Cardiopulmonary Exam

Front 1

What are the big picture components of the CP exam?

Back 1

General Assessment
Vital Signs
Posterior Exam
Anterior Exam supine- lungs
Anterior Exam supine- heart
Anterior Exam sitting

Front 2

What are the components of the general assessment of the patient?

Back 2

*Assess general appearance, including signs of distress.
*Inspect skin, lips, nails for general appearance and color, texture, or lesions.
*Could check cap refill and radial/dorsalis pedis pulses here.
**LOWER PATIENT'S GOWN BELOW SHOULDERS; HAVE PT HOLD THE GOWN IN PLACE**

Front 3

What are the components of the posterior exam?

Back 3

*LOOK:
1) Assess general respiratory effort.
2) Observe symmetry of chest expansion and shape of chest wall.

*FEEL:
1) Palpate anterior, posterior, and lateral chest walls for tenderness. Do this at upper chest and lower chest levels. Do several levels on the back as well.
**RAISE GOWN BACK UP, BUT DON'T TIE IT**
2) Assess respiratory expansion at the 10th rib.

*LISTEN:
1) Percuss posterior lung fields at 4 levels and at mid axillary line.
2) Auscultate posterior lung fields at 4 levels and at mid axillary line.

Front 4

What are the components of the anterior lung exam?

Back 4

**LOWER THE EXAM BED TO 30˚, LAY PATIENT DOWN AND DRAPE THE LEGS TO THE WAIST**

*LOOK:
1) Observe shape and movement of chest wall.

*LISTEN:
*RAISE PATIENT'S GOWN UP FROM BELOW*.
1) Percuss anterior lung field at 2 levels.
2) Auscultate the anterior lung fields at 2 levels.

Front 5

Discuss the Tactile Fremitus test:

Back 5

*Use ulnar surface of your KNIFE-HANDS!

*Posteriorly:
1) Place hands at position 1, horizontally.
2) Place hands vertically, between 2 and 3.
3) Place hands horizontally again, below position 3.

*Anteriorly:
1) Knife hands should be horizontal, at upper lung level (1) and lower level (below nipple or bra line).

*Patient says "toy boat." If there's decreased transmission of voice sounds, the test is positive.

Front 6

Discuss the Bronchophony test:

Discuss the Egophony test:

Discuss the Whispered Pectoriloquy test:

Back 6

BRONCHOPHONY:
*Listen with stethoscope and have patient say "99."
*Louder voice sounds are a positive test.

EGOPHONY:
*Listen with stethoscope and have patient say "eeee."
*If what you hear is "A," that's a positive test.

WHISPERED PECTORILOQUY:
*Listen with stethoscope and have patient whisper "99."
*If what you hear is loud and clear, that's a positive test.

Front 7

What are the components of the anterior heart exam?

Back 7

*LOOK:
**PATIENT SHOULD ALREADY BE SUPINE AT 30˚**
1) Patient should turn head to left.
2) Look for JV pulsations and distention.

*FEEL:
1) Test for HJ reflux.
2) Palpate the carotid pulses, one at a time.
3) Palpate for heaves using palm of your hand--do this over the sternum, and in tricuspid and mitral areas.
4) Palpate for thrills using the ball of your hand. Do this in the 4 heart areas.

*LISTEN:
1) Auscultate all 4 heart areas using both bell and diaphragm.
2) Put patient in LLDP, and auscultate mitral and axillary areas using the bell.
**PUT GOWN BACK DOWN, BACK UP OVER SHOULDERS, AND HELP PATIENT SIT UP.**
3) Auscultate aortic and pulmonic areas with diaphragm while patient leans forward.
4) Auscultate carotids while patient holds breath.

Front 8

What is the NORMAL CP exam oral presentation?

Back 8

*ON CARDIOVASCULAR EXAM:
-NO JVD, or HJR.
-PMI is well localized to the 5IC in the MCL.
-No heaves or thrills.
-Regular rhythm.
-Crisp S1 and S2, with normal splitting of S2.
-No murmurs, rubs, or gallops.
-Carotid upstrokes are brisk, w/o bruits.
-Radial, femoral, and dorsalis pedis pulses are 2+ and symmetric bilaterally.

*ON PULMONARY EXAM:
-Thorax is symmetric with no increase in AP diameter.
-Good expansion on respiration.

-No TTP of the chest wall.

-Resonant to percussion with no areas of dullness.
-LCAB, no crackles, wheezes, rhonchi, or rubs.

*BONUS:
-TF is symmetric.
-No e to a ∆ on egophony.
-No increase in loudness on bronchophony or Whispered Pectoriloquy.