Vital signs. Pulse, blood pressure,

Vital signs. Pulse, blood pressure, temperature, respiratory rate and quality (shallow,
splinting, labored, retraction, accessory muscle use).
- General. Altered mental status is common at onset.
- HEENT. Increasing jaundice.
- Neck. Nucal rigidity.
- Chest. Check for point tenderness, swelling, erythema, retraction, asymmetry.
- Lungs. Percussion and palpation for dullness, increased resonance, fremitus.
Auscultation for rales, wheezes, rhonchi, inspiratory:expiratory ratio, change in breath sounds, E
to A. Listen to cough.
- Heart. Neck veins for venous pressure and pulse, point of maximum impulse, thrills, S1,
S2, S3, S4, murmur, rubs, edema.
- Abdomen. Bowel sounds, hepatosplenomegaly, tenderness, rebound, masses. Subcostal
retractions in child.
- Extremities. Cyanosis, clubbing, edema, calf swelling, calf tenderness, cords, erythema,
pulses.
- Neurologic. Mental status, cranial nerves, coordination, muscle strength, sensation.