Anaphylaxis physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(11 intermediate revisions by the same user not shown)
Line 2: Line 2:
{{Anaphylaxis}}
{{Anaphylaxis}}
{{CMG}}, {{AE}} [[User:Dushka|Dushka Riaz, MD]]
{{CMG}}, {{AE}} [[User:Dushka|Dushka Riaz, MD]]


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
[[Patient|Patients]] with [[anaphylaxis]] usually appear [[flushed]]. [[Physical examination]] of [[Patient|patients]] with [[anaphylaxis]] is usually remarkable for swollen [[lips]] or other areas, [[Wheeze|wheezing]], [[cyanosis]], and [[Hypotension|low blood pressure]]. It is vital for the [[physician]] to assess [[Heart|cardiac]] and [[respiratory]] symptoms for any compromise as soon as possible. <ref name="pmidhttps://doi.org/10.1016/S0091-6749(18)30572-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/S0091-6749(18)30572-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].


OR
The [[diagnosis]] is likely when any one of the following [[criteria]] is met: <ref name="pmid21293765">{{cite journal| author=Bjornsson HM, Graffeo CS| title=Improving diagnostic accuracy of anaphylaxis in the acute care setting. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 5 | pages= 456-61 | pmid=21293765 | doi= | pmc=3027438 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21293765  }} </ref>


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*1. [[Acute (medicine)|Acute]] onset with involvement of [[Mucous membrane|mucosal]] tissue, [[skin]], or both and one of the following:
**[[Respiratory Physiology|Respiratory]] compromise
**[[Hypotension|Reduced blood pressure]] or evidence of [[end-organ dysfunction]]
*2. Exposure to a likely [[antigen]] for the patient followed by two of the following:
**[[Skin]] involvement
**[[Respiratory]] compromise
**[[Hypotension|Reduced blood pressure]]
**[[Gastrointestinal tract|Gastrointestinal]] symptoms
*3. Exposure to a known [[allergen]] to the patient followed by [[Hypotension|reduced blood pressure]]


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
[[Physical examination]] of [[patients]] with [[anaphylaxis]] is usually remarkable for [[flushing]] and [[pruritis]]. The presentation can vary for [[patients]] and it is important not to delay [[treatment]].  <ref name="pmiddoi: 10.1016/S1081-1206(10)61367-1.">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi: 10.1016/S1081-1206(10)61367-1. | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref> <ref name="pmidhttps://doi.org/10.1186/s13223-018-0283-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1186/s13223-018-0283-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref> <ref name="pmid20584005">{{cite journal| author=Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK | display-authors=etal| title=Management of anaphylaxis in primary care: Canadian expert consensus recommendations. | journal=Allergy | year= 2010 | volume= 65 | issue= 9 | pages= 1082-92 | pmid=20584005 | doi=10.1111/j.1398-9995.2010.02418.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20584005  }} </ref> <ref name="pmid20176258">{{cite journal| author=Simons FE| title=Anaphylaxis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S161-81 | pmid=20176258 | doi=10.1016/j.jaci.2009.12.981 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176258  }} </ref> <ref name="pmid21377030">{{cite journal| author=Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J | display-authors=etal| title=World Allergy Organization anaphylaxis guidelines: summary. | journal=J Allergy Clin Immunol | year= 2011 | volume= 127 | issue= 3 | pages= 587-93.e1-22 | pmid=21377030 | doi=10.1016/j.jaci.2011.01.038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21377030  }} </ref> <ref name="pmid16948628">{{cite journal| author=Brown SG, Mullins RJ, Gold MS| title=Anaphylaxis: diagnosis and management. | journal=Med J Aust | year= 2006 | volume= 185 | issue= 5 | pages= 283-9 | pmid=16948628 | doi=10.5694/j.1326-5377.2006.tb00619.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16948628  }} </ref>


OR
===Appearance of the Patient===


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*Patients with [[anaphylaxis]] usually appear [[flushed]] with swollen areas.


OR
===Vital Signs===


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*[[Hypotension|Low blood pressure]]
*Rapid [[pulse]] or [[tachycardia]]


OR
===Skin===
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].


===Vital Signs===
*[[Hypotension|Low blood pressure]]
*Rapid [[pulse]]
===Skin===
*[[Hives]]
*[[Hives]]
*Skin that is blue from lack of oxygen or pale from shock
*Skin that is blue from lack of oxygen or pale from shock
*[[Eczema]]
*[[Goose bumps|Piloerection]]
*Warm feeling
===Heart===
===Heart===
*Abnormal heart rhythm ([[arrhythmia]])
*Abnormal heart rhythm ([[arrhythmia]])
*[[Palpitations]]
*[[Chest pain]]
===Lungs===
===Lungs===
*[[Wheezing]]
*[[Wheezing]]
*Fluid in the lungs ([[pulmonary edema]])
*Fluid in the lungs ([[pulmonary edema]])
*[[Nasal congestion]]
*[[Sneezing]]
*[[Cough]]
*[[Hoarseness]]
*[[Rhinorrhea|Rhinorrhea]]
*[[Dyspnea]]
===Neurologic===
===Neurologic===
*Mental [[confusion]]
*Mental [[confusion]]
*[[Dizziness]]
*[[Syncope]]
===Other===
===Other===
*Swelling ([[angioedema]]) in the throat that may be severe enough to block the [[airway]]
*Swelling ([[angioedema]]) in the throat that may be severe enough to block the [[airway]]
*Swelling of the eyes or face
*[[Swelling]] of the eyes or face
*Weakness
*[[Weakness]]
 
*[[Nausea and vomiting|Nausea or vomiting]]
The health care provider will wait to test for the specific allergen that caused anaphylaxis (if the cause is not obvious) until after treatment.
*[[Abdominal pain]]
 
*[[Diarrhea]]
 
*[[Anxiety]]
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===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]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|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===
The health care provider will wait to test for the specific [[allergen]] that caused [[anaphylaxis]] (if the cause is not obvious) until after treatment.
* 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==
==References==

Latest revision as of 18:03, 14 April 2021

Anaphylaxis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Anaphylaxis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Anaphylaxis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Anaphylaxis physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Anaphylaxis physical examination

CDC on Anaphylaxis physical examination

Anaphylaxis physical examination in the news

Blogs on Anaphylaxis physical examination

Directions to Hospitals Treating Anaphylaxis

Risk calculators and risk factors for Anaphylaxis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Dushka Riaz, MD

Overview

Patients with anaphylaxis usually appear flushed. Physical examination of patients with anaphylaxis is usually remarkable for swollen lips or other areas, wheezing, cyanosis, and low blood pressure. It is vital for the physician to assess cardiac and respiratory symptoms for any compromise as soon as possible. [1]

The diagnosis is likely when any one of the following criteria is met: [2]

Physical Examination

Physical examination of patients with anaphylaxis is usually remarkable for flushing and pruritis. The presentation can vary for patients and it is important not to delay treatment. [3] [4] [5] [6] [7] [8]

Appearance of the Patient

Vital Signs

Skin

Heart

Lungs

Neurologic

Other

The health care provider will wait to test for the specific allergen that caused anaphylaxis (if the cause is not obvious) until after treatment.

References

  1. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/S0091-6749(18)30572-4 Check |pmid= value (help).
  2. ↑ Bjornsson HM, Graffeo CS (2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
  3. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID 10.1016/S1081-1206(10)61367-1. doi: 10.1016/S1081-1206(10)61367-1. Check |pmid= value (help).
  4. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1186/s13223-018-0283-4 Check |pmid= value (help).
  5. ↑ Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK; et al. (2010). "Management of anaphylaxis in primary care: Canadian expert consensus recommendations". Allergy. 65 (9): 1082–92. doi:10.1111/j.1398-9995.2010.02418.x. PMID 20584005.
  6. ↑ Simons FE (2010). "Anaphylaxis". J Allergy Clin Immunol. 125 (2 Suppl 2): S161–81. doi:10.1016/j.jaci.2009.12.981. PMID 20176258.
  7. ↑ Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J; et al. (2011). "World Allergy Organization anaphylaxis guidelines: summary". J Allergy Clin Immunol. 127 (3): 587-93.e1-22. doi:10.1016/j.jaci.2011.01.038. PMID 21377030.
  8. ↑ Brown SG, Mullins RJ, Gold MS (2006). "Anaphylaxis: diagnosis and management". Med J Aust. 185 (5): 283–9. doi:10.5694/j.1326-5377.2006.tb00619.x. PMID 16948628.


Template:WikiDoc Sources CME Category::Cardiology

Retrieved from "https://www.wikidoc.org/index.php?title=Anaphylaxis_physical_examination&oldid=1697209"