Examination Of Precordium Introduction Consent 1.Inspection Visible Scar marks Deformity Pectus Excavatum Carinatum Any bulge in the thorax Any visible pulsation Anything Abnormal 2. Palpation Must rub your hands if cold weather (i) First palpate Apex beat feel it with your fingers after feeling count it from Manubrium Sterni which is in the 2nd intercostal space Locate intercostal space & weather it is in mid clavicular line or displaced Check weather Apex beat is normal or Tapping or Heaving with your finger If Tapping your finger will be tapped/touched slightly. If Heaving your finger will be lifted upwards (not just touched) Ill heave finger lifted up for short time Well sustained heave finger lifted up for long time (ii) Right Ventricular Heave/ Left Parasternal Heave (iii) Palpate both Aortic & Pulmonary Areas with fingers & palms of your hand to see if a thrill is present or not. (iv) Palpate trachea (v) Feel Epigastric Pulsation 3. Auscultation Starts from MITRAL AREA after locating AB i. Place the steth at mitral area ii. Synchronize it with carotid iii. Give command Of Respiration to patient Murmur of right heart exaggerate during inspiration & left heart exaggerate during expiration سانس اندر لیں باہر نکالیں اور روک لیں iv. Ask patient to go to left lateral position see if there is an exaggeration of a murmur Murmur of Aortic regurgitation exaggerates in this position v. Check radiation of murmur in axillary area Now TRICUSPID AREA same 3 steps Place the steth at exact area Synchronize it with carotid Give command of respiration سانس اندر لیں باہر نکالیں اور روک لیں Next PULMONARY AREA Place the steth at exact point Synchronize it with carotid artery pulsation Give command of respiration سانس اندر لیں اور روک لیں NEXT AORTIC AREA i. Place the steth at exact area ii. Synchronize it with carotid iii. Give command of respiration سانس اندر لیں باہر نکالیں اور روک لیں iv. Ask the patient to sit up & lean forward to check gor murmur of aortic as it exaggerates in this position بیٹھیں اور تھوڑا سا جھک جائیں v. Check the radiation in the neck 4. Do the relevant examination Look for the basal crepts Do The Hepatojugular reflex Look for hepatomegaly Look for Pedal Edema Examine Hands for signs of Infective endocarditis like Splinter Hemorrhages Janeway Lesions Osler Nodes Petechiae Bruises & other things. Say thank you & cover the patient
Description of Findings I've an 8 years old boy lying comfortably on bed with no obvious distress or dysmorphic features. (environment of pt Cannulated or not O2 administered or not) On Inspection there are no visible Scar marks or visible pulsations, no deformity Pectus Excavatum Carinatum or any other. On palpation AB is in 5th intercostal space in mid clavicular line tapping in character. There were no Parasternal Heave or thrill present. The Trachea was central & there are no epigastric pulsations Both the first & second heart sounds are audible with grade 3 pan systolic murmur maximum heard at the lower left para sternal border radiating to the whole of precardium with no exaggeration on respiration & change of posture. The pitch of the murmur is high & the character of murmur was harsh/blowing This child is not in heart failure & there are no signs of Infective endocarditis.
you didnt tell about where to examine which area from where, for example at which intercostal space is the mitral, pulmonary etc. also the findings you told were of a normal patient ???? please confirm
First we auscultate with diaphragm and then close it and again auscultate with bell on mitral as well as aortic areas but in this video he didnot mentioned it
