Expansion
Hands, pulse, face, neck, praecordium, then back and legs
Expansion
Position: 45 degrees, chest exposed.
- General inspection: breathlessness, cachexia, scars, pacemaker box
- Hands: clubbing, splinter haemorrhages, Osler nodes, Janeway lesions, tar staining, xanthomata, peripheral cyanosis, temperature, capillary refill
- Pulse: rate, rhythm, character, radioradial and radiofemoral delay, collapsing pulse
- Blood pressure, including for a wide or narrow pulse pressure
- Face: conjunctival pallor, corneal arcus, xanthelasma, malar flush, central cyanosis under the tongue, dental hygiene
- Neck: JVP (height and waveform), hepatojugular reflux, carotid character and bruits
- Praecordium: inspect for scars, palpate the apex beat (position and character), heaves and thrills
- Auscultate the four areas with bell and diaphragm, with the carotids and axilla; sit forward in expiration for aortic regurgitation, roll left for mitral stenosis
- Complete: lung bases, sacral and ankle oedema, peripheral pulses, abdomen for aneurysm and hepatomegaly
To finish: observations, ECG, fundoscopy, urine dipstick.