Physical Exam Key Points

1. General appearance and vital signs. Assess general appearance, respiratory rate, oxygen saturation, heart rate, and BP.

2. Cardiopulmonary system. Assess pattern of breathing. Look for chest deformities and retractions. Evaluate for signs of impending respiratory failure or tension pneumothorax. Signs and symptoms of impending respiratory failure include use of accessory muscles, diaphoresis, inability to speak, cyanosis, and pallor. Evaluate for hypoxia: Look for cyanosis or pallor by examining lips, nail beds, and skin. Evaluate for adequate ventilation by evaluating breath sounds, chest movement, and expansion. Assess equality and adequacy of breath sounds; listen for rales and wheezes. Auscultate heart sounds and listen for muffled heart sounds, new gallops, or murmurs.

3. Other findings. Assess neurologic status and muscle strength. Look for petechiae and rashes. Evaluate extremities for adequate perfusion.

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