early diastolic

- Pulmonary stenosis- harsh ejection systolic murmur

- Mitral regurg- pan systolic murmur