Inspection(undreess patient to the waist,inspect carefully for 10 scnd),lying 45 degree
Comment on:
- Chest wall movement with each respiration
- symmetrically or not
- chest wall deformity
- surgical scar
- silated veins
- skin discolouration
- visible pulsation
- Pecardial bulge
- Apex beat( mitral area)
- Cari apex beat from inferior lateral region,dy biasa beloow nipple skit
- If x jumpa,roll pateint over left side
- LOcate apex beat (tunjuk kat examiner kiraan ribs)
- Access character of :Tapping, Heaving(forceful,sustained,undisplaced impulse "pressure overload due to aortic stenosis/ LV hypertrophy),Thrusting (forceful,unsustainedd,undislace impulse->aortic regurgitation/enlargmnt in mitral),Thrill( palpable murmur)
- Palpate using palm for: parasternal heave(fro rt ventricular & left atrial hypertrophy),thrill at mitral ,aortic and pulmonary area.suggestd for any stenosis
Auscultation
- Mitral area->using bell,listen for pan systolic murmurs suggested mitral stenosis
- using diapghrm->trace up from mitral area to axillae suggested mitral regurgitation
- Tricuspid area-> serach for pansystolic murmurs( ask patient to breath in ,hold and breath out)
- Pulmonary area nad aortic area->listen for ejection systolic murmurs for aortic and pulmonary stenosis
- listen kt lt n rt carotid area sugested for ejaction systolic murmur radiate to carotid area,
- sit the pateint up and listen at 3 area again. This time ask patient to breath in,breath out and hold.
- Impapable apex beat due tu:
- obesity
- pleural & pericardial effusion
- COPD
- Dextocardia(rasa kr sbelah kanan)
