When To Refer Eleven year old girl seen after bicycle accident History Listen Diagnosis Refer? History Eleven year old girl with two centimeter laceration on the right knee requiring four sutures Exam Use the auscultation button above to virtually auscultate this patient. Auscultation Tips Significant independent predictors of the presence of a confirmed cardiac lesion: A loud murmur of intensity 3 or greater. Best heard at the pulmonic location (2LICS). Harsh sound. Pansystolic murmur. Systolic click. Abnormal second heart sound - fixed splitting during respiration. Table of Contents 14 month old girl. Failure to thrive. 26 month old boy 34 year old with fainting episode 410 year old with chest pain. 56 month old with poor appetite 612 year old with respiratory infections 7Twelve year old girl with periodic dizziness 8Eleven year old girl seen after bicycle accident 9Eight year old girl with elevated temperature 10Eight year old boy with generalized malaise 11Fifteen year old boy complains of dizziness #283