CVS examination Flashcards
general structure x7
- intro
- general observation
- general examination
- blood pressure
- JVP
- precordium
- pulses
2.general observations
Initial Assessment:
Do you need to make an immediate intervention?
General observations:
Assess how comfortable/distressed e.g. secondary to pain,
cough, dyspnoea.
Is the patient sweaty or cyanosed?
Environment:
any medications (e.g. GTN spray, inhalers/nebuliser)
oxygen
sputum pot
monitiors
CHECK CHARTS
3.general examination: structure
- hands and arms
- head
- lower limbs
3.general examination: arms and hands
3 groups with 11
- Tar staining of fingers
- Warmth of hands - (think why the hands may be cool or
warm and sweaty) - Peripheral cyanosis or anaemia
- Splinter haemorrhages in the nail beds
- Capillary refill time
- Fine tremor (arms outstretched, fingers slightly spread)
heart rate:
1. rate
2. rythm
3. volume
4. character
Arms:
* track marks
3.general examination: head x5
Face:
malor flush
eyes:
conjunctivae-pallor/anemia
xanthelasmata
corneal arcus
toung and lips:
central cyanosis – blue discolouration of tongue and/
or lips
3.general examination: legs
pitting oedema- ankle
arterial disease- ischemia e.g. cold, smooth, hairless skin; increased capillary refill time; arterial leg ulcers or gangrene
Varicose veins, lipodermatosclerosis, ulceration,
4.blood pressure main points
pump until silent
release
when sounds starts- systolic
when sound stops- diastolic
5.JVP
lying at 45°
head turned slightly to the left.
Look for the double venous flickering of blood in internal
jugular vein in supraclavicular area.
Jugular Venous Pressure assessment = vertical height of
flickering column of blood within the vein, above the sternal
angle. JVP normally <4cm.
6.precordium- inspection x4
get patient to lower top
- deformaties- Kyphoscoliosis
- scars
- pacemaker
- pulsation
6.palpation
tracheal position
pacemaker
apex beat- count intercostal spaces
Heaves- left of sternum (right ventricular
hypertrophy)
thrills- Feel at apex and both sides of sternum with flat of fingers (systolic usually)
6.palpation
tracheal position
pacemaker
apex beat- count intercostal spaces
Heaves- left of sternum (right ventricular
hypertrophy)
thrills- Feel at apex and both sides of sternum with flat of fingers (systolic usually)
7.ausculation
Heart sounds:
palpate carotid and cover all 4 valve areas with
* diaphragm
* bell
to time S1 and S2
Listen for:
Palpate carotid pulse simultaneously to time S1 and S2
“S1+2+0”
“No extra heart sounds”
Left Systolic Murmers:
1.Aortic Stenosis:
aortic valve area again and then over both the
carotid arteries with diaphragm
2.Mitral regurgitation:
Listen again over the apex and then in L axilla with the
diaphragm
Left Diastolic Murmurs:
1. Mitral stenosis
roll onto their left side
listen at the apex with bell with the breath held
- Aortic regurgitation
sit up, leaning forwards, and ask them to
**hold their breath in expiration **
Listen at the lower left sternal edge
with the diaphragm
ECG overview x8
- intro + consent
- turn on machine
- expose arms and legs and chest
- place patches
- attach leads
- record and print- ask patient to keep still
- remove leads
- remove tabs and allow to get redressed
how to position the 4 limb leads
2 things to ensure
ensure hand patches face down
ensure leg patches face up
Red- Right arm
YeLlow- left arm
Green-left foot
Black- right foot
Ride Your Green Bike
how to position the 6 chest leads
1 thing to ensure
ensure all patches are facing downwards
- V 1 = 4th intercostal space to the right of the
sternum - V 2 = 4th intercostal space to the left of the
sternum - V 4 = 5th left intercostal space midclavicular line- apex
- V 3 = midway between Leads 2 and 4
- V 5 = same horizontal level as Lead 4 anterior
axillary line - V 6 = same horizontal level as Lead 4 mid axillary line
interoperating ECG:
what is the PR interval
and what should the PR interval be in seconds and squares
time taken from atrial depolarisation (P) to ventricular depolarisation (R)
0.12-0.2s
3-5 squares
interoperating ECG:
what is the QRS complex
and what should the QRS complex be in seconds and squares
ventricular depolarization
under 0.12s
under 3 squares
interoperating ECG:
what is the QT interval
and what should the QT interval be in seconds and squares
time spent in ventricular depolarization and repolarization
max 0.42 secs
no more than 10 squares
how much time does a large and small square represent
what should paper me
large = 0.2s
small = 0.04s
25mm/s
how to calculate heart rate on ECG
for regular QRS:
count the number of large squares between the peaks of QRS and dividing that number into 300
for irregular QRS:
count the amount of QRS in 30 squares (6s) and times by 10
examination of peripheral pusles x7
carotid as well
do each twice and compare sides
