Cyanosis physical examination: Difference between revisions
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*[[Human physical appearance|Appearance]] of [[Patient|patients]] with [[cyanosis]] will vary depending to the underlying condition. | *[[Human physical appearance|Appearance]] of [[Patient|patients]] with [[cyanosis]] will vary depending to the underlying condition. | ||
**[[Lip|Lips]], [[tongue]], [[buccal mucosa]], [[Hand|hands]], and feet will appear blue in [[Patient|patients]] with [[cyanosis]]. | **[[Lip|Lips]], [[tongue]], [[buccal mucosa]], [[Hand|hands]], and feet will appear blue in [[Patient|patients]] with [[cyanosis]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Fever]] | *[[Fever]] | ||
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*[[Hepatojugular reflux]] | *[[Hepatojugular reflux]] | ||
=== Heart ===<ref name="pmid15852070">{{cite journal |vauthors=Berg A, Greve G, Hirth A, Rosland GA, Norgård G |title=[Evaluation of cardiac murmurs in children] |language=Norwegian |journal=Tidsskr. Nor. Laegeforen. |volume=125 |issue=8 |pages=1000–3 |date=April 2005 |pmid=15852070 |doi= |url=}}</ref><ref name="pmid15275985">{{cite journal |vauthors=Sasidharan P |title=An approach to diagnosis and management of cyanosis and tachypnea in term infants |journal=Pediatr. Clin. North Am. |volume=51 |issue=4 |pages=999–1021, ix |date=August 2004 |pmid=15275985 |doi=10.1016/j.pcl.2004.03.010 |url=}}</ref><ref name="pmid8772770">{{cite journal |vauthors=Ammash N, Warnes CA |title=Cerebrovascular events in adult patients with cyanotic congenital heart disease |journal=J. Am. Coll. Cardiol. |volume=28 |issue=3 |pages=768–72 |date=September 1996 |pmid=8772770 |doi= |url=}}</ref> | |||
=== Heart === | |||
*Cardiovascular examination of patients with [[cyanosis]] will show: | *Cardiovascular examination of patients with [[cyanosis]] will show: | ||
**[[Tachycardia]]/ [[Bradycardia]] | **[[Tachycardia]]/ [[Bradycardia]] | ||
| Line 103: | Line 103: | ||
*Measure blood pressure in both upper and lower extremities | *Measure blood pressure in both upper and lower extremities | ||
=== Lungs === | === Lungs ===<ref name="pmid15275985">{{cite journal |vauthors=Sasidharan P |title=An approach to diagnosis and management of cyanosis and tachypnea in term infants |journal=Pediatr. Clin. North Am. |volume=51 |issue=4 |pages=999–1021, ix |date=August 2004 |pmid=15275985 |doi=10.1016/j.pcl.2004.03.010 |url=}}</ref><ref name="pmid8575588">{{cite journal |vauthors=Maitre B, Similowski T, Derenne JP |title=Physical examination of the adult patient with respiratory diseases: inspection and palpation |journal=Eur. Respir. J. |volume=8 |issue=9 |pages=1584–93 |date=September 1995 |pmid=8575588 |doi= |url=}}</ref><ref name="pmid19462358">{{cite journal |vauthors=Kosacka M, Brzecka A, Jankowska R, Lewczuk J, Mroczek E, Weryńska B |title=[Combined pulmonary fibrosis and emphysema - case report and literature review] |language=Polish |journal=Pneumonol Alergol Pol |volume=77 |issue=2 |pages=205–10 |date=2009 |pmid=19462358 |doi= |url=}}</ref> | ||
*[[Tachypnea]] is seen in [[Patient|patients]] with [[Lung|respiratory]] and [[Heart|cardiac diseases]] presenting with [[cyanosis]]. | *[[Tachypnea]] is seen in [[Patient|patients]] with [[Lung|respiratory]] and [[Heart|cardiac diseases]] presenting with [[cyanosis]]. | ||
*[[Nasal]] flaring, grunting, intercostal and substernal retractions, and prolonged [[breathing]] may indicate respiratory distress. | *[[Nasal]] flaring, grunting, intercostal and substernal retractions, and prolonged [[breathing]] may indicate respiratory distress. | ||
| Line 124: | Line 124: | ||
**Neurologic conditions associated with [[hypoventilation]] (eg, [[muscle weakness]], [[coma]], and [[Seizure|seizures]]) | **Neurologic conditions associated with [[hypoventilation]] (eg, [[muscle weakness]], [[coma]], and [[Seizure|seizures]]) | ||
**[[Pulmonary embolism]] | **[[Pulmonary embolism]] | ||
=== Extremities === | === Extremities === | ||
Revision as of 20:49, 14 March 2018
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Cyanosis physical examination On the Web |
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Risk calculators and risk factors for Cyanosis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
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].
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 of patients with [disease name] is usually normal.
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 patients with cyanosis will vary depending to the underlying condition.
Vital Signs
Skin
- Skin usually appears blue in patients with cyanosis.
- It is very difficult to find bluish discoration in dark-skinned individuals and in poor lighting conditions.
- Sites to look for central cyanosis: Tongue, inner aspect of lips, gums, soft palate, buccal mucosa, and sites of peripheral cyanosis.
- Sites to look for peripheral cyanosis: Nose tip, ear lobules, outer aspect of lips, fingertips, nail bed, extremities.
HEENT
- Evidence of head trauma
Neck
- Cardiovascular examination of patients with cyanosis will show:
- Tachycardia/ Bradycardia
- Bradycardia is an ominous sign for imminent cardiovascular collapse.
- Paradoxic pulse: Acute airway obstruction, Pulmonary embolism, cardiac tamponade, and asthma.
- Auscultate for abnormal (loud, single or widely split S2) and additional heart sounds and murmurs (Grade, timing, location, radiation, intensity).
- Tachycardia/ Bradycardia
| S2 | Murmur | |
|---|---|---|
| TOF | single | systolic |
| Tricuspid atresia | single | with or with out systolic |
| Ebstein's anomaly | split | systolic |
| TGA | single | none |
| Truncus arteriosus | single | systolic murmur/ with or with out diastolic murmur |
| Pulmonary stenosis | single | systolic |
| Pulmonary atresia | single | systolic |
| TAPVC | split | systolic |
| HLHS | single | with or with out systolic |
| Tricuspid atresia | single | with or with out systolic |
- Measure blood pressure in both upper and lower extremities
- Tachypnea is seen in patients with respiratory and cardiac diseases presenting with cyanosis.
- Nasal flaring, grunting, intercostal and substernal retractions, and prolonged breathing may indicate respiratory distress.
- Traumatic injury involving chest wall or lung will show following abnormalities:
- Chest wall movement abnormalities
- Chest wound (eg, open or sucking)
- Abrasions
- Ecchymosis
- Focal tenderness can be elicited on palpation over ribs, sternum, or scapula.
- Deviation of Trachea
- Subcutaneous air with crepitus
- Stridor, voice changes, suprasternal retractions, drooling and prolonged inspiration can be found in patients with upper airway obstruction.
- Wheezing, rales / crackles and assymmetric breath sounds will suggest Intrinsic lung diseases.
- Tactile fremitus:
- Increased: Consolidation by pneumonia ,atelactasis
- Decresed: Pleural effusion, pneumothorax
- Lung sounds may be clear on auscultation in patients with
- Cyanotic congenital heart disease
- Methemoglobinemia
- Neurologic conditions associated with hypoventilation (eg, muscle weakness, coma, and seizures)
- Pulmonary embolism
Extremities
- Clubbing is seen in some patients presenting with cyanosis.
- Congenital heart diseases
- Pulmonary diseases: COPD, bronchiectasis, cystic fibrosis, pulmonary fibrosis, pulmonary arteriovenous malformations.
- edema of lower extremities due to congestive heart failure and pulmonary embolism, pulmonary edema, pulmonary hypertension.
References
- ↑ Berg A, Greve G, Hirth A, Rosland GA, Norgård G (April 2005). "[Evaluation of cardiac murmurs in children]". Tidsskr. Nor. Laegeforen. (in Norwegian). 125 (8): 1000–3. PMID 15852070.
- ↑ 2.0 2.1 Sasidharan P (August 2004). "An approach to diagnosis and management of cyanosis and tachypnea in term infants". Pediatr. Clin. North Am. 51 (4): 999–1021, ix. doi:10.1016/j.pcl.2004.03.010. PMID 15275985.
- ↑ Ammash N, Warnes CA (September 1996). "Cerebrovascular events in adult patients with cyanotic congenital heart disease". J. Am. Coll. Cardiol. 28 (3): 768–72. PMID 8772770.
- ↑ Maitre B, Similowski T, Derenne JP (September 1995). "Physical examination of the adult patient with respiratory diseases: inspection and palpation". Eur. Respir. J. 8 (9): 1584–93. PMID 8575588.
- ↑ Kosacka M, Brzecka A, Jankowska R, Lewczuk J, Mroczek E, Weryńska B (2009). "[Combined pulmonary fibrosis and emphysema - case report and literature review]". Pneumonol Alergol Pol (in Polish). 77 (2): 205–10. PMID 19462358.