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Examination |
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1. Signs of distress—does the patient need urgent treatment before examination? 2. Hydration—thirst, oliguria, loss of skin turgor, tachycardia, postural hypotension. 3. Cyanosis—increase in de-oxygenated haemoglobin. Either peripheral (secondary to poor perfusion) or central (lung disease). 4. Anaemia—check conjunctive inside lower lid. Not reliable unless gross. 5. Jaundice—check the sclera. 6. Clubbing—loss of angle between nail and nailbed. Seen in cardiac disease (infective endocarditis, cyanotic congenital disease), respiratory disease (bronchogenic carcinoma, pus in chest cavity), gastrointestinal disease (alcoholic cirrhosis, malabsorption) or hereditary.
CARDIOVASCULAR SYSTEM 1. Cyanosis, clubbing, anaemia, splinter haemorrhages, ankle oedema. 2. Pulses– radial and carotid. Rate, rhythm and character. 3. Blood pressure. 4. Jugular Venous Pressure (JVP)-with the patient sitting a 45 degrees, normally just visible above the clavicle. 5. Apex Beat –the outermost lowest point of the heart’s impulse. Normally in the fifth intercostal space in the mid-clavicular line. 6. Auscultation—listen initially at the apex, then all over the precordium. Be able to recognize the first and second heart sounds (‘Lub-Dub’). Note any additional sounds in systole or diastole and any radiation to the axilla or carotid region. |
General Appearance |
