Physical Exam Key Points

1. General assessment and vital signs. Assess responsiveness and obtain vital signs.

a. Respiratory rate. Fast rate can indicate a toxic or metabolic abnormality. Slow rate is often an ominous sign that is suggestive of impending respiratory arrest, a toxin, or intracranial hypertension. Assess oxygenation by pulse oximetry.

b. Heart rate and rhythm. Is heart rate absent or is a collapse rhythm present? Identify asystole, pulseless electrical activity, ventricular fibrillation, and pulseless ventricular tachycardia. Is rate slow (sinus bradycardia, complete heart block) or rapid (sinus tachycardia, supraventricular tachycardia, or ventricular tachycardia)? Evaluate rate and rhythm, and listen for murmurs suggestive of congenital heart defect or acquired heart disease.

c. BP. Is BP high (intracranial hypertension, toxin, or hypertensive emergency) or low (decompensated shock)?

d. Temperature. High or low temperature suggests an infection or toxin. Hypothermia may be indicative of the environment.

2. CNS. Low Glasgow Coma Scale score may indicate head injury. Examine head and fontanelle; bulging fontanelle can occur with intracranial hypertension or meningitis, whereas sunken fontanelle indicates hypovolemia and dehydration. Look for boggy swelling, palpable fracture, or other signs of trauma. Note presence of a ventricular shunt.

3. Eyes. Examine for signs of trauma (raccoon's eyes) or hypovolemia and dehydration (sunken). Assess pupil size and reaction. Pupillary size can give clues to the presence of a toxin. Depressed or absent reaction may indicate structural CNS lesion, herniation or impending herniation, or cardiopulmonary arrest. Asymmetry can indicate structural CNS lesion. Papilledema of the optic disk may occur with intracranial hypertension; however, absence of papilledema does not rule it out. Hemorrhages of the disk suggest intracranial injury.

4. Neck and trachea. Palpate for injury to the cervical spine or tracheal deviation. Look for venous distention that may indicate tension pneumothorax.

5. Thorax. Observe for old surgical scars or signs of rib fractures.

6. Lungs. Auscultate lungs and assess effectiveness of ventilation. Listen for decreased breath sounds (consolidation, pneumonia, pleural effusion, or pneumothorax), rales (pneumonia, bronchiolitis, or pulmonary edema), and wheezing (asthma, bronchiolitis, foreign body aspiration, pulmonary edema), which are suggestive of lower airway disease, or stridor (foreign body, croup, tracheitis, epiglottitis, retropharyngeal abscess), suggestive of upper airway disease.

7. Abdomen. Palpate for signs of injury, tenderness, and hepatomegaly.

8. Skin and extremities. Look for any signs of injury or bruising, perfusion, and rash.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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