Rural Emergency Medicine

Cardiovascular exams are used in conjunction with the appropriate history taking to ascertain the likelihood of a cardiovascular disease (e.g. congestive heart failure, arrhythmias, infective endocarditis and so on).

Important Symptoms and Clinical Signs
Some of the most important symptoms to look for and evaluate are;
  • Chest Pain
  • Dysponea (shortness of breath)
  • Palpitations (subjective awareness of heartbeat)
  • Peripheral Oedema
  • Syncope or pre-syncope (e.g. fainting)
  • Sputum
  • Leg Pain
Red Flags (i.e. important symptoms to follow up on)
  • Irregular irregular pulse (Think Atrial Fibrillation)
  • Cold, white painful limb
  • Unilateral leg swelling (Think DVT)
  • Very sudden onset of severe tearing chest, back, or neck pain
Major Threats to Life
  • Acute Coronary Syndrome
  • Aortic Dissection
  • Pulmonary Embolism
  • Pneumothorax

Clinical Examination
As with any clinical examination you should begin with an introduction and general inspection of the patient. It is important to remember to always wash your hands, preferably with an antimicrobial gel/wash before beginning the examination. In a typical cardiovascular exam you will then proceed through the following sections.
  • Hands and Upper Limbs
  • Face
  • Neck
  • Chest
  • Back
  • Abdomen
  • Lower Limbs
It is important to have the patient angled at 45 degrees for most of this exam. However, remember to lie the patient flat (or supine) when conducting the abdominal section of the exam.

Assessing Pulse: Assess pulses for rate, rhythm and volume (radial, femoral, carotid, popliteal - popliteal can be hard to palpate on some patients). Assess radio-radial and radio-femoral delay.

The video below done by the Clinical Skills Online project from the University of London below provides a good demonstration of how to perform a cardiovascular exam.

Please note that while a certain number of medical schools teach percussion as part of this exam, it is generally unnecessary in clinical practice unless pleural effusion (i.e. fluid at the lung bases) is suspected and other diagnostic tools are not available.

For practice in recognising heart sounds try this tutorial offered by Blaufuss Multimedia.

Finally some further assessment includes;
  • Urinalysis
  • Fundoscopy
  • ECG
Other Clinical Exams
Cardiovascular | Respiratory | Gastrointestinal | Neurological | Musculoskeletal

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