Vision

• Position
• Shape/size
• Colour
• Texture
• Compare left and right sides

Hearing

• Voice/speech
• Stethoscope - things that move

Feel

• Temperature
• Texture
• Pain
• Attachments

Smell

• Smoke
• Alcohol
• Sweat/urine
• Infections
• Ketosis
• Diarrhoea

Order

• Look - inspection
• Feel/touch - palpation and percussion
• Listen - auscultation

Approach

• Greet and consent to examine

• Environmental clues

• General examination (hands off)

• Hands-on examination from right hand side of bed

• Move to other positions for specific observations

• Signs above the bed

Colour

Blood

• Blood - red oxygenated blood
• Increased blood in vessels means more redness
• Blood breakdown products

flowchart LR
	Purple --> Green --> Yellow

• Deoxygenated blood - deep red-purple
• Cyanosis - deoxygenation of blood

Skin pigment

• Melanin - brown
• Absorbs UV light
• Cultural variation
• Hyperpigmentation/depigmentation

Artificial pigment

• Tattoos
• Cigarettes
• Venous pigmentation
• Statis dermatitis

Shape

• Obesity/malnutrition
• Height/stature
• Limb asymmetry
• Spinal shape
• Abdominal distension (flatus, faeces, foetus, fat, fluid, fatal)

Clubbing

• Loss of nail angle
• Nail convex in both planes
• Bulbous/drumstick end of finger

Oedema/edema

• Fluid in soft tissues - swelling
• Local/general
• Acute/chronic
• Test by gradually increasing pressure over bony site - at least 15 seconds
• Skin can be shiny stretched, blistered, weeping, ulcerated