SH Focused Exam Chest Pain Brian Foster 2020/2021

Appearance (1/1 point) • No visible abnormal findings • Rash or lesion • Cyanosis • Pallor • Redness or flushing • Evidence of trauma (scar, laceration, or bruising) Height Of Venous Pressure (1/1 point) • 4 cm or less above the sternal angle • More than 4 cm above the sternal angle Symmetry (1/2 point) • Symmetric • Asymmetric Appearance (1/2 point) • No visible abnormal findings • Rash or lesion • AP diameter abnormal • Intercostal retraction while breathing • Excessive use of accessory muscles while breathing • Pectus excavatum • Skin growths (freckles or moles) • Evidence of skin trauma (scar, laceration, or bruising) Right: Appearance (1/4 point) • No visible abnormal findings • Redness • Moles or skin tags • Masses (warts, cysts, or tumors) • Freckles, birthmark, or other discoloration • Excessive dry or flaking skin • Purpura • Scarring • Laceration, lesion, or wound • Bruising • Rash Left: Appearance (1/4 point) • No visible abnormal findings • Redness • Moles or skin tags • Masses (warts, cysts, or tumors) • Freckles, birthmark, or other discoloration • Excessive dry or flaking skin • Purpura • Scarring • Laceration, lesion, or wound • Bruising • Rash Right: Nail Changes (1/4 point) • No visible abnormal findings • Pallor • Cyanosis • Splinter hemorrhages • Clubbing Left: Nail Changes (1/4 point) • No visible abnormal findings • Pallor • Cyanosis • Splinter hemorrhages • Clubbing Right: Appearance (1/4 point) • No visible abnormal findings • Visible distortion or swelling • Brownish pigmentation • Skin thickening • Ulceration • Varicose veins Right: Nail Changes (1/4 point) • No visible abnormal findings • Pallor • Cyanosis • Splinter hemorrhages • Clubbing Left: Appearance (1/4 point) • No visible abnormal findings • Visible distortion or swelling • Brownish pigmentation • Skin thickening • Ulceration • Varicose veins Left: Nail Changes (1/4 point) • No visible abnormal findings • Pallor • Cyanosis • Splinter hemorrhages • Clubbing Right: Edema (1/4 point) • No edema • Pitting • Non-pitting Right: Severity Of Edema (1/4 point) • No edema • 1+ Slight pitting • 2+ Deeper pit, disappears in 10 to 15 seconds • 3+ Noticeably deep pit that lasts more than a minute • 4+ Very deep pit that lasts 2 to 5 minutes Left: Edema (1/4 point) • No edema • Pitting • Non-pitting Left: Severity Of Edema (1/4 point) • No edema • 1+ Slight pitting • 2+ Deeper pit, disappears in 10 to 15 seconds • 3+ Noticeably deep pit that lasts more than a minute • 4+ Very deep pit that lasts 2 to 5 minutes Fingers (1/2 point) • Less than 3 seconds • Greater than 3 seconds Toes (1/2 point) • Less than 3 seconds • Greater than 3 seconds Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Location (1/3 point) • Present at midclavicular line and 5th intercostal space • Displaced laterally Diameter (1/3 point) • Less than 3 cm • Greater than 3 cm Amplitude (1/3 point) • Brisk and tapping • Increased amplitude (hyperkinetic) Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Right: Vibration (1/4 point) • No thrill • Thrill Right: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Left: Vibration (1/4 point) • No thrill • Thrill Left: Amplitude (1/4 point) • 0 Absent • 1+ Diminished or barely palpable • 2+ Expected • 3+ Increased • 4+ Bounding pulse Right (1/2 point) • No bruit • Bruit Left (1/2 point) • No bruit • Bruit Heart Sounds (1/2 point) • S1 and S2 audible • S1, S2, and S3 audible • S1, S2, and S4 audible • S1, S2, S3, and S4 audible Extra Heart Sounds (1/2 point) • No extra sounds • Gallops • Murmur • Friction rub • Valve clicks Sounds (1/1 point) • No bruit • Bruit Right: Renal (1/6 point) • No bruit • Bruit Right: Iliac (1/6 point) • No bruit • Bruit Right: Femoral (1/6 point) • No bruit • Bruit Left: Renal (1/6 point) • No bruit • Bruit Left: Iliac (1/6 point) • No bruit • Bruit Left: Femoral (1/6 point) • No bruit • Bruit Breath Sounds (1/3 point) • Present in all areas • Diminished in some areas • Absent in some areas Adventitious Sounds (1/3 point) • No adventitious sounds • Wheezing • Fine crackles • Stridor • Rhonchi • Rales Location (1/3 point) • All areas clear • Adventitious sounds in anterior right upper lobe • Adventitious sounds in anterior right middle lobe • Adventitious sounds in anterior right lower lobe • Adventitious sounds in anterior left upper lobe • Adventitious sounds in anterior left lower lobe • Adventitious sounds in posterior right upper lobe • Adventitious sounds in posterior right lower lobe • Adventitious sounds in posterior left upper lobe • Adventitious sounds in posterior left lower lobe Performed EKG 1 of 1 point Sinus Rhythm (1/2 point) • Regular • Irregular St Changes (1/2 point) • No ST elevation • ST elevation present Subjective Data Collection: 23 of 23 (100.0%) A combination of open and closed questions will yield better patient data. The following details are facts of the patient's case. Chief Complaint Finding: Established chief complaint Finding: Reports chest pain (Found) Pro Tip: Asking a patient broadly about their chief complaint allows them to answer in their own words and confirm information that you may have already received from another source. Example Question: Do you have chest pain? History of Presenting Illness Finding: Asked about onset and duration of chest pain Finding: Reports chest pain started about five minutes ago (Found) Pro Tip: Establishing the onset of a patient's chest pain is essential in diagnosing its severity as well as the comfort of the patient. Example Question: When did the chest pain start? Finding: Reports chest pain has been constant since it began (Available) Pro Tip: Knowing the duration of a patient's pain gives you