General approach wrist
⑥ Introduce ourself I
gain consent ① Radial
pulse (30s
only
② Hand R.R
delay, R-F delay.
rub
-Rate (now), rhythm, volume,
S
③ Identify & explain to ot ② Collapsing pulse cortic
coatation
i) Purpose of examination
-
Imustfortable s -
aortic regurgitation
④ Position by touch
Pt 450 we
comfort PDA
-
&expose to the waist Pt ③ Blood
pressure
*
BCG scar
General inspection
-look at patient (at the end
of bed) ↑
ace
O surrounding (attachment
-
Or supplementation -
In line -
chest tube &Eye
suction machine (anemia)
Nasal prong -medicine
Conjuctive: if pale
-
- -
③ Consciousness (greet patient) + ask
permission
-
Sclera: yellow (jaundice
-
alert or not -
in
pain or not -Xanthelasma: cholesterol deposits
③ Nutrition & hydration status ② Mouth
-
cachexic O Cyanosis
④ Breathing effort 84 arched palate: Marfan's Syndrome
In resp distress/not Use of ene &
Teeth Hygiene: Infective Endocarditis
accessory male
-
③ Any syndromic features scM abdo muscle
of
-Dsymorphisti not in adult unless umph
③ Neck
sngE ① Carotid pulse
Systematic examination @ LN
③ JUP: <3cm (significants
m and not
medial
↓
elevated
to SoM
Palms A fingers
①
Peripheral cyanosis: HF Specific Examination (Precordium Examination)
② Nail clubbing
③ Splinter hemorrhage (nail bed ① Inspection
Scar, visible
-Infective endocarditis pulse, pacemaker
-Vasculitis
Janeway lesions
irregular, nontender hemorrhagic macules located on the palms, soles, thenar and
hypothenar eminences of the hands, and plantar surfaces of the toes. @ Palpation
-
Infective endocarditis ⑥ Apex beat -
1 cm medial to left midclaricular lines
O 5th intercostal
⑱ Osler nodes
(metaphalanges) tender space.
~
erythematous, tender nodules located principally on the pads
of the fingers and toes. <painful
*
highlighted people: Stigmata of I.G Must 8
Touch" ② Parasternal heave
Right Ventricular Hypertrophy.
-
if naik: abnormal -opt tap, mata same level dan chest 900
-if X vasa tolak: norm
of -
if chest more kene tangan (abnormal)
-
@side HF
⑰
D Q ③
③ Thrills (palpable murmur)
x
Thrills + carotid pulsation =
systolic thril
3
- Thrills # carotic pulsation: diastolic thrill.
Systolic
(Usediaphragm the
is
③ Auscultation
and is -> -- 2nd0i.s
3
diastolic
jx
3 th@ i.s 5@ i.s, midclavicular
&
Heart sound
81: mitual & tricuspid valve close (Palpate carotidifberdengut an Additival
Sa: Aortic & pulmo value close (carotid pulse xberdengut O When auscultate murmur +
palpate carotid pulse -
also
go
together in heart sounds to laterally as It can be radiation axilla
②Murmur 8
when find murmur, locate the best heard where
->
O systolic murmur (important)
-
when auscultate (ada murmur) +
palpate carotid
↳it's occur
together
It can be pansystolic, ejection systolic
-
Lesions.
- Aortic stenosis murmur
③ At back
->
i) Auscultate lung Base for crepts (means add HES
② Diastolic murmur (important) (pulmonary Oedema)
carotid tpiada member
Xsame with
value
am
or limbs
must as
pt in
paca/not
Y
-
Lesions: O Pitting edema. ada, beats, tugk until
if
- Mitral stenosis murmur
↳@ ventricular problem 3 mana
pitting oedema
-left lateral position
place at mitral area I look at pt face
- Aortic regurgitation murmur
left lower sternal edge
-place at
Deep inspiration max expiration
- +
How To Present (basically present yg
Pt th
je)
O
-I have been 450
examine this patient who
lying comfortably in on his bed.
-
He is
x and
comfortable -> more
lug add in
general inspection)
not
x
in resp-distress
② Peripheral examination
-
There was noted presence/absence of clubbing A cyanosis
-However, no
stigmata of I.E.
-Radial pulse:
x normal pulse x no
collapsing pulse
delay
->
no v-r
There was no
collapsing pulse
no
jaundice, pallon & arch palate
-
-
No JVP visible.
③ Pericardial Examination
-
On inspection:
↳ There were no visible scar seen a no abnormalities
-
On palpation,
x Apex beat: at 5th is midelaricular line
- heave?
-
On duscultation
y normal S.B Sa
-any murmur
A if pansystolic -
eg: in all precordiums loudest at left sternal edge.
A Grade
no leg edema
In
-
conclusion:
To complete examination, I would like to measure BP s others'
my
vital signs
