Test Ascultate carotid artery Palpate carotid artery

Estimate the jagular venous pressure If more than 2cm Palpate for hepato-jagular reflux Pericardium : Inspection Palpation : land marks Apical pulse Percussion : Cardiac boarders Auscultation : Normal heart sounds : After .. Palpate carotid artery

Normal findings No swishing" bruit " or blowing or other sounds heard from carotid artery . Contour is snooth with rapid upstroke & slower down stroke , strength is 2+ ( or more ) And its equal bilaterally . 2cm or less ----No heaves , no lifts ( forceful pulsation ) No thrills . Soft vibration , a tapping sensation with each heart beat . Dullness percussion in the left 5th ICS in the MCL in the size of 1-2 cm S2 loudest in the BASE S1 loudest in the APEX S1=S2 at the ERB's POINT No thrills . No bruit No extra sounds or murmur

Using bell listen to apical pulse Listen to extra heart sounds

Upper extremities : Test Inspection Normal findings Pink ,even bilaterally , nail bed angle is 160degree . Symmetrical , worm bilaterally . Return in less than 2sec. Regular bilaterally and grade the amplitude . NOT palpable Color return's in 2-5 sec

Palpation Capillary refill time Palpate radial and brachial pulses Palpate epi-trochlear lymph nodes Allen's test

Lower extremities : Test inspection Normal Findings Unified color , free of lesions or ulceration , no swelling or atrophy , no edema either pitting or non pitting edema . Symmetrically Worm , same size bilaterally normal differences in 1cm . non tender movable lymph nodes

Palpation Calf muscle circum Inguinal lymph nodes

Palpate pulses : femoral plpliteal , dorsalis pedis , posterior tibial . Homan's sign test Position test Inspect for varicosities

Regular bilaterally and grade the amplitude .

No tenderness Color returns in less than 10 sec . Superficial veins around feet fill's in 15 sec . Veins are flat and barely seen under the surface of skin .