Cardio-Respiratory Examination Superior

Adorning Mtfmwa washhands Take name Explain Cardiovascular and Respirators are separate Do13 chaperone warn about clothingremoval sit them on bed Étignessatrest pallor Cyanosis Scars item of note aroundthe bed HandExamination WITTbing nailsback to bar Cyanosis cigarette staining asplinter haemorrhage a peripheral Nail bed capillary refill Take radial pulse rate rhythm is seconds Take both arm's radial pulses radial radial delay Cutpsinghimpilsewommtemarm above theirhead feeling for radial pulse addition Take brachial pulse rate and rhythm a use blood pressure aft measure blood pressure on both Brachiand arms oration eh Faleexamination Winton flush mitral stenosis Patient lookup No peripheral stigmata of cardiovascular disease look for pale conjunction of anaemia corneal arm hypercholesterolemia Xanthelasma of patient stick out tongue look for Dentition condition Central cyanosis blue j P above Tom frommsternal anshe notgood indicates venoushypertension rightheartfailure son feign.ca Imitating Myths a midlinestemotomy scar visible apical pulsation audible prosthetic pacemaker heat valve char for femoral scar plz no openheart surgery ftp pearqiiimstnintnstaspace test min cranial urine note any characterof apex beat such as differentlocation enlarge etc use base of palm to palpate just left of sternum Iglooggggov could indicate Left parasternal heave is palpateover the valvular areas took for father'll abnormal vibration betterskin caused un by murmur X S S S E Murmurs a carotid pulsation indicates systole Ascuttate on expiration and hold breath Usediaphragmoff stethoscope at apex hearfor S and Sz or any other heat soundsto hearfor any murmurs at mitral area for mitral valve disease Listen at axilla listen for mitral regurgitation lean left at apex again Use Bell ask patient to roll to left listen note a bit for low pitch murmur of mitral stenosis ve Diaphragm at lower left sternal edge tricuspid area 2nd intercostal space pulmonary 2nd intercostal space leanforwams aortic Base of her Left then right carotid aortic area Left Right area sursitam Miggy carotidartery bruits sound of RT blood cutting a narrowed vessel aorticstenosis radiation patient sits up and leans forwards o left lowersternal edge best heard when patient breathes out placediaphragm on their back listen for Crackles theyare still leaned forwards where lung buses are offer to do thesetwo PFiteae posterior tibial puke FO.tw Im Lam int behind medial malleolus pherae oedema patient Press am going to heatfailure thinness DM hit touch ankle may for S Secondsbehind media matter lit look foroedema pittingoedema CHDD Year 2 THE CARDIOVASCULAR SYSTEM – PHYSICAL EXAMINATION GUIDE Preparation Wash hands Introduction Consent and explanation Position patient appropriately √ clothesoff whennecessary ask General Inspection √ Comments Comments Is the patient breathing comfortably? Conscious Level? Is the patient in any pain? Colour? any items around patient √ Issee Bosee √ Hands General Inspection Radial pulse: rate and rhythm Arms Brachial pulse: character Blood pressure Comments Comments are ante in eye ye fantabletips Face General inspection of face (e.g. mitral facies), eyes (e.g. corneal arcus) and mouth Malar flush of mitral stenosis Neck √ Comments √ Comments √ Comments √ Comments Peripheral 1 acganosis JVP Carotid pulses murmur lowest orepint of hey hey Same C phone Chest - Inspection Scars Pacemaker Visible pulsation valve issue Chest - Palpation Apex beat Heaves hypertrophied Thrills heatmule agentchest causes push Chest - Auscultation √ Comments intercostal Apex (Mitral area) Stu middenialur line Mitral area (with bell, pt rolled to left: ?MS) Axilla Tricuspid area Pulmonary area Aortic area Neck (over carotid arteries) Sitting forward 5th ICS left sternal edge (?AR) Lung bases (?pulmonary oedema) Intuitive light Peripheral Oedema Sacrum Feet/ankles/legs √ Comments Peripheral Pulses Doralis pedis and Posterior Tibial √ Comments offertodothese m_ Takei Don Enripirone warn about clothing removal sit them on bed uspertatbaseutbef count respiratory rate for Jo seconds while lurking for below County a items around them Cyanosis a Shortness of breath dyspnea Cough wheeze exhale discomfort stridor noisy breathing observation charts obstructed air thou inhale Lookathand They bring hands up peripheral Cyanosis fingernails Tum hands over Tar staining clubbing Take smoking place thumbs nails backto back radial pulse rate and rhythm They hold their hands out with wrists Look for hepatic flap abnormal indicates Look for hand tremor fine OFpfiftth.tn eresenas They open mouth with tongue out Look for central Cyanosis Look for asymmetry a co retention and extended asterixis look for pale anivitiva anaemia thentongueupwards anoteanything tattoo piercings Scars deformities e g barrelchest scoliosis mterstpalpation notch and feel for trachea should be central Tracheal Tug whentrachea wire Feel at suprastemal Tensionpneumothorax arms cancertowns Distance between suprustomal notch and thyroidcartilage should be 4 finger widths long trachea length put both hands around the chest and thumbs are touching on so fingers wrap aroundsides their tips they take deepbreath in and out X2 do this in more than I location look for more than 2am movement t If then chest want percuss 485474 axillae compareside to side ii Use the Bell of stephoscore suprudancularfolsaf.y use diaphragm for front of chest gy axillae Nakhimmnd mmmm P TE IIIntainmat Scars Shape deformities put both hands around the back and thumbs are touching on so fingers wrap aroundsides their tips they take deepbreath in and out X2 do this in more than I location look for more than 2am movement I l g manana jÉ avoid thescapula Yggumqffinitt same route as percussion abnormal sounds like crackling patient say ninety nine hear both 1mg my niet something in the way like pneumothorax Completion Cardiovascular System heat failure Bedside tests temperature A A peak flow test Examine any sputum A CHDD Year 2 THE RESPIRATORY SYST EM - PHYSICAL EXAMINATION GUIDE Preparation Wash hands Introduction Consent and explanation Position patient appropriately √ Comments General Inspection Obvious discomfort/pain Colour Evidence of dyspnoea? Any audible wheeze / stridor? Respiration rate Items of note around bed? √ Comments Hands Clubbing Peripheral Cyanosis Cigarette tar stains Radial Pulse √ Comments Face Conjunctiva (anaemia) Central cyanosis √ Comments Lymph nodes Supraclavicular (including for Scalene) Submandibular and Submental Post-auricular and Pre-auricular Anterior and posterior cervical Occipital √ Comments Chest Inspection Asymmetry Scars Shape/deformities √ Comments Chest Palpation Trachea Chest expansion √ Comments Chest Percussion All areas Compares side to side √ Comments Chest Auscultation Breath sounds Vocal resonance √ Comments Course Gobletmeans Shid 2N√bassComments Completing the Examination Temperature Perform Peak flow reading Examine any sputum CHDD Year 2 OSCE Examination Station Marksheet 10 minutes Global Rating Scale (please circle) Fail Borderline Pass Good Excellent Read the introductory statement to student: This is ….(add name)…. Please perform an examination of their …………….. system. SCORE 0 Patient care  Introduces self, gains consent and washes hands  Correct positioning of patient  Appropriate interaction with patient during examination  Ensures patient comfort during examination General inspection and supporting information  Appropriate inspection of immediate patient environment  Appropriate general inspection of patient in relation to the system being examined Physical Examination  Completes physical examination competently and systematically  Good examination technique  States appropriate additional information to complete examination (e.g. TPR chart, PR examination) Completing the examination  States appropriate additional investigations/tests relevant to the system examined Appropriate communication of clinical findings Students may present this during their examination or summarise at the end  Confident, accurate and clear communication of examination findings 1 2 3 4 5 6