Clinical Skills/Observations Flashcards
3 Things to Evaluate for Arterial Pulses
Rate of Rise
Pulse Volume
Contour
Jugular Vein Distension (easier to see and more accurate measure of venous pressure)
Ext. jugulars easier to see but less accurate than int. jugs bc int. are more straight, so instead look at skin around int. jugs and see pulsating
Trick to Measure Jugular Vein Distension
Measure from sternal angle to height of highest point you can see venous pulsation (just the vertical value, use a card to carry across). Add those cms to 5cm bc that’s distance from sternal angle to middle of RA, so that’s JVP
4 Possible Precordial Impulses
Normal: 5th IC, midclavicular line. LV
Upper left sternal border: pulmonary HTN/pulmonary valve
Lower Left Sternal Border: Enlarged RT ventricle
Inferiolateral Displacement: Displaced LV
Normal Size of PMI
Dime. Quarter is enlarged
Heart Cycle Phase of Precordial Impulses/Carotid Pulse
Early systolic/isovolumetric contraction
Sustained Precordial Impulses
Aortic stenosis
4 Reasons for Absent Apical Impulses
Obese
No LV Enlargement
Increased AP diameter from COPD/Smoking
RV Enlargement pushes LV post
2 Uses of L Lateral Decubitus Position
Feel PMI
Hear low pitch sounds like S3/4
Use of Sitting Up Auscultation
High freq sounds
Use of Active Relaxation Overshoot in Isovolumetric Relaxation
Helps suck blood into vent during diastole
Atrial Kick
Atrial contraction pushing blood into vent. Missing it usually isn’t a problem unless you have stiff vents and shit like that. Lose w/ Afib and it can really fuck these pts up
Normal S2 Splitting (what it is and 3 mechs)
A2 slightly louder and before P2 on inspiration
Increased pulmonary compliance from dilated blood vessels on inhalation most important
Increased venous return/decreased intrathoracic pressure means it takes longer to empty RV so P2 closes later
Less blood on L side so it closes sooner
S1 Splitting
Normal variant you may hear in tricuspid area. M comes slightly before T
First 1/3 of Systole
Majority of blood leaves vent
