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Basics of examination

General examination

"Patient looks generally well, pink on air, no evidence of dyspnoea or tachypnoea and no obvious scars, deformity or other abnormality."

If your patient is completely normal then these are the things you say in order to get across the idea that they're completely well. The other things to look for are if there any obvious aids, particularly, oxygen, nebulisers or if their legs are in traction. Just think - is there anything obviously wrong with them?

Hands

Face

Neck

Feel for a carotid pulse. Say:
"I'm just going to feel the pulse in the side of your neck."
Feel the pulse in the side of your neck. It's just in front of your big neck muscle. You should be look for volume and character.

Look for a raised JVP. Say:
"Turn your head slightly to the left"
If they pull it all the way across, their sternocleidomastoid muscle will get in the way of seeing the JVP. It should theoretically be a pulsation seen in the side of tthe neck. Like the Loch Ness monster, no medical student has ever seen one.

Assess for tracheal deviation. Say:
"I'm just going feel either side of your windpipe. It may be a little uncomfortable but it shouldn't hurt"
Put your index and ring finger on the insertions of your sternocleidomastoids, found at the top of your sternum. Tense your neck and you should be able to feel your own. Then poke your middle finger (gently!) either side of the patients trachea. It should be in the middle.

And the end of this, you can say, "carotid pulse is of normal volume and character. JVP not raised and no evidence of tracheal deviation."

System