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Put the steps in order for when doing a CVS examination

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Click and drag

Radial pulse, radio-radial delay

Hands - clubbing, Janeway lesions, Osler's nodes, splinter haemorrhages, colour, tar

Check for sacral and peripheral oedema

Feel carotid and ausculate valves with bell and diaphragm. Listen to axilla with diaphragm (mitral regurg)

Feel for thrills (over valves) and heaves (left sternal edge)

Ask about pain/tenderness

Collapsing pulse

Listen to carotids with diaphragm/bell whilst patient holds breath

Wash hands, introduce yourself, ask patient's name and DOB

Thank patient and wash hands

Auscultate lung bases

Sit patient forward and listen over lower left sternal edge with diaphragm in expiration

Face - eyes for xanthalosma, lips, tongue, teeth for dental caries

Palpate apex beat - 5th ICS, mid clavicular

Pre-warn patient of possible discomfort, gain consent, adequate exposure

JVP

Feel carotids and ask patient to roll on to left side - listen to apex

Inspect chest - scars, asymmetries

Carotid pulses

Brachial pulse, mention BP

Explain reason for exam. and outline what it will consist of

End of bed inspection - GTN, monitors etc, breathless, sweating

Cap refill (hold for 5, less than 2 seconds refill)


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