Synopsis
Perform a consented, hypothesis-led and reproducible physical examination, interpret findings in physiological context, and present their meaning safely in clinical and written assessments.
- Observe before touching: general appearance, work of breathing, interaction, movement, equipment and immediate physiological threat determine the examination's order.
- Explain purpose and extent, obtain valid consent, provide privacy and exposure only as needed, manage pain, clean hands and use an appropriate chaperone process.
- Choose manoeuvres that answer a clinical question; sequence inspection, palpation, percussion and auscultation only where each step has anatomical or physiological value.
Reasoning priorities
Detect physiological compromise and select a safe examination sequence.
Recheck implausible values with suitable equipment while responding immediately to genuine instability; a device number without the patient context can mislead.
Worked reasoning
A patient with episodic dizziness has a monitor pulse of 42/min, appears well, and has a palpable radial rhythm that feels irregular; the automated blood pressure device repeatedly errors.
- Treat the display as a measurement requiring verification: assess perfusion and symptoms, palpate the pulse for rate and pattern, and count long enough to characterise irregularity.
- Recognise that pulse deficit or device algorithm failure may make the displayed rate differ from electrical heart rate, so the discordance is mechanistically plausible rather than automatically artefact.
- Obtain a manual blood pressure and an ECG or monitored rhythm appropriate to the setting while escalating immediately if perfusion, consciousness or chest symptoms deteriorate.
- State the outcome as an irregular palpable pulse with unreliable automated measurements and possible pulse deficit, avoiding a definitive rhythm label until electrical evidence is available.
- Verify by repeating measurements with correct cuff and position, documenting symptom timing, and matching peripheral pulse events to the ECG before revising the interpretation.