Look around the room to see if any accessories/ instruments like wheelchairs/ inhalers/ Sputum sample

Once the child is seated, ask if you could expose the upper body.

For lower body, you may need to ask permission from the examiner also

General examination

• Level of consciousness- Alert/ Oriented/ cooperative
• Decubitus (position in bed)
• Gait
• Built- Average/ small or large for age
• Nutrition- Average/ undernutrition
• Any obvious dysmorphism
• Respiration effort- rate, rhythm, pattern, depth, laboured or not

Face

1. Dysmorphism
2. Cyanosis/ Pallor
3. Respiratory distress- nasal cannula/ nasal flaring

Cardiovascular system examination involves 2 systems- peripheral and central cardiovascular systems

Start from the periphery and then come to the central .

Peripheral system

1. Pulse
   • Rate
   • Rhythm
   • Volume
2. Radial comparison of both hands
3. Radio femoral delay
4. Any special character
5. Examination of neck veins
6. Raised JVP

Central CVS

Inspection

Precordium

1. Shape- any deformity
2. Pulsation- see in these areas
3. Apical impulse
4. Aortic area
5. Pulmonary area
6. Parasternal area
7. Suprasternal area
8. Carotid pulsation
9. Engorged superficial veins
10. Scars

Inspect back for

1. Scoliosis
2. Kyphosis
3. Scars
4. Winging of scapula

Palpation

Mitral area (Apex beat)

1. Site
2. Character
3. Palpable heart sound
4. Thrill

Tricuspid area (Left parasternal area at 5th intercostal space) 

1. Left parasternal heave
2. Palpable heart sound
3. Thrill

Aortic area  (Right parasternal area at 2nd intercostal space)

1. Pulsation
2. Palpable heart sound
3. Thrill

Pulmonary area
( Left parasternal area at 2nd intercostal space)

1. Pulsation
2. Palpable heart sound
3. Thrill

Thrill in carotid area

Direction of blood flow in engorged superficial veins

Percussion- not done

Auscultation- Done in all 4 areas- Mitral/ Tricuspid/ Aortic/ Pulmonary

1. Heart rate-
   • Normal for age?
2. Rhythm-
   • Regular/ Irregular? Listen for a full minute
3. Murmur-
   • Present or absent?
   • Systolic or Diastolic?
4. Other sounds-
   • Opening snap/ ejection click
5. Splitting of heart sounds
6. S3 and S4 if heard

Auscultate over carotid areas to complete