Expansion
Inspection, palpation, percussion, auscultation
Expansion
The universal sequence:
- Inspection: from the end of the bed, then closer. The most underused and most informative step
- Palpation: light before deep, painful area last, watching the face rather than the hand
- Percussion: comparing side to side
- Auscultation
Exceptions worth knowing
- Abdomen: auscultate before palpation, since palpation alters bowel sounds
- Paediatrics: opportunistic order, doing whatever the child tolerates first and leaving distressing parts until last
Framing the whole encounter: introduce yourself, confirm identity, explain, gain consent, ensure privacy, position the patient (usually at 45 degrees for cardiovascular and respiratory, flat for abdominal), and expose adequately while preserving dignity.
Completing the examination is as marked as performing it: state that you would check observations, examine relevant other systems, look at the charts, and perform any bedside tests such as urinalysis, blood glucose or ECG.
The general to specific principle applies throughout: general inspection, then hands, then arms, then face and neck, then the system itself.