Examination of Precordium by Dr Junaid

excellent video

Jazak Allah Sir... Very informative especially the variation with respiration point

Nice one sir

Very welldone doc 👌

Thank you sir.

Saviour,,👏

Description of Findings
I've an 8 years old boy lying comfortably on bed with no obvious distress or dysmorphic features. (environment of pt Cannulated or not O2 administered or not)
On Inspection there are no visible Scar marks or visible pulsations, no deformity Pectus Excavatum Carinatum or any other.
On palpation AB is in 5th intercostal space in mid clavicular line tapping in character.
There were no Parasternal Heave or thrill present. The Trachea was central & there are no epigastric pulsations
Both the first & second heart sounds are
audible with grade 3 pan systolic murmur maximum heard at the lower left para sternal border radiating to the whole of precardium with no exaggeration on respiration & change of posture.
The pitch of the murmur is high & the character of murmur was harsh/blowing
This child is not in heart failure & there are no signs of Infective endocarditis.

Examination Of Precordium
Introduction Consent
1.Inspection
Visible Scar marks
Deformity Pectus Excavatum Carinatum
Any bulge in the thorax
Any visible pulsation
Anything Abnormal

2. Palpation
Must rub your hands if cold weather
(i) First palpate Apex beat feel it with your fingers after feeling count it from Manubrium Sterni which is in the 2nd intercostal space
Locate intercostal space & weather it is in mid clavicular line or displaced
Check weather Apex beat is normal or Tapping or Heaving with your finger
If Tapping your finger will be tapped/touched slightly.
If Heaving your finger will be lifted upwards (not just touched)
Ill heave finger lifted up for short time
Well sustained heave finger lifted up for long time
(ii) Right Ventricular Heave/ Left Parasternal Heave
(iii) Palpate both Aortic & Pulmonary Areas with fingers & palms of your hand to see if a thrill is present or not.
(iv) Palpate trachea
(v) Feel Epigastric Pulsation

3. Auscultation
Starts from MITRAL AREA after locating AB
i. Place the steth at mitral area
ii. Synchronize it with carotid
iii. Give command Of Respiration to patient
Murmur of right heart exaggerate during inspiration & left heart exaggerate during expiration
سانس اندر لیں باہر نکالیں اور روک لیں
iv. Ask patient to go to left lateral position see if there is an exaggeration of a murmur Murmur of Aortic regurgitation exaggerates in this position
v. Check radiation of murmur in axillary area
Now TRICUSPID AREA same 3 steps
Place the steth at exact area
Synchronize it with carotid
Give command of respiration
سانس اندر لیں باہر نکالیں اور روک لیں
Next PULMONARY AREA
Place the steth at exact point
Synchronize it with carotid artery pulsation
Give command of respiration
سانس اندر لیں اور روک لیں
NEXT AORTIC AREA
i. Place the steth at exact area
ii. Synchronize it with carotid
iii. Give command of respiration
سانس اندر لیں باہر نکالیں اور روک لیں
iv. Ask the patient to sit up & lean forward to check gor murmur of aortic as it exaggerates in this position
بیٹھیں اور تھوڑا سا جھک جائیں
v. Check the radiation in the neck

4. Do the relevant examination

Look for the basal crepts
Do The Hepatojugular reflex
Look for hepatomegaly
Look for Pedal Edema
Examine Hands for signs of Infective endocarditis like Splinter Hemorrhages Janeway Lesions Osler Nodes Petechiae Bruises & other things.
Say thank you & cover the patient

So its a case of VSD then (inferred from the description of murmur)?

Awesome

JazakAllah o khairan kasiraa....may Allah bless you sir always.
So helpful videos

Love from india kolkata

JazakAllah khair sir

29 march

Excellent 👍

Best way to teach clinicals ❣️

وعليكم السلام

Why do we syncronise with carotids?

Amazing sir❤️
Keep doing 🙌

Excellent