Cardio/Pulm Physical Exam

vital signs

blood pressure

pulse

respiratory rate

oxygen

pulmonary

general appearance (RR, cyanosis, audible wheezing, retractions)

inspect chest

inspect AP diameter

chest expansion

tactile fremitus

percussion

auscultation

cardio

position patient

inspect JVD and carotid

measure JVD

auscultate carotid

palpate carotid

palpate PMI

palpate lifts/heaves

palpate thrills

palpate left sternal border

auscultate 6 spots with diaphragm

auscultate LLSB and apex with bell

auscultate apex with bell in LLD

auscultate left sternal border with diaphragm in a leaning forward sitting position

vascular

inspect arms - size, symmetry, swelling, color of skin and nails, hair distribution, prominent veins

capillary refill

palpate brachial pulse

palpate epitrochlear nodes

palpate radial pulse

inspect legs - size, symmetry, swelling, color of skin and nails, hair distribution, prominent veins or varicosities, pigment changes, ulcers

capillary refill

palpate inguinal nodes

palpate femoral pulse

palpate popliteal pulse

palpate posterior tibial pulse

palpate dorsalis pedis pulse

pulmonary normal findings

Normal rate and effort of breathing, speaking in full sentences, no retractions, nasal flaring or grunting. No cyanosis or audible wheezing or stridor.

Chest wall without deformity, scars or lesions. AP:lateral diameter <2:1. Chest expansion is symmetrical. No tenderness to palpation, palpable deformity or step offs of the thorax or chest wall.

Percussion resonant and symmetric throughout all lung fields, anteriorly and posteriorly.

Tactile fremitus present and equal bilaterally, decreasing in intensity towards lung bases.

Lungs clear to auscultation throughout all anterior and posterior lung fields, without wheezes, rhonchi, crackles or focal adventitious sounds.

cardio normal findings

Jugular venous pressure is 7 cm above the sternal angle at 30° elevation. Carotid upstrokes are normal bilaterally without bruits.

Apical impulse visible at 5th ICS, mid-clavicular border, otherwise no visible pulsations or heave on inspection of the precordium. PMI palpated at 5th intercostal space, mid clavicular line, measures approximately 2cm in diameter, tapping and discrete. No palpable lifts, heaves or thrills across precordium.

Regular rate and rhythm on auscultation, S1 and S2 normal in intensity with physiologic splitting of S2 noted with inspiration. No S3 or S4. No murmurs, rubs, clicks or gallops

vascular normal findings

Upper extremities symmetric in appearance without edema, discoloration or varicosities. Temperature and hair distribution appropriate. Brachial and radial pulses 2+ and symmetrical bilaterally. UE capillary refill <2 seconds bilaterally. No epitrochlear lymphadenopathy.

Lower extremities symmetrical without edema, varicosities, discoloration or ulceration. Temperature and hair distribution appropriate. No unilateral calf swelling or tenderness to palpation. No inguinal lymphadenopathy. Femoral, popliteal, PT and DP pulses 2+ and symmetrical bilaterally. LE capillary refill <2 seconds bilaterally.