[VIDEO SKILL OSCE - PEMERIKSAAN FISIK JANTUNG + UKUR JVP]

Summary

In this medical examination video, Dr. Vira conducts a thorough physical assessment of a 23-year-old patient named Haikal. The process includes inspecting for deformities, redness, wounds, and scars, as well as performing palpation, percussion, and auscultation to assess the heart's health. The doctor evaluates murmurs, determines the heart’s boundaries, and measures the patient’s venous pressure. Throughout, Dr. Vira ensures the patient's comfort, privacy, and cooperation, explaining each step carefully. The examination concludes with a detailed evaluation of the venous pressure and the doctor’s hand-washing routine, ensuring the patient’s well-being is prioritized.

Takeaways

• 😀 The doctor introduces themselves as Doctor Vira, who is on duty at the polyclinic.
• 😀 The patient, Haikal, is 23 years old and presents with complaints that require a physical examination.
• 😀 The doctor explains the physical examination process and assures Haikal that privacy will be respected and the examination will be performed carefully.
• 😀 Haikal is asked to remove his top and lie down in a half-sitting position for the examination.
• 😀 The doctor starts with a general inspection of the patient's chest, looking for deformities, redness, wounds, scars, and visible pulsations in the heart area.
• 😀 A check is made for visible signs of conjunctiva animis and leg edema as part of the initial general examination.
• 😀 The doctor performs palpation to feel for any abnormalities, such as cast or tenderness in the chest area, and checks the heart's projection and pulmonary areas.
• 😀 Percussion is used to determine the boundaries of the heart, starting from the right border and moving to the left to assess the heart's positioning.
• 😀 The doctor auscultates different areas of the chest to check for murmurs and evaluates the location, phase (systolic/diastolic), and severity (degree 1-6) of any murmurs found.
• 😀 Regular venous pressure measurements are conducted with the patient in a half-sitting position, and the doctor checks for visible veins and measures the amount of venous pressure using rulers.

Q & A

Who is the speaker in the script and what is their role?

The speaker is Doctor Vira, who is on duty at the polyclinic and is performing a physical examination on the patient, Haikal.

What is the first step in the physical examination?

The first step involves asking the patient, Haikal, about his age and then explaining that a physical examination will be conducted.

What does Doctor Vira inform Haikal about the physical examination process?

Doctor Vira explains that during the examination, they will feel Haikal's chest, which might be uncomfortable, but assures Haikal that they will be careful and protect his privacy.

What position is Haikal asked to be in for the examination?

Haikal is asked to lie down in a half-sitting position (semi-recumbent) for the examination.

What initial steps does Doctor Vira take during the inspection phase?

Doctor Vira begins by inspecting the chest for deformities, redness, wounds, surgical scars, and pulsations, as well as checking for general signs like conjunctival anemia and leg edema.

What is the purpose of palpating the chest?

Palpation is used to feel for any abnormalities, such as tenderness or resistance in the chest area, and to check the projections of the heart.

What does Doctor Vira do during the percussion phase?

During percussion, Doctor Vira checks the boundaries of the heart by tapping on various areas of the chest, starting from the right and left borders, and evaluating heart location and size.

How does Doctor Vira assess the heart valves?

Doctor Vira uses auscultation to listen for any murmurs at each heart valve projection, including the aortic valve, pulmonic valve, mitral valve, and tricuspid valve, while evaluating the murmur's location, timing, and intensity.

What does the measurement of venous pressure entail?

Venous pressure is measured by positioning the patient at a 45° angle, checking the jugular vein for visible signs of pressure, and using rulers to measure the height of the venous pressure.

What is considered normal for central venous pressure (CVP)?

Normal central venous pressure (CVP) is typically R + 3, where 'R' is a constant value of 5, and the measurement is done using a perpendicular line from the jugular vein to a ruler.