CSU 5 - Dr.FIA

CSU session with my god - Dr.Achike

- went over the whole procedure of CVS.

- emphasized/reinforced points

1. have a mindset of warming your hands, warning the patient, ask if it is warm enough, than tell patient not to worry and to ask to stop if it gets uncomfortable. every time before palpation.

- new things learnt

1. during OSCE, the examiner may mark the apex beat for you - to create an artificial pathology.
   when the point is at the 6th left ICS, 5cm lateral to the MCL, do NOT report that the "Apex is palpated at the 5th left ICS, 1cm medial to MCL". acknowledge what is in front of you, and locate accordingly.
   you can use MCL, AAL, MAL, PAL for referance. and use a ruler. use a ruler.
   
   
2. in the case of Right Heart Failure
   main sign will be the pitting edema, and rise of JVP.
   test pitting edema by going to the foot of the patient, press 15 sec, let go, and observe. work your way upwards, from the PEDAL, ANKLE, SHIN, and SACRAL.
   this is to find out the EXTENT of Edema.
   for the JVP, carry out the Hepato-Jugular Reflux, which you would see an extensive filling of JVP, and furthurmore you will see a Dilatation of JVP as pre-load is high.
   
   
3. in the case of Left Heart Failure
   main sign will be the basal crepitation, secondary to pulmonary effusion.
   heard at the side of the chest, nearest to the bed - which means you will auscultate at the posterior axilliary line or the mid-axillary line. you will hear crepitation in the presence of pulmonary effusion, secondary to Left Heart Failure.