ABSTRACT
Take a standard focused surgical history (presenting complaint, history presenting complaint, past medical history, drug history and allergies, social history, family history, systemic enquiry). General and peripheral stigmata – Oxygen and ventilation adjuncts, electrocardiogram (ECG) monitor, pulse oximeter, anaemia and cyanosis (cardiorespiratory disease), tar stains, splinter haemorrhages (infective endocarditis), amputations (peripheral vascular disease [PVD]), venous graft harvesting scars (long saphenous vein, radial artery). Focussed inspection – Chest scars (midline sternotomy, drains, pacemaker, implantable cardiac defibrillator [ICD]), chest wall movements (asymmetry – lung problem). Physical examination of the respiratory system (lungs), peripheral vascular system, abdomen (abdominal aortic aneurysm [AAA]). Observation chart (heart rate [HR], blood pressure [BP], temperature, respiratory rate [RR], oxygen saturation). Hepatomegaly and splenomegaly: You palpate an enlarged liver. Extension distance beneath the costal margin (cm/finger breadths). Percuss upper liver border of the liver (to assess whether it is pushed down by lung hyperexpansion).
