Skip to 0 minutes and 13 seconds The fifth video section is assessment of the respiratory and cardiovascular systems. Consider why the jugular venous pressure is measured with the couch or bed set at 40 degrees.
Skip to 0 minutes and 27 seconds Okay, now I need to examine your back and the back of your chest. Would you mind taking your T-shirt off for me? So the inspection starts with the assessment of the skin for lesions or scars. Then the movement of the chest, noting rate, depth and effort of breathing. Right, so, just first of all looking at your back, okay. Any pain anywhere? No. The chest wall is palpitated for tenderness, then the costovertebral angle is percussed to elicit renal tenderness indicating pyelonephritis or trauma to the kidneys. Okay, when you feel my hands on your back like that, I want you to say 99. 99. And again. 99. And again. 99. Thank you.
Skip to 1 minute and 14 seconds Now I would like you to take a deep breath in for me. And out. Finally, lung expansion is assessed for equality and tactile fremitus is assessed for abnormality, indicating consolidation. I’m going to tap on your back.
Skip to 1 minute and 34 seconds I percuss the back medial to the shoulder blades to assess the tympanic quality of the lung fields. Dullness indicates consolidation or tumour, a higher pitch may indicate pneumothorax. We use a ladder motion to compare one lung to the other. Okay, so now could you put your arms around yourself as if you’re hugging yourself. And now I am going to listen in those same places.
Skip to 1 minute and 57 seconds Okay, so if you could open your mouth and breathe in and out through your mouth for me.
Skip to 2 minutes and 6 seconds Auscultation should give us a range of loud bronchial breathing near the top of the lungs, fading to quiet vesicular breaths towards the bases.
Skip to 2 minutes and 36 seconds The final check is for sacral oedema, which could indicate heart failure. While I’m round the back I’m just checking there’s no swelling at the base of your spine.
Skip to 2 minutes and 47 seconds Okay. That’s lovely. Can you sit on the end of the couch for me.
Skip to 2 minutes and 56 seconds Okay, so now I am just going to have a look at the front of your chest, okay. So first of all just let me have a look. The examination begins with an inspection of the skin for lesions, rashes or scars, noting any use of accessory muscles in breathing. Then the chest wall is palpitated for pain. And does it hurt when I’m touching you? No. Can I push everywhere without it hurting? That’s fine. Okay. I’m just going to tap, as we did on the back.
Skip to 3 minutes and 23 seconds Percussion and auscultation before breath sounds follow as before in a ladder motion.
Skip to 3 minutes and 34 seconds And now I’m going to listen in those same places.
Skip to 3 minutes and 45 seconds If you could turn your head slightly that way and breathe in and out through an open mouth.
Skip to 3 minutes and 58 seconds I am careful to listen over the right middle lobe, which is the right side of the sternum and right axilla, as it is a common site for inhaled foreign bodies, infection and tumours. That’s lovely, thank you. Now I need you to move back onto the bed, so that you’re reclined.
Skip to 4 minutes and 28 seconds That’s lovely. Are your comfortable at that angle? Yes. Lovely. And the first thing I want you to do is to just turn your head slightly that way for me. I am assessing the jugular venous pressure, JVP, at 40 degrees. It appears as a small double flicker of the skin in the anterior triangle of the neck. It should not be raised to more than 4 centimetres above the sternal angle. This would indicate right-sided heart failure.
Skip to 4 minutes and 55 seconds And I’m going to listen to a few places. Then we palpate and auscultate each carotid pulse in turn. If you can occlude both at once you cut off the blood supply to the brain. Not advised!
Skip to 5 minutes and 11 seconds If you could take a deep breath in for me, and out and hold it. I listen for any swishing sound in the pulse there - a bruit. This would indicate disorganised blood flow and may show narrowing of the artery. Then in and out and hold it.
Skip to 5 minutes and 33 seconds Lovely. Thank you. You can breathe again normally. And now I am just going to put my hands on your chest again. I feel for heaves, indicating ventricular hypertrophy, thrills indicating valvular disease and the apex beat, usually below the left nipple in the fifth intercostal space, but can be more laterally in cardiomyopathy. And now I’m going to listen to your heart.
Skip to 5 minutes and 57 seconds Assessing the heart beat requires us to listen to a complete lub dub or two over each area relating to the four heart valves - aortic, pulmonic, tricuspid and mitral. Listen for any abnormal sounds and try to identify when they come in the cardiac cycle lub dub. Listen first with the diaphragm for high pitch sounds, then the bell for low pitch sounds.
Skip to 6 minutes and 36 seconds That’s lovely, thank you.
Head to toe (part 5)
Having covered examination of neck and upper limbs in the previous step, watch the fifth (5/6) video, which covers the respiratory and cardiovascular examinations.
Please note that the voice-over does not correspond accurately to the cardiac assessment: assessment of ‘Thrills’ are felt over the valves and ‘Heaves’ over the ventricles, opposite to that shown in the video clip.
Why is jugular venous pressure (JVP) measured with the couch or bed set at 40 degrees?
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