Ward Round Notes

Grade 1 - heard by specialist in optimum conditions Grade 2 - heard by non specialist in optimum conditions Grade 3 - Easily heard no thrill Grade 4 - loud murmur with thrill Grade 5 - very loud heard over wide area with thrill Grade 6 - Murmur heard without stephoscope Douglas G, Nicol F, Robertson C, Macleod's clinical examination 12th ed . Edinburgh, churchill livingstone, 2009. 

Persistent hyperkalaemia (above 7mmol/L) Acidosis - pH less than 7.2 or base excess over 10 refractory pulmonary oedema Uraemic encephalopathy Uraemic pericarditis High catabolic state with progressive renal failure Reference Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR, Oxford handbook of clinical medicine, 8th ed. Oxford, Oxford university press, 2010.