Precordial Exam Flashcards
how should you drape for this exam?
the patient must be uncovered to the upper abdomen so a full inspection of the precordium can be performed .female patients can be uncovered intermittently, as needed during the course of the examination.
inspection of anterior chest
PLADS pulsality/pulsation lifts/heaves apex beat deformities scars
after identification (PLADS) what do you do
identify the location of here valves - pulmonic valve aortic valve tricuspid valve mitral valve
after you identify and inspect, what is next
palpation:
1. lifts/heaves: large movement associated with right ventricular hypertrophy. best felt with either the ulnar aspect or the heel of the hand along ht left sternal border.
- thrills: palpable small vibration caused by turbulent blood flow. best felt with fingertips over the valve areas .
3. apex beat: only palpable in some. if the apex beat is palpable, characterize it in terms of LAIDS: location amplitude duration-- should last 2/3's of systole size impulse.
- if unable to palpate the apex beat, can try to accentuate it by asking the patient to roll onto their left side. ask the patient to exhale fully and stop breathing for a few seconds.
how to characterize apex beat
LAIDS: location amplitude duration-- should last 2/3's of systole size impulse.
what to do if you cannot get the apex beat supine
- if unable to palpate the apex beat, can try to accentuate it by asking the patient to roll onto their left side. ask the patient to exhale fully and stop breathing for a few seconds.
Do you percuss in this precordial exam?
not usually, but it can be useful id you suspect COPD or pericardial effusion
explain auscultation
- should be done lying supine, lying on left side, and sitting up while leaning forward.
1. auscultate for S1 and S2 over all 4 valve areas. most clinicians will start at either the apex or base of the heart - auscultate to see if s2 is split: normally splits with inspiration
- auscultate for S3 and S4 (abnormal diastolic sounds)
s3; rapid ventricular filling from high preload
s4; ventricular filling with a stiff ventricle. “a - stiff- walll”
- auscultate at the APEX along the left lower steal border with the BELL. BeLL for LLow sounds– such as s3/s4 for murmurs.
3. listen for murmurs and characterize it in terms of location, radiation, timing (systolic or diastolic), intensity (grade), pitch, quality (harsh, blowing, rumbling, musical), shape, and things that alter it.
4. OPENING SNAP: occurs in mitral stenosis. best hear by DIAPHRAGM. best heard along the left lower sternal border with the patient sitting up, leaning forward and briefly holding their breath.
5. PERICARDIAL RUB
what part of stethoscope would hear murmurs best
bell
how to characterize murmurs
location, radiation, pitch (high/low), timing (systolic and diastolic), character (harsh/soft/rumbling/muscial), shape (crescendo, decresecndo), intensity (grade), and things that alter it.
how to accentuate aortic murmur:
ask the patient to sit up, lean forward, exhale completely, and stop breathing at the end of inspiration
how to accentuate mitral murmur;
ask the patient to roll onto the left side, likee for apex beat
if you were to hear murmurs;
aortic murmurs radiate to the ___
mitral murmurs radiate to ___
aortic: radiate to carotids
mitral; radiate towards the axillary line.
after the auscultation phase, you must check the carotid artery. outline the carotid exam
- auscultate for a bruit; ensure that there is not plaque or debris in the artery that could be dislodged.
- avoid pressing on the carotid sinus which lies at the level of the thyroid cartilage.
characterize the pulse in terms of thrills, rate, rhythm, contour amplitude.
murmurs and s3 and s4 are best heard by a ___, whereas s1 and s2, opening snaps and pericardial rubs are heard best with ____
murmurs and s3 and s4 are best heard by a BELL, whereas s1 and s2, opening snaps and pericardial rubs are heard best with DIAPHRAGM
