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Toronto Notes - Case 3: Volume Status

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General OSCE Tips Respirology Cardiovascular Case 1: Shortness of Breath Case 2: Chest Pain Case 3: Volume Status Case 4: Syncope Gastroenterology Musculoskeletal Urology Pediatrics Peripheral Vascular Women's Health Neurology Psychiatry Ophthalmology and Otolaryngology Geriatrics

Case 3: Volume Status

Please assess the volume status of Mr. Kennedy, a 61 year old male, and comment on your findings.

Physical Examination
Vitals Assesses heart rate by palpating the radial pulse Measures blood pressure while supine Assesses orthostatic changes by measuring blood pressure and heart rate with patient standing Comments on vital signs findings of a patient who is hypovolemic JVP Observes JVP with correct patient position (30 degrees head-up-tilt); adjusts patient accordingly if JVP is not initially evident Confirms JVP by changing angle of head of bed Occludes JVP to confirm location Comments on the multiple waveforms of the JVP Comments on the JVP height Peripheral Vasculature Comments on capillary refill Comments on skin turgor, mottling Comments on mucus membranes Examines for peripheral edema Comments on peripheral temperature

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