General approach wrist

⑥ Introduce ourself I
gain consent ① Radial
pulse (30s
only
② Hand R.R
delay, R-F delay.
rub
-Rate (now), rhythm, volume,
S
③ Identify & explain to ot ② Collapsing pulse cortic
coatation
i) Purpose of examination
-
Imustfortable s -

aortic regurgitation
④ Position by touch
Pt 450 we
comfort PDA
-

&expose to the waist Pt ③ Blood

pressure
*
BCG scar

General inspection
-look at patient (at the end
of bed) ↑
ace
O surrounding (attachment
-
Or supplementation -
In line -

chest tube &Eye

suction machine (anemia)

Nasal prong -medicine
Conjuctive: if pale
-
- -

③ Consciousness (greet patient) + ask

permission
-

Sclera: yellow (jaundice

-

alert or not -
in
pain or not -Xanthelasma: cholesterol deposits
③ Nutrition & hydration status ② Mouth

-
cachexic O Cyanosis
④ Breathing effort 84 arched palate: Marfan's Syndrome
In resp distress/not Use of ene &
Teeth Hygiene: Infective Endocarditis

accessory male
-

③ Any syndromic features scM abdo muscle

of
-Dsymorphisti not in adult unless umph
③ Neck
sngE ① Carotid pulse

Systematic examination @ LN
③ JUP: <3cm (significants
m and not
medial
↓
elevated
to SoM
Palms A fingers
①
Peripheral cyanosis: HF Specific Examination (Precordium Examination)
② Nail clubbing

③ Splinter hemorrhage (nail bed ① Inspection

Scar, visible
-Infective endocarditis pulse, pacemaker
-Vasculitis

Janeway lesions
irregular, nontender hemorrhagic macules located on the palms, soles, thenar and
hypothenar eminences of the hands, and plantar surfaces of the toes. @ Palpation
-

Infective endocarditis ⑥ Apex beat -

1 cm medial to left midclaricular lines

O 5th intercostal
⑱ Osler nodes
(metaphalanges) tender space.
~

erythematous, tender nodules located principally on the pads

of the fingers and toes. <painful

*
highlighted people: Stigmata of I.G Must 8

Touch" ② Parasternal heave

Right Ventricular Hypertrophy.
-

if naik: abnormal -opt tap, mata same level dan chest 900
-if X vasa tolak: norm
of -

if chest more kene tangan (abnormal)

-

@side HF
 ⑰
D Q ③

③ Thrills (palpable murmur)

x
Thrills + carotid pulsation =
systolic thril

3
- Thrills # carotic pulsation: diastolic thrill.

Systolic
(Usediaphragm the
is
③ Auscultation

and is -> -- 2nd0i.s

3
diastolic
jx
3 th@ i.s 5@ i.s, midclavicular

&
Heart sound

81: mitual & tricuspid valve close (Palpate carotidifberdengut an Additival

Sa: Aortic & pulmo value close (carotid pulse xberdengut O When auscultate murmur +
palpate carotid pulse -

also
go

together in heart sounds to laterally as It can be radiation axilla

②Murmur 8
when find murmur, locate the best heard where

->

O systolic murmur (important)

-
when auscultate (ada murmur) +
palpate carotid

↳it's occur
together
It can be pansystolic, ejection systolic

-
Lesions.

- Aortic stenosis murmur

③ At back

->
i) Auscultate lung Base for crepts (means add HES

② Diastolic murmur (important) (pulmonary Oedema)

carotid tpiada member
Xsame with
value

am
or limbs
must as
pt in
paca/not
Y
-
Lesions: O Pitting edema. ada, beats, tugk until
if
- Mitral stenosis murmur
↳@ ventricular problem 3 mana
pitting oedema

-left lateral position

place at mitral area I look at pt face
- Aortic regurgitation murmur

left lower sternal edge

-place at
Deep inspiration max expiration
- +
 How To Present (basically present yg
Pt th
je)

O
-I have been 450
examine this patient who
lying comfortably in on his bed.
-
He is

x and
comfortable -> more
lug add in
general inspection)
not
x
in resp-distress

② Peripheral examination
-

There was noted presence/absence of clubbing A cyanosis

-However, no
stigmata of I.E.

-Radial pulse:
x normal pulse x no
collapsing pulse
delay
->
no v-r

There was no
collapsing pulse
no
jaundice, pallon & arch palate
-

-
No JVP visible.

③ Pericardial Examination

-
On inspection:
↳ There were no visible scar seen a no abnormalities
-
On palpation,
x Apex beat: at 5th is midelaricular line

- heave?

-
On duscultation

y normal S.B Sa

-any murmur

A if pansystolic -

eg: in all precordiums loudest at left sternal edge.

A Grade

no leg edema

In
-

conclusion:

To complete examination, I would like to measure BP s others'

my
vital signs