Physical Exam Key Points

1. Extent of cyanosis. Constant or intermittent? Peripheral or central? Is differential cyanosis present?

2. Airway and breathing. Is patient apneic? Any airway noises audible? Is patient breathing comfortably or with increased effort? Is there weakness or asymmetry to chest movement?

Is patient able to speak or cry? What is the character of speech or crying?

3. Lungs. Listen for symmetry of breath sounds and quality of air movement. Any abnormal lungs sounds (eg, wheezing)?

4. Heart. Assess heart rate and BP. Listen to heart sounds and examine for murmur, gallop, or rub.

5. Pulses. Simultaneously assess pulses for quality in upper and lower extremities. Use right arm and either femoral area. Left arm may be distal to an aortic coarctation and misleading in the assessment. Evaluate for equality of pulsation and presence of femoral delay.

6. Abdomen. Assess for liver size, presence of ascites, or spider veins across the abdomen (indicators of congestive heart failure or liver disease).

7. Neurologic exam. Assess muscular tone and symmetry of movement. Is there gross seizure activity? Check pupil size and symmetry. Assess for sunset sign.

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