1. 👐Palpation
1.1. *Palpating the carotid {rate, rhythm, amplitude, contour, symmetry, elasticity, thrills} *Assess capillary rafill"nail beds on the fingers and toes " *palpate for arterial pulses {temporal, caroted, redial, ulner, poplotial, tepial, dorsal spedias}_(volume, symmetry, rhythm, strenghth)
1.1.1. Palpate precordium
1.2. Carotid *each carotid separately *Regular rhythm *smooth less acute descent *soft and pliable *strong amplitude
1.2.1. _Palpate by palm *Apex{5th intercostal space midclavicular line}thrills _palpate by thumps *Base left( pulmonic area) 2th intercostal space left sternal border *Base right(aortic area) 2th intercostal space right sternal border *LLSB(tricuspid area) 4th to5th intercostal space at left sternal border *Epigastric area (below the xphoid process
1.2.2. Normal findings
1.3. Abnormal findings
1.3.1. *Arrhythmia *Abnormal pulses *Unequal pulses *stiff, cordlike arteries *positive abdominojugular reflux *Apical impulse right side "congenital heart disease" *Aortic stenosis
2. ¶carotid *lightly palpate each carotid separately *Regular rhythm *strong amplitude *equal pulses *soft and pliable ¶jugular *flatten *normally distends
2.1. New Topic
3. *Percution middile with middelfinger *percution at the anterior axillary line continue toward the sternum along the "5th" intercostal space *changes sound from resonance to dullness over the left border of the heart
4. Percution🖐️
5. ¶Abnormal sounds *carotid "bruits" *jugular "hums"
6. 👂Auscultation
6.1. By the{bell, diaphragm} *the bell¦narrwer, smalker circular, low sound *the diaphragm ¦wider, large circular, higt sound
6.2. Neck ¶ have pt hold breath *Auscult the caroted with the bell *Auscult the jugular with the bell
6.2.1. ¶Important
6.2.2. 🔊Normal suonds *S1:lub, systole *S2:dub, diastole
6.2.3. 🔇Abnormal sounds *S3:taa, lub, dub *S4:taa, lub, dub, taa
7. ¶Precordium €listen at each site with both the bell and diaphragm. *Auscult at Apex "4th intercostal space midclavicular line" _rate, rhythm, extra sounds or murmurs *{All Patient Take Medication} *A_ (Aortic area) R 2th intercostal space close to the sternum *P_(pulmonic area) L2th intercostal space close to the sternum *T_(Tricuspid area) between 3th,4th, 5th,and 6th intercostal space at left sternal border *M_(Miteal area) 5th,6th intercostal space in midclavicular line
7.1. Jugular veins *jugular Venous pulsation is not *Jugular pulsation affected *affected by respiration
8. 👀INSPECTION
8.1. *Assess pt v/s{Temp, HR, RR,and spo2} *jugular Venous pulsation "insupine position" *carotid artery at"any position " *suprastiernal notch pulsation" supraclavicular erea "
8.2. Abnormal findings
8.3. *large bounding visible pulsation *Distended neck veins *Distended chest wall *Elevated jugular vein pulsation *pulsation to right sturnum "aortic aneurysm" *Apical pulsation toward axillary line "ventricular hypertrophy
8.4. Normal findings
8.4.1. Caroted artery *carotid pulsation is normally *carotid pulsation is not unaffected by position *un affected by respiration