Page 433 - 2021 IDMT Digital

(rotation and shoulder shrug)
Lungs and Chest
56. Inspect chest “no deformities; AP < lateral diameter”
Posterior chest
57. Inspect posterior thorax “posterior chest is symmetric without
lesion or cyanosis”
58. Palpate chest wall expansion “symmetric expansion”
59. Palpate chest wall “no masses, crepitus, or tenderness”
60. Palpate for tactile fremitus “tactile fremitus is equal in all fields”
61. Percuss lung fields “resonant with no areas of dullness”
62. Auscultate lung fields “equal breath sounds bilaterally with no
adventitious sounds”
63. Voice Sounds “No egophony, bronchophony or
(All 3 of the following: egophony, whispered pectoriloquy”
bronchophony, whispered pectoriloquy)
Anterior chest
64. Inspect anterior thorax “anterior chest is symmetric without
lesion or cyanosis”
65. Palpate chest wall expansion “symmetric expansion”
66. Palpate chest wall “no masses, crepitus, or tenderness”
67. Palpate for tactile fremitus “equal in all fields”
68. Percuss lung fields “resonant with no areas of dullness”
69. Auscultate symmetric lung fields “equal breath sounds bilaterally with no
adventitious sounds”
70. Voice Sounds “No egophony, bronchophony or
(All 3 of the following: egophony, whispered pectoriloquy”
bronchophony, whispered pectoriloquy)
Cardiovascular
Continue in seated position
71. Auscultate with diaphragm at 4 Verbalize areas as you proceed
rd
valvular locations and left 3 ICS
72. Auscultate with bell at 4 valvular Verbalize areas as you proceed
rd
locations and left 3 ICS
73. Auscultate for S2 split “Listening for S2 split with inspiration”
(Diaphram @ Erb’s point)
74. Auscultate for aortic regurgitation “No murmur of aortic regurgitation”
(left sternal border, leaning
forward, exhale holding breath)
(Diaphram @ Erb’s point)
75. Palpate, then auscultate carotid “no carotid bruits, carotid pulse is __”
arteries with diaphram
Move patient to supine position with HOB @ 30 degrees with tangential light
76. Inspect precordium at 4 valvular “ no lifts or heaves; PMI is not
areas and locate PMI displaced”
77. Palpate precordium for thrills (4 “No vibrations/thrills”
valvular areas); PMI if unable to
visualize
78. Auscultate with diaphragm at 4 Verbalize areas as you proceed
rd
valvular locations and left 3 ICS
79. Auscultate with bell at 4 valvular Verbalize areas as you proceed
rd
locations and left 3 ICS
80. Auscultate for gallops (Listening “I am listening for S3 and S4 with bell”
with bell at left lateral recumbent
position”
81. Verbalize quality “rate and rhythm are regular without
murmurs, gallops, or rubs”

[ 432 ]