Cardio

Question 1

intro

Answer 1

Ive been asked to do an examination on your cardiovascular system today. so what that will involve is having a look at your hand, feeling your pulses, having a look at your face and having a feel and listen to your heart

Question 2

1

Answer 2

Inspect hands (general inspect before this though)

“id like to start by looking at your hands if you could just bring them up infront of you please. and if you could turn them over”

Question 3

4

Answer 3

Cap refill

Question 4

5

Answer 4

radial

“I’d now like to feel the pulse in your wrist”

Question 5

6

Answer 5

Assess for radio radial delay

“I’d now like to feel the pulse in your other wrist at the same time”

Question 6

9

Answer 6

palpate the brachial

Im now going to feel a pulse at the front of the elbow

Question 7

10

Answer 7

collapsing pulse

Im now going to assess for a collapsing pulse so im going to have my hand on your wrist and lift your arm up rather briskly… any pain in your shoulder at all

Question 8

11

Answer 8

Palpate the carotid one at a time

checking vol and character

Question 9

12

Answer 9

JVP - hepato reflex

“if you could just turn your head to the left for me. Any p[ain in your tummy? im just going to press down on your stomach”

apply pressure to the liver only once and look at JVP

…. and bring your head back

Question 10

13

Answer 10

EYES (pull down) and MOUTH

im now going to have a look at your face and eyes, if that’s ok with you. If you could just look straight ahead for me.

look at eyes before doing pallor test. also look at face for malar flush

Question 11

14

Answer 11

Inspect the chest

Lift arms up both sides looking for scars/chest wall deformities

Question 12

15

Answer 12

Palpate apex

“im now going to feel for a pulse on the chest”

Question 13

16

Answer 13

assess for a parasternal heave (bit more central than apex) put palm down

thrills on 4 valve areas, put palm on side

Question 14

17

Answer 14

Auscultate each heart valves

Heart valves are at:
below left nipple, side of left nipple, then up more centrally

(Med school - If extra sounds are heard, palpate the carotid pulse to time them with the first and second heart sounds?)

Question 15

18

Answer 15

Auscultate the left axilla for mitral incompetence

Question 16

19

Answer 16

Mitral manoeuvre -
switch to bell for this

“and roll on to your left hand side for me… deep breath in and out (say in and out quickly) and hold it for me …. and breath normally”

Question 17

20

Answer 17

Aortic Manoeuvre - switch to the diaphragm

“now sit forward for me. (straight away) deep breath in, deep breath out. and hold it there…and breath normally”

Question 18

21

Answer 18

auscultate the lungs

“im now going to listen to the back of your chest, can you just sit forward for me.”

Question 19

22

Answer 19

assess for sacral oedema and ankles

“im just going to feel at the bottom of your back”

Question 20

23

thrills - dont put much pressure
do apex, then do vertical over top 2/top of heart, and then do 4 horizontal over each valve

ausuclate bottom of the lungs only
sacral oedema only

Answer 20

Auscultate the carotids

-Sit the patient back

complete:
on inspection….

BP!!
12 lead ECG
Fundoscope