Cardio examination Flashcards
Introduction
act it out and check afterwards
Wash yo hands Introduce yourself, status Check their full name, DOB, wristband *Ask how they like to be addressed Explanation Consent *Pain/tenderness Positioning of bed - ask if comfortable Exposure
Initial observations / general assessment
Immediate intervention?
Patient is comfortable and does not appear distressed:
- No obvious pain
- No obvious signs of dyspnoea
- Not sweaty or cyanosed
Environment:
- Medications, Oxygen
- Sputum pot (check inside), vomit bowl
- Notes and monitors
NEWS2 chart (if there): - Temp, Pulse, Blood pressure, Resp rate
Hands
Tar staining on fingers
Warmth
Peripheral cyanosis or anaemia
Clubbing
Splinter haemorrhages
Cap refill
Fine tremor (for cardio it doesn’t say to do flapping tremor)
Radial pulse (after hands)
Calculate rate then take pulse with harm held upwards. Then comment on:
1) Rate
2) Rhythm:
- Regular
- Regularly irregular
- Irregularly irregular
- Irrerrregurarly reggegular
3) Volume:
- Normal, bounding, thready, full, low volume
4) Character:
- Normal, slow rising, collapsing
can check radial-radial delay so you don’t need to do it later
Check for IV track marks
Head
Face: - Malar flush (MS)
Inform patient you wish to pull down their eyelids:
- Pallor or anaemia
Xanthelasmata
Corneal arcus
Ask patient to stick out tongue:
- Central cyanosis (blue lips/tongue)
- Iron deficiency anaemia (red)
Angular stomatitis (iron def anaemia)
After the head, what do you inspect?
Back
Ask patient to swing their legs over the side away from you and give them a pillow
Back
Auscultate lung bases for crackles
- Left sided heart failure
If patient is up and about then you don’t check Sacral oedema (press over sacral area) but you should state this
Lower limbs
Inspect:
Compare legs for signs of ischaemia:
- pallor, hairless, leg ulcers, gangrene
Palpate:
- Capillary refill on toe
- Jack pechey loves toes
Pitting oedema:
- Start at malleolus and move up until oedema stops
- 15s firm pressure with thumb
Ask patient to stand:
- Varicose veins - front & back
- While they get out of bed, ask them if they have varicose veins
Assessment of JVP
Ensure patient lying in bed correctly
Ask them to turn and look up/away from you and relax
To measure JVP:
- Vertical height of highest point of flickering above the sternal angle
- Normally should be below <4cm / 4 fingers or 3 fingers if you have big meaty sausage hands
Precordium - pre-auscultation bit
INSPECTION - comment on:
- Chest deformities
- Scars
- Pulsation
- Pacemaker - just ask the patient
Palpation:
- Tracheal position (warn patient)
Summarise the order of Precordium examination
INSPECTION
Tracheal position
Apex beat
Heaves
Thrills
w/ Carotid pulse
4 valves with diaphragm
4 valves with Bell
Aortic stenosis –> Carotid arteries
Mitral regurgitation –> Left axilla
Mitral stenosis with the BELL
Aortic regurgitation with diaphragm
Precordium auscultation
this one is long
PALPATE THE FECKIN CAROTID
All 4 with diaphragm, then all 4 with bell Comment on: - Added sounds (3rd ± 4th) - Snaps, clicks of mechanical valve - Pericardial rub - Murmurs
Aortic stenosis with diaphragm:
- 2nd right intercostal space —-> Both carotids
- ‘No systolic murmur of…’
Mitral regurgitation with diaphragm:
- Apex —-> L axilla
- ‘No systolic murmur of…’
Mitral stenosis with BELL (explain beforehand):
- Place on apex then ask patient to roll onto left side
- Breath held on expiration
Aortic regurgitation with diaphragm:
- Ask patient to sit up & lean forward
- LOWER LEFT STERNAL EDGE
- Breath held on expiration
Peripheral pulses
Radial-radial delay
Brachials
Carotids (individually)
- Auscultate carotids for Bruits
Femorals
- get permission
- Auscultate those fuckers
- Radial-femoral delay
Popliteal
Posterior tibial - can do both at once if youre feeling spicy
Dorsalis pedis - both at once
