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ECOS Spring Final Exam > Lab- Cardiac, Rib HVLA, and Counterstrain > Flashcards

Lab- Cardiac, Rib HVLA, and Counterstrain Flashcards

1
Q

First thing to do in Physical Exam for Cardiac complaint?

A

Inspection - general appearance (cyanosis, posture, resp distress, etc) Chest shape (barrel chest, pectus carinatum, pectus escavatum)

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2
Q

Landmarks of Cardiac physical exam?

A
  • Sternal notch
  • Sternal angle
  • Xiphoid process
  • Costochondral joints & Intercostal muscles
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3
Q

TART screen of cardiac physical exam?

A
  • Is the pain reproducible? If yes, MSK is most likely (Only 3% of cardiac pain is reproducible)
  • Pain from rib dysfunction is often experienced at the anterior intercostal spaces with associated intercostal spasm
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4
Q

Chapman’s Points of cardiac complaint?

A
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5
Q

Autonomic Associations of cardiac complaint

A
  • Sympathetic
    • Heart: T1-6
    • Upper GI: T5-10
    • Adrenals: T5-10 (T10)
  • Parasympathetic
    • Vagus = Suboccipital
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6
Q

Point of Maximal Impulse (PMI)

A
  • Estimates the size of the heart and location of the apex of the heart
  • Assessment:
    • Supine or Lateral Recumbent
    • 5th Intercostal space in the mid-clavicular line
  • Normally <2.5cm (quarter size)
    • >2.5 indicative of LVH or dilated cardiomyopathy
  • Palpation may be easier leaning forward or left lateral recumbent
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7
Q

Auscultation of Cardiac physical exam - Listening posts

A
  • Aortic valve: right 2nd ICS at sternal border
  • Pulmonic valve: left 2nd ICS at sternal border
  • Tricuspid valve: left 4th ICS at sternal border
    Mitral valve: left 5th ICS at mid-clavicular line
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8
Q

Auscultation of cardiac sounds - what is the process and what is important to note?

A
  • ALWAYS LISTEN ON BARE SKIN!
  • Listen to all 4 posts with diaphragm AND bell
    • S1, S2, AR, MR: Better heard with diaphragm
    • S3, S4, MS: Better heard with bell
  • Listen for S1 and S2 (Lub Dub)
    • Get in touch with the pattern/rhythm (a-fib, early beat, pause)
    • Then listen in between the beats for extra sounds: murmurs, clicks
      • After LubDub = diastolic, S3 or S4
      • In between = systolic
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9
Q

Systolic Murmurs, when are they heard? - cardiac physical

A
  • Systolic = Between S1 and S2
    • AS, PS, MR, TR
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10
Q

Diastolic Murmurs, when are they heard?

A
  • Diastolic = Between S2 and S1
    • AR, PR, MS, TS
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11
Q

How do we grade heart sound murmurs?

A
  • Grade 1: Very faint
  • Grade 2: Quiet, but heard easily with stethoscope
  • Grade 3: Loud, NO thrill
  • Grade 4: Loud WITH a thrill
  • Grade 5: Very loud with a thrill
  • Grade 6: Heard with stethoscope off chest
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12
Q

How do we grade pulses?

A
  • 0 = Absent, Not palpable
  • 1+ = Diminished
  • 2+ = Normal
  • 3+ = Bounding, Increased
  • Always assess bilaterally!
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13
Q

How to assess Carotid pulse during cardiac physical exam

A
  • Medial to the SCM
  • DO NOT ASSESS SIMULTANEOUSLY!
    • Pressure on the carotid baroreceptors may cause a hypotensive reflex and possible syncope
  • Carotid Bruits
    • Use the bell of the stethoscope
    • Have patient hold breath, and listen to the artery
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14
Q

Importance of capillary refill in cardiac physical exam? How to do it?

A
  • Tests digital perfusion
  • Apply pressure to fingernail/toenail until blanching
  • Remove pressure
  • Note the time it takes for color to return
    • Normal = <3 seconds
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15
Q

Vascular testing in cardiac physical exam, what do we check?

A

Pulses, carotid pulse, capillary refill, peripheral edema

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16
Q

Peripheral edema - how to do it, what is grading scale?

A
  • Press over bone firmly for five seconds, then release
    • Most commonly on anterior tibia
  • Grading
    • 0 = Absent
    • 1+ = 2mm indentation, disappears rapidly
    • 2+ = 4mm indention, disappears 10-15 sec
    • 3+ = 6mm indentation, disappears >1 min
    • 4+ = 8mm indentation, disappears 2-5 min
17
Q

Cardiac physcial exam special tests - what are they?

A

Jugular Venous Pressure (JVP)
Allen Test

18
Q

What is Jugular Venous Pressure test?

A
  • Measures jugular venous distention (JVD)
    • Best estimated over right internal jugular vein
    • Behind SCM
  • Raise head of bed to 30⁰, turn patient’s head slightly left
  • Identify the most superior point of pulsation and distention
    • JVP = vertical distance from sternal angle to highest point of pulsation + 5cm
    • Hepatojugular reflux (HJR) = jugular distention with liver pressure demonstrates abdominal and liver edema
19
Q

what is the allen special test?

A
  • Evaluates the presence and function of radial and ulnar arteries
  • Occlude both arteries, have patient open and close fist until palm blanches
  • Release pressure of ulnar artery and observe color return
  • Repeat with radial artery
  • Normal = 5-10 seconds
    • >10 seconds is delayed
  • Clinical use: Demonstrates absence of either artery and is therefore a contraindication for radial catheterization
20
Q

Rib Somatic Dysfunction- BITE mneumonic

A

Bottom Inhalation Top Exhalation

  • _B_ottom _I_nhalation
    • If a group of ribs is found to have inhalation SD, the bottom of the group is the key rib
    • Inhalation dysfunction = treat inferior rib
  • _T_op _E_xhalation
    • If a group of ribs is found to have exhalation SD, the top rib of the group is the key rib
    • Exhalation dysfunction = treat superior rib
  • Key rib = the rib that maintains a group in dysfunctional motion
    • Treat this rib FIRST
21
Q

Rib Counterstrain - anterior rib tender points

A
22
Q

Rib Counterstrain anterior rib 1 & 2

A

FSRT

  • Patient supine or seated
  • Lift head and neck ~40 degrees
  • Sidebend & Rotate Toward the side of the dysfunction
    • Expect about 45 degrees of each

Pro-tip: ribs 1&2 are often elevated because of the scalenes. This position also places them at ease.

23
Q

Rib Counterstrain: Anterior rib 3-10

A

f-FRST

  • Pt. seated
  • Place pt’s arm on side opposite dysfunction on your knee
  • Slightly Sidebend & Rotate trunk Toward dysfunction
  • Add flexion
24
Q

Rib Counterstrain - posterior rib tenderpoints

A
25
Q

Rib Counterstrain: Posterior rib 1

A

MAVERICK - eSaRt-T

  • Pt seated or supine or other creative position as needed
  • Add slight Extension
  • Slightly Sidebend Away
  • Moderately Rotate Toward
  • Balance tissues at the level of the dysfunction
26
Q

Rib Couterstrain: Posterior rib 2

A

fSARA

  • Pt seated or supine or other creative position as needed
  • Flex head
  • Sidebend & Rotate the trunk/neck Away
  • Balance tissues at the level of the dysfunction
27
Q

Rib Counterstrain: Posterior ribs 3-10

A

FSARA

  • Pt seated
  • Support arm of side of dysfunction on top of your knee
  • Grasp shoulder or brace head
  • Sidebend & rotate superior portion (head or torso) away
  • Balance at level of the dysfunction

Pro-tip: elevates the affected inhaled rib

ECOS Spring Final Exam (7 decks)

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