sprint123
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hey..I am confused with what to start first. Let me tell you what I think and lz drop your duggestions.
I am thinkning of doing CVS examination first in the supine position by untying the gown and exposing the anterior chest.
Then, proceed to examine RS in the anterior chest. Ask the patient to sit up-Tie the gown and then examine the posterior aspect for RS.
Then, ask the patient to lie down. Examine for abdomen!
Is this the way we should do???
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| DrVirgo
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This is how I do the Cardiovascular Exam:
1. Sitting:
Carotids: auscultate and palpate
Pulses: radial, dorsalis pedis, and posterior tibial
while you are down there check for pedal edema as well
2. Lie back
Inspect for JVD
Palpate for PMI
Auscultate 4 points
3. Sit up again
Auscultate 4 points
lean forward and listen to base
auscultate lungs
check for tenderness along costochondral margins
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| sprint123
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Thanx virgo...Should we have to do it two times-Both sitting and supine??
hOW DO YOU PROCEED TO ABDOMINAL EXAMINATION FROM THERE?Can u tell me about the untying of gown?
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| DrVirgo
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Yes, do it both sitting and supine.
when pt. is sitting ask if you can untie the gown, then ask him/her to lower the gown.
For a female patient ask: can you please lift your breast before palpating for PMI.
when you are done, you can ask the patient to please raise the gown, and say I will tie it for you or something like that.
Proceeding to the abdominal exam, lift the gown from the bottom and cover the legs and pelvis with the drape... Remember to only expose the area you are examining to "preserve the modesty of the patient". 
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| sprint123
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So..You first make the patient SIT and then SUPINE for heart and thena gain SIT for LUNGS nad then again SUPINE for abdomen...
Can we do CVS first by having the patient SIT and SUPINE and then do abdomen in the same position adn then do RS by sitting???
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| DrVirgo
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If it's an abdominal CC then I would just auscultate the heart at two points of the precordium, and also auscultate the lungs at two levels anteriorly, and three levels posteriorly while the patient is sitting.
What's RS?
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| kity
Certified.............
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hey this is very mp discussion I was also wondering how to go with this PE
RS(respiratory system) this is what I think I will follow.. feel free to add or comment
1. sitting.. untie gown
inspection,
palpation.. tactile fremitus
auscultate
percussion
( CVA if applicable)
2. lie down... inspect ant chest
palpation.. tactile fremitus
auscultate
percussion
CVS exam if applicable do here
look for jvp
now ask him to sit up. for ant chest exam in sitting position...
( was wondering if this step imp even if not CVS case too??)
I think we will tie his gown back again when we are done here...
then if abdo exam if needed ask pt to lie down again... & pull up the gown to expose just abdo..
What do you think????? is there a shorter way??
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| sprint123
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Hey kity..I can't get you..Should we have to do RS examination twice in both sitting and supine position?
I am thinking of this :
CVS case :
untie gown-->Supine--->do everything for CVS
Then, Ask the patient to sit up-->Do everything for CVS again.
With the same position--->Do everything for lungs -both anterior and posterior-->Tie gown
Then -->Ask the patient to Sit--->Do abdomen examination!
RS case :
untie gown-->Sitting position-->Do everything for lungs -both anterior and posterior-->Ask the patient to lie down-SUPINE--->Heart examination--->Tie the gown
Then, proceed to abdomen examination
Abdomen case :
Patient SUPINE-->Do abdomen examination-->Finish
Pstient sitting-->Untie the gown--->Examine heart and lungs.
This is very confusing!! Can we untie the gown of the patient when he is supine???Can we examine the anterior chest in sitting position for Lungs,heart??
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| Malithahe
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This is how I practised and did in the real exam
- 1.Head, eyes ears (if necessary cranial nvs too)
- neck LN and thyroid
- front chest-palpated heart, listened to heart and neck
- front chest for lungs (in CVS case to a detail CVS of front chest first and then quickly listen to lungs in h=the front, in RS case quickly listen to heart first and then do detail front for lungs(so that without inturreption in between I can do back for lungs)
- cover the front chest detail back of chest for lungs
- if back prob or CVA tenderness nedded do it at this time
- If it is CNS before going to chest do upperlimb and lower limb power, tone, reflexes, sensory and then quickly listened to lungs and heart
- then ask the sp to lay down
- In CVS case only did listened to heart checked JVD on angle
- Then abd
- ankles for edema
- gait nad rombergs
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| sprint123
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Thanx malithahe! You were examining the front chest in sitting position???
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| Malithahe
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sitting as well as lying in CVS , RS I used to do sitting since it is quick and I didn't expect any findings. This is my way. Not the exact correct way 
You know I always followed my ways . Just some one sent me a PM asking to reply to this thread. So I mentioned my way
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| sprint123
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Thanx for your input malithahe!!!I was not sure how to examine a female patient's anterior chest by sitting?
Moreover, I am confused how to drape in that situation? Should we expose the chest fully or should we ask them to hold it for a while?? I am not sure!!
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| kity
Certified.............
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Thanx malithahe for replying..
sprint 123... I think in abdo case I 'll examine CVS & RS in sitting only & will do detail Abdo exam in lying down.. not going to repeat it in lying down...
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| Malithahe
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Females are wearing bras, you can palpate just belllow it. If she is having big breasts you can ask her to lift her breast for a while.They allow you to uncover the fromt part of the gown fully up to epigastrium. Don't worry it is not a big deal. But when you are practicing practice in the same way all the time
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| CocaCola
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guys remember this exam is also about efficiency - having the patient lie down, sit up, lie down again, then sit up again isn't efficient... my suggestion - try to have the patient lie down once - you can do a complete exam this way and it helps with time...
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