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
examination of peripheral pusles x7
carotid as well
do each twice and compare sides
