Bronchiolitis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Bronchiolitis}} | {{Bronchiolitis}} | ||
{{CMG}}; {{AE}} {{Alonso}} | {{CMG}}; {{AE}}{{Alonso}}{{AEL}} | ||
==Overview== | ==Overview== | ||
Patients infected with bronchiolitis have a [[Toxicity|toxic]] appearance and may be [[cyanotic]]. [[Fever]] is one of the signs of the [[disease]], but a lack of it does not exclude the diagnosis.There may be abnormalities on [[Inspection (medicine)|inspection]] and [[auscultation]] of the chest, for example, [[intercostal]] and [[Substernal pain|substernal retractions]], [[wheezing]], and [[crackles]]. Extrapulmonary manifestations may occur as well, including [[pharyngitis]], [[conjunctivitis]], [[arrythmias|arrhythmias]], [[tachycardia]], and [[seizures]]. | |||
==Physical Examination== | ==Physical Examination== | ||
=== | ===Appearance of the Patient=== | ||
*Ill or toxic appearance | *Ill or toxic appearance | ||
*[[Cyanosis]] | *[[Cyanosis]] | ||
=== | ===Vital Signs=== | ||
*[[Low-grade fever|Low grade fever]] | |||
*[[Tachycardia]] | |||
*[[Tachypnea]] | *[[Tachypnea]] | ||
*[[ | |||
===Skin=== | |||
*[[Cyanosis]] | |||
===HEENT=== | |||
In some cases of bronchiolitis, the following may be observed:<ref name="pmid9521943">{{cite journal| author=Andrade MA, Hoberman A, Glustein J, Paradise JL, Wald ER| title=Acute otitis media in children with bronchiolitis. | journal=Pediatrics | year= 1998 | volume= 101 | issue= 4 Pt 1 | pages= 617-9 | pmid=9521943 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9521943 }} </ref> | |||
*[[Conjunctivitis]] | |||
*[[Otitis media]] | |||
*[[Pharyngitis]] | |||
===Lung=== | ===Lung=== | ||
Rapid changes in respiratory signs are characteristic of bronchiolitis. | * Rapid changes in respiratory signs that are characteristic of bronchiolitis. These signs include: | ||
**Inspection | |||
***Chest retractions: | |||
****[[Intercostal]] [[Retraction|retractions]] | |||
****Substernal retractions | |||
***[[Nasal]] flaring in infants | |||
**Auscultation | |||
***[[Wheezing]] | |||
***[[Rales]] (crackles) | |||
***Decreasing [[respiratory sounds]] may indicate a progression in [[airway obstruction]], which may evolve to [[respiratory failure]].<ref name="pmid14757603">{{cite journal| author=Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L et al.| title=Diagnosis and testing in bronchiolitis: a systematic review. | journal=Arch Pediatr Adolesc Med | year= 2004 | volume= 158 | issue= 2 | pages= 119-26 | pmid=14757603 | doi=10.1001/archpedi.158.2.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14757603 }} </ref> | |||
==== | * The association between [[cyanosis]] and [[rales]] has been shown as a predictor of severity.<ref name="pmid1971330">{{cite journal| author=Mulholland EK, Olinsky A, Shann FA| title=Clinical findings and severity of acute bronchiolitis. | journal=Lancet | year= 1990 | volume= 335 | issue= 8700 | pages= 1259-61 | pmid=1971330 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1971330 }} </ref><ref name="pmid16859512">{{cite journal| author=Eisenhut M| title=Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. | journal=Crit Care | year= 2006 | volume= 10 | issue= 4 | pages= R107 | pmid=16859512 | doi=10.1186/cc4984 | pmc=1751022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16859512 }} </ref> | ||
: | |||
=== | ===Heart=== | ||
In rare cases of bronchiolitis, [[cardiovascular]] manifestations may be detected. These signs include:<ref name="pmid8021780">{{cite journal| author=Donnerstein RL, Berg RA, Shehab Z, Ovadia M| title=Complex atrial tachycardias and respiratory syncytial virus infections in infants. | journal=J Pediatr | year= 1994 | volume= 125 | issue= 1 | pages= 23-8 | pmid=8021780 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8021780 }} </ref><ref name="pmid16859512">{{cite journal| author=Eisenhut M| title=Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. | journal=Crit Care | year= 2006 | volume= 10 | issue= 4 | pages= R107 | pmid=16859512 | doi=10.1186/cc4984 | pmc=1751022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16859512 }} </ref> | |||
*[[Atrial tachycardia]] | |||
*[[Second degree heart block|Second-degree heart block]] | |||
*[[Arrhythmias|Arrhythmia]] | |||
===Neuromuscular=== | |||
[[Neurological]] manifestations can also occur in cases of [[RSV]] bronchiolitis, including:<ref name="pmid15866430">{{cite journal| author=Sweetman LL, Ng YT, Butler IJ, Bodensteiner JB| title=Neurologic complications associated with respiratory syncytial virus. | journal=Pediatr Neurol | year= 2005 | volume= 32 | issue= 5 | pages= 307-10 | pmid=15866430 | doi=10.1016/j.pediatrneurol.2005.01.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15866430 }} </ref> | |||
*[[Seizures]] | |||
*Central [[apnea]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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{{WikiDoc Sources}} | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Pulmonology]] | |||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Infectious disease]] | |||
Latest revision as of 20:44, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]Ahmed Elsaiey, MBBCH [3]
Overview
Patients infected with bronchiolitis have a toxic appearance and may be cyanotic. Fever is one of the signs of the disease, but a lack of it does not exclude the diagnosis.There may be abnormalities on inspection and auscultation of the chest, for example, intercostal and substernal retractions, wheezing, and crackles. Extrapulmonary manifestations may occur as well, including pharyngitis, conjunctivitis, arrhythmias, tachycardia, and seizures.
Physical Examination
Appearance of the Patient
- Ill or toxic appearance
- Cyanosis
Vital Signs
Skin
HEENT
In some cases of bronchiolitis, the following may be observed:[1]
Lung
- Rapid changes in respiratory signs that are characteristic of bronchiolitis. These signs include:
- Inspection
- Chest retractions:
- Intercostal retractions
- Substernal retractions
- Nasal flaring in infants
- Chest retractions:
- Auscultation
- Wheezing
- Rales (crackles)
- Decreasing respiratory sounds may indicate a progression in airway obstruction, which may evolve to respiratory failure.[2]
- Inspection
Heart
In rare cases of bronchiolitis, cardiovascular manifestations may be detected. These signs include:[5][4]
Neuromuscular
Neurological manifestations can also occur in cases of RSV bronchiolitis, including:[6]
References
- ↑ Andrade MA, Hoberman A, Glustein J, Paradise JL, Wald ER (1998). "Acute otitis media in children with bronchiolitis". Pediatrics. 101 (4 Pt 1): 617–9. PMID 9521943.
- ↑ Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L; et al. (2004). "Diagnosis and testing in bronchiolitis: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 119–26. doi:10.1001/archpedi.158.2.119. PMID 14757603.
- ↑ Mulholland EK, Olinsky A, Shann FA (1990). "Clinical findings and severity of acute bronchiolitis". Lancet. 335 (8700): 1259–61. PMID 1971330.
- ↑ 4.0 4.1 Eisenhut M (2006). "Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review". Crit Care. 10 (4): R107. doi:10.1186/cc4984. PMC 1751022. PMID 16859512.
- ↑ Donnerstein RL, Berg RA, Shehab Z, Ovadia M (1994). "Complex atrial tachycardias and respiratory syncytial virus infections in infants". J Pediatr. 125 (1): 23–8. PMID 8021780.
- ↑ Sweetman LL, Ng YT, Butler IJ, Bodensteiner JB (2005). "Neurologic complications associated with respiratory syncytial virus". Pediatr Neurol. 32 (5): 307–10. doi:10.1016/j.pediatrneurol.2005.01.010. PMID 15866430.