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Techniques of Physical Examination | Part Three

Cardiovascular System
Evaluate Four areas:

  • Arterial Pulse – check for rate (bradycardia – tachycardia), regularity/rhythm (skipped or extra beats), and character/amplitude (strong, weak…):
    • radial (most often for conscious patients)
    • carotid (patients with shock or poor circulation)
    • femoral (also patients with shock or poor circulation) – brachial – infants
  • Blood pressure: normotension = normal limits normal = 90-140 over 60-90 mm
    • Hg. Varies with age, sex and body size
    • Hypotension: continuous low BP under 90/60 – Hypertension: continuous high BP over 140/90 – Cuff too small = false high
    • Cuff too big = false low
    • Orthostatic Hypotension: BP drops when they stand up (10-20 mm Hg), pulse rate increases (10-20 bpm)
    • Pulse pressure = the difference between Systolic and Diastolic pressures normal is 40. early shock, pericardial tamponade, or tension pneumothorax can cause decrease
  • Jugular venous pressure and pulsation: distension is abnormal pressure, CHF, cardiac tamponade. Venous pulsations are rarely palpable
  • Heart: find the PMI (point of max impulse) 5th intercostal space medial to the left midclavicular line where the apical beat is observed

Examination of the Abdomen, Normal and abnormal findings.

General approach: they need to be supine. Auscultate before Palpate (go alphabetical -)

  • Skin : scars, striae, dilated veins, rashes, lesions
  • Contour : flat or protuberant
  • Pulsations : small upper abdominal aorta movement may be seen, excessive may = aneurysm
  • Auscultate :
    • Absent bowel sounds: suggests abdominal pathology – Decreased: listen for a period of time
    • Increased: anxiety, diet, hunger
    • Bruits: high pitched whoosing of blood in arteries
  • Palpate:
    • Tenderness: pain with movement or palpation – Guarding: deliberate tensing
    • Muscular Rigidity: suggests peritonitis – Rebound tenderness: also peritonitis

Female Genitalia Normal and abnormal findings of: Male examiner have a female partner present. Note Inflammation, Discharge, Bleeding, Swelling

Male Genitalia Normal and abnormal findings of: Female examiner have a male partner present. Note Inflammation, Discharge, Bleeding, Swelling

Extremities: Assess for:

Signs of inflammation: swelling, tenderness, heat, redness, decreased function
Crepitus: palpable or audible crunching made by movement
Deformities
Muscular strength
Symmetry: are injuries bilateral or on one side _ Atrophy, loss of muscle mass
Pain: try to localize complaint without causing more pain _ Tenderness same as above
Peripheral pulses (feet – dorsalis pedis and hands – radial): Increased, normal, diminished, absent
Motor function (feet and hands):
Sensory function (feet and hands):
Spine: Inspect the spine from side and from behind, gently palpate for symmetry, tenderness and spasm

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