Physical Exam Key Points

1. Vital signs. Check heart rate and regularity. Assess respiratory rate, BP, and temperature. Perform peripheral pulse oximetry as indicated by exam (respiratory distress, cyanosis) or history (congenital heart disease, respiratory disease).

2. Heart. Assess pulses and perfusion. Look for signs of congestive heart failure (liver size, gallop, peripheral edema). Check for murmurs.

3. Lungs. Listen for evidence of respiratory illness or congestive heart failure. Assess for presence of pneumothorax.

4. Skin. Assess for discoloration of skin consistent with café au lait spots of neurofibromatosis (pheochromocytoma) or ash-leaf spots of tuberous sclerosis (cardiac rhabdomyomas and ventricular tachycardia).

5. Neck. Assess for thyromegaly.

B. Laboratory Data. Not every patient with tachycardia needs a complete laboratory assessment. Patients with routine SVT need little more than an ECG. Unusual presentations or histories warrant further laboratory investigations.

1. Electrolytes. Assess levels of potassium, magnesium, and calcium.

2. ABGs. Assess for hypoxemia and acidemia in patients with significant respiratory distress, cyanosis, or hypoperfusion.

3. CBC with differential. May demonstrate anemia or evidence of infection.

4. Glucose. Hyperglycemia or hypoglycemia may cause tachycardia.

5. Cultures. Obtain if infection is suspected.

6. Thyroid profile. Assess levels of thyroid-stimulating hormone and thyroxine.

7. Plasma, urine catecholamines. These tests, which assess levels of circulating catecholamines, are helpful in diagnosis of pheochromocytoma and some forms of autonomic dysfunction.

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