The next step in the bedside evaluation of our patient is the assessment of precordial or chest wall movements. We want to analyze three things: the location of the impulse, the size of the impulse and its contour. In our patient here, the location is the fifth interspace, midclavicular line; and the size - dime sized.

The next step is to analyze contour. What is your opinion about the contour? Well, we'll put a cotton swab on there and see if we can enhance the impulse, so that you can observe it very readily and then, of course, we want to time it, so we'll use yet another cotton swab on the carotid vessel, so that you can get both an idea of the contour of the impulse and its timing.