Pulseless electrical activity physical examination: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 18: | Line 18: | ||
==Physical Examination== | ==Physical Examination== | ||
A rapid physical examination should be performed to identify rapidly reversible causes of PEA: <ref name="pmid30020721">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=30020721 | doi= | pmc= | url= }}</ref> | A rapid physical examination should be performed to identify rapidly reversible causes of PEA: <ref name="pmid30020721">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=30020721 | doi= | pmc= | url= }}</ref> <ref name="pmid24297818">{{cite journal |vauthors=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM, Goldhaber JI, Lathrop DA, Liu P, Niemann JT, Ornato JP, Sopko G, Van Eyk JE, Walcott GP, Weisfeldt ML, Wright JD, Zipes DP |title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a National Heart, Lung, and Blood Institute workshop |journal=Circulation |volume=128 |issue=23 |pages=2532–41 |date=December 2013 |pmid=24297818 |doi=10.1161/CIRCULATIONAHA.113.004490 |url=}}</ref><ref name="pmid22650157">{{cite journal |vauthors=Kalava A, Kalstein A, Koyfman S, Mardakh S, Yarmush JM, Schianodicola J |title=Pulseless electrical activity during electroconvulsive therapy: a case report |journal=BMC Anesthesiol |volume=12 |issue= |pages=8 |date=May 2012 |pmid=22650157 |pmc=3403950 |doi=10.1186/1471-2253-12-8 |url=}}</ref> | ||
'''Pulse''' | '''Pulse''' | ||
| Line 166: | Line 166: | ||
*Muscle atrophy | *Muscle atrophy | ||
*Fasciculations in the upper/lower extremity | *Fasciculations in the upper/lower extremity | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 15:32, 24 April 2020
 |
Resident Survival Guide |
|
Pulseless electrical activity Microchapters |
|
Differentiating Pulseless Electrical Activity from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Pulseless electrical activity physical examination On the Web |
|
American Roentgen Ray Society Images of Pulseless electrical activity physical examination |
|
Pulseless electrical activity physical examination in the news |
|
Directions to Hospitals Treating Pulseless electrical activity |
|
Risk calculators and risk factors for Pulseless electrical activity physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A rapid physical examination should be performed to identify rapidly reversible causes of PEA. Absence of palpable pulses is the main finding. Depending upon the cause of PEA, physical findings can be distended neck veins, tracheal deviation, unilateral absence of breath sounds, tachycardia, decreased skin turgor, traumatic chest, cool extremities, and cyanosis.
Physical Examination
A rapid physical examination should be performed to identify rapidly reversible causes of PEA: [1] [2][3]
Pulse
- Absence of palpable pulses is the main finding.
Depending upon the cause, the following might be found:
Neck
- Distended neck veins suggests cardiac tamponade
- Tracheal deviation suggests tension pneumothorax
Lungs
- Unilateral absence of breath sounds suggests tension pneumothorax
Heart
- Tachycardia
General
- Decreased skin turgor
- Traumatic chest
- Cool extremities
- Cyanosis
Appearance of the Patient
- Patients with [disease name] usually appear [general appearance].
Vital Signs
- High-grade / low-grade fever
- Hypothermia / hyperthermia may be present
- Tachycardia with regular pulse or (ir)regularly irregular pulse
- Bradycardia with regular pulse or (ir)regularly irregular pulse
- Tachypnea / bradypnea
- Kussmal respirations may be present in _____ (advanced disease state)
- Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
- High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure
Skin
- Skin examination of patients with [disease name] is usually normal.
OR
HEENT
- HEENT examination of patients with [disease name] is usually normal.
OR
- Abnormalities of the head/hair may include ___
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- Hearing acuity may be reduced
- Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
- Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
- Exudate from the ear canal
- Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
- Inflamed nares / congested nares
- Purulent exudate from the nares
- Facial tenderness
- Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
- Neck examination of patients with [disease name] is usually normal.
OR
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
Lungs
- Pulmonary examination of patients with [disease name] is usually normal.
OR
- Asymmetric chest expansion OR decreased chest expansion
- Lungs are hyporesonant OR hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds OR distant breath sounds
- Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
- Wheezing may be present
- Egophony present/absent
- Bronchophony present/absent
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with [disease name] is usually normal.
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with [disease name] is usually normal.
OR
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Back examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
References
- ↑ "StatPearls". 2020. PMID 30020721.
- ↑ Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM, Goldhaber JI, Lathrop DA, Liu P, Niemann JT, Ornato JP, Sopko G, Van Eyk JE, Walcott GP, Weisfeldt ML, Wright JD, Zipes DP (December 2013). "Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a National Heart, Lung, and Blood Institute workshop". Circulation. 128 (23): 2532–41. doi:10.1161/CIRCULATIONAHA.113.004490. PMID 24297818.
- ↑ Kalava A, Kalstein A, Koyfman S, Mardakh S, Yarmush JM, Schianodicola J (May 2012). "Pulseless electrical activity during electroconvulsive therapy: a case report". BMC Anesthesiol. 12: 8. doi:10.1186/1471-2253-12-8. PMC 3403950. PMID 22650157.