toronto notes - case 3_ volume status

11/24/12 Toronto Notes - Case 3: Volume Status

1/1www.torontonotes.ca/osce-cardiovascular/case-3:-volume-status

Case 3: Volume StatusPlease assess the volume status of Mr. Kennedy, a 61 year old male, and comment on your findings.

Physical Examination

Vitals

Assesses heart rate by palpating the radial pulse

Measures blood pressure while supine

Assesses orthostatic changes by measuring blood pressure and heart rate with patient standing

Comments on vital signs findings of a patient who is hypovolemic

JVP

Observes JVP with correct patient position (30 degrees head-up-tilt); adjusts patient accordingly if JVP is not

initially evident

Confirms JVP by changing angle of head of bed

Occludes JVP to confirm location

Comments on the multiple waveforms of the JVP

Comments on the JVP height

Peripheral Vasculature

Comments on capillary refill

Comments on skin turgor, mottling

Comments on mucus membranes

Examines for peripheral edema

Comments on peripheral temperature

General OSCE Tips

Respirology

Cardiovascular

Gastroenterology

Musculoskeletal

Urology

Pediatrics

Peripheral Vascular

Women's Health

Neurology

Psychiatry

Ophthalmology and Otolaryngology

Geriatrics

Case 1: Shortness of Breath

Case 2: Chest Pain

Case 3: Volume Status

Case 4: Syncope

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