Appearance (1/1 point)
No visible abnormal findings
Rash or lesion
Cyanosis
Pallor
Redness or flushing
Evidence of trauma
... [Show More] (scar, laceration, or bruising)
Inspected for jugular venous distension
1 of 1 point
Height Of Venous Pressure (1/1 point)
4 cm or less above the sternal angle
More than 4 cm above the sternal angle
Inspected chest
1 of 1 point
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)
Inspected hands and fingernails
1 of 1 point
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
Inspected lower extremities and toenails
1 of 1 point
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
Inspect lower extremities for edema
1 of 1 point
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
Tested capillary refill time
1 of 1 point
Fingers (1/2 point)
Less than 3 seconds
Greater than 3 seconds
Toes (1/2 point)
Less than 3 seconds
Greater than 3 seconds
Palpated carotid arteries
1 of 1 point
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 [Show Less]