Med School Atlas

    Cardiopulmonary Exam

    Cardio Exam: Step-by-step

    1. Adjust table to a 45 deg angle (opening the foot rest) and stand to patient's right side
      Pasted image 20230814112805.png
    2. Drape patient so as to access the left side of their chest
    3. Inspect precordium: Palpate 2nd, 3rd, and 4th intercostal spaces (right and left side of sternum)
      Pasted image 20230814113016.png
    4. Palpate PMI (Point of Maximal Impulse): 5th ICS/midclavicular
      • The patient may have to raise their left breast to access this
    5. Auscultate heart with steth (All Physicians Take Money). Use Diaphragm to hear S1 ("lub") and S2 ("dub") sounds.
      1. Aortic: 2nd ICS/right sternal border
      2. Pulmonic: 2nd ICS/left sternal border
      3. Tricuspid: 5th ICS/midclavicular line
      4. Mitral: 5th ICS/midclavicular line
        Pasted image 20230814113910.png
    6. Repeat with bell
      1. Tricuspid: 5th ICS/midclavicular line
      2. Mitral: 5th ICS/midclavicular line
    7. Palpate carotid arteries: Bilaterally, one at a time (lol)
    8. Auscultate carotid arteries (diaphragm)
      1. Have patient to hold breath when listening
    9. Listen at medial border of SCM (diaphragm)
      1. Ask patient to hold breath
    10. Check jugular venous pressure
      1. Identify
      2. Locate top of jugular pulsations (meniscus)
      3. Place vertical ruler at sternum
      4. Place straight edge at top of jugular, intersecting with ruler perpendicularly
      5. Calculate JVP
        1. Measure vertical height on ruler and add 5cm
        2. 6-8 cm H2O is normal
          Pasted image 20230814114515.png
    11. Check bilateral radial pulses in wrists
    12. Check bilateral dorsalis pedis (top of foot) pulses
    13. Check for swelling. Firm pressure with thumbs looking for indentation in 3 areas (bilaterally):
      1. Dorsum of foot
      2. Lower tibia
      3. Upper tibia

    Pulm Exam: Step-by-step

    1. Ask patient to expose back
    2. Inspect shape of chest rise
      1. Observe breathing rate, effort, and muscle use
    3. Respiratory expansion (normal rate = 12-16 BPM)
      1. Place hands on mid back, around lower rib 10
      2. Ask patient to take deep breath
      3. Assess chest excursion, checking for symmetry
    4. Percuss posterior lung fields (horizontal and then vertical, to compare sides)
      1. Place hand on back, tapping firmly on middle finger
      2. 5 posterior and 2 lateral levels. Bilaterally and symmetrically, avoiding scapula
        Pasted image 20230814115004.png
    5. Percuss anterior lung fields: 2 levels
      1. 1 above clavicle and 1 below clavicle
        Pasted image 20230814115026.png
    6. Auscultate lungs
      1. Ask patient to take deep breaths though open mouth
      2. 5 posterior and 2 lateral levels (same as above)
      3. 1 above clavicle and 1 below clavicle (same as above)

    Note on steth

    Diaphragm: Good for all frequencies
    Bell: Good for medium and low frequencies

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