General Inspection

• Wash hands
• Does the patient match the stated age?
• What is the position of the patient (sitting, laying, in wheelchair)?
• Does the patient look comfortable or in distress?
• What is the level of alertness?
• Does the patient look pale? Diaphoretic?
• Body shape, deformities, nutritional state, unusual behaviors/expressions, signs of pain/tremor/difficulty breahting

The patient looks his stated age of 74 and is sitting comfortably on the exam bed dressed in a hospital gown. He is alert and breathing well on room air. He does not seem to be in pain or distress, and there are no obvious skin discolorations, rashes, or deformities.

Heart Rate

1. Stand in front of patient and palpate both radial arteries (base of the thumb at the wrist crease)

   • Are the pulses symmetrical?

2. Palpate the radial artery on one side, count 30s

   • Multiply heart rate by 2, state beats per minute
     • Normal: 60-100 beats per minute
   • Are the pulses regular (click on the arrow to expand)?
   • What is the quality of the pulses (click on the arrow to expand)?

   <aside> 💡 For weak or irregular pulses, take one minute to count the heart rate.

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3. Continue to palpate the radial artery, but now focus on counting resp. rate for 30s

   • Multiply resp. rate by 2
     • Normal 12-20

Patients’ pulse are symmetrical on both wrists. Palpating the pulse on the right side, I count 32 beats over 30 seconds, which translates to a heart rate of 64 beats per minute which is normal. The pulses are regularly regular, 2+ for quality which is normal. Respiratory rate was 6 breaths over 30 seconds which gives a respiratory rate of 12 breaths per minute, which is normal.