Respiratory failure physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(6 intermediate revisions by 2 users not shown)
Line 2: Line 2:
{{Respiratory failure}}
{{Respiratory failure}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{HM}}


==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].
Patients with respiratory failure usually appear distressed with [[altered mental status]]. Physical examination of patients with respiratory failure is usually remarkable for [[dyspnea]], [[stridor]], and [[tachypnea]].
 
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 presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with respiratory failure is as follows:<ref name="pmid10559098">{{cite journal |vauthors=Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA |title=Interobserver variability in applying a radiographic definition for ARDS |journal=Chest |volume=116 |issue=5 |pages=1347–53 |date=November 1999 |pmid=10559098 |doi= |url=}}</ref><ref name="pmid3298678">{{cite journal |vauthors=Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G |title=Adult respiratory distress syndrome profiles by computed tomography |journal=J Thorac Imaging |volume=1 |issue=3 |pages=25–30 |date=July 1986 |pmid=3298678 |doi= |url=}}</ref>
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
Patients with respiratory failure usually appear distressed with [[altered mental status]]  
 
===Vital Signs===


*High-grade / low-grade fever
===Vital Signs===
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]]  
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Cardiac arrhythmia|Arrhythmia]]
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]]
*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===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]  
*[[Cyanosis]]  
*[[Jaundice]]
*[[Bruise|Bruises]]
* [[Pallor]]
**May be due to insult to the neck or thorax
* Bruises
*[[Clubbing]]
 
*[[Rash|Rashes]]
<gallery widths="150px">
**May suggest [[atopy]]
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*Evidence of trauma
OR
*Ophthalmoscopic exam may be abnormal with findings of [[papilledema]]
* Abnormalities of the head/hair may include ___
*[[Accessory muscles of respiration|Flared nares]]
* Evidence of trauma
*[[Nasal polyp|Nasal polyps]]
* Icteric sclera
**May suggest [[atopy]] or aspirin-induced asthma
* [[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===
* Neck examination of patients with [disease name] is usually normal.
*[[Bruise|Bruises]]  
OR
*Elevated [[jugular venous pulse]]
*[[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===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
*Fine [[crackles]] upon auscultation of the lung bases bilaterally
OR
*Evidence of preexisting lung disease may also be present such as:
* Asymmetric chest expansion / Decreased chest expansion
**Paradoxical thoraco-abdominal breathing
*Lungs are hypo/hyperresonant
**[[Wheeze]]  
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
***Typically absent and secondary to severe airway obstruction, representing a [[Status asthmaticus|silent chest]]
*Rhonchi
**Persistent scattered rhonchi
*Vesicular breath sounds / Distant breath sounds
**Prolonged expiration
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
**Diffusely decreased breath sound
*[[Wheezing]] may be present
**Coarse crackles with inspiration
*[[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 otoscope
 
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
 
OR
*[[Abdominal distention]]
*[[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===
* Neuromuscular examination of patients with [disease name] is usually normal.
*[[Altered mental status]]
OR
*[[Clonus]]
*Patient is usually oriented to persons, place, and time
**May be present
* 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===
* Extremities examination of patients with [disease name] is usually normal.
*[[Cyanosis]]
OR
*Peripheral [[edema]]
*[[Clubbing]]
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
Line 174: Line 62:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
 
[[Category:Surgery]]
[[Category:Up-To-Date]]
[[Category:Medicine]]
[[Category:Emergency medicine]]
[[Category:Pulmonology]]
[[Category:Anesthesiology]]

Latest revision as of 23:58, 29 July 2020

Respiratory failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Respiratory Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Electrocardiogram

CT

MRI

Echocardiography and ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical therapy

Oxygen therapy

Mechanical ventilation

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Respiratory failure physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Respiratory failure 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 Respiratory failure physical examination

CDC on Respiratory failure physical examination

Respiratory failure physical examination in the news

Blogs on Respiratory failure physical examination

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Respiratory failure physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with respiratory failure usually appear distressed with altered mental status. Physical examination of patients with respiratory failure is usually remarkable for dyspnea, stridor, and tachypnea.

Physical Examination

Physical examination of patients with respiratory failure is as follows:[1][2]

Appearance of the Patient

Patients with respiratory failure usually appear distressed with altered mental status

Vital Signs

Skin

HEENT

Neck

Lungs

  • Fine crackles upon auscultation of the lung bases bilaterally
  • Evidence of preexisting lung disease may also be present such as:
    • Paradoxical thoraco-abdominal breathing
    • Wheeze
      • Typically absent and secondary to severe airway obstruction, representing a silent chest
    • Persistent scattered rhonchi
    • Prolonged expiration
    • Diffusely decreased breath sound
    • Coarse crackles with inspiration

Neuromuscular

Extremities

References

  1. ↑ Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA (November 1999). "Interobserver variability in applying a radiographic definition for ARDS". Chest. 116 (5): 1347–53. PMID 10559098.
  2. ↑ Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (July 1986). "Adult respiratory distress syndrome profiles by computed tomography". J Thorac Imaging. 1 (3): 25–30. PMID 3298678.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Respiratory_failure_physical_examination&oldid=1642815"