Toxic shock syndrome physical examination: Difference between revisions
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{{Toxic shock syndrome}} | {{Toxic shock syndrome}} | ||
{{CMG}}{{AE}}{{MIR}} | |||
== Overview == | |||
Patients with [[toxic shock syndrome]] (TSS) usually present with [[shock]]. [[Physical examination]] of patients with TSS is usually remarkable for [[hypotension]], [[fever]], and diffuse [[erythroderma]]. The presence of [[desquamation]] on [[physical examination]] is highly suggestive of TSS. | |||
==Physical Examination== | ==Physical Examination== | ||
Physical exam in TSS patients usually include these findings:<ref name="urlTintinallis Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books">{{cite web |url=https://books.google.com/books?id=FNKLCgAAQBAJ&q=It%27s+main+characteristics+involve+diffuse,+red,+macular+rash+resembling+sunburn+that+can+also+involve+the+palms+and+soles.&dq=It%27s+main+characteristics+involve+diffuse,+red,+macular+rash+resembling+sunburn+that+can+also+involve+the+palms+and+soles.&hl=en&sa=X&ved=0ahUKEwjlq-LXoODTAhVF7CYKHQ3aDkoQ6AEIJzAA |title=Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books |format= |work= |accessdate=}}</ref><ref name="pmid7282746">{{cite journal |vauthors=Chesney RW, Chesney PJ, Davis JP, Segar WE |title=Renal manifestations of the staphylococcal toxic-shock syndrome |journal=Am. J. Med. |volume=71 |issue=4 |pages=583–8 |year=1981 |pmid=7282746 |doi= |url=}}</ref><ref name="pmid2928649">{{cite journal |vauthors=Olson RD, Stevens DL, Melish ME |title=Direct effects of purified staphylococcal toxic shock syndrome toxin 1 on myocardial function of isolated rabbit atria |journal=Rev. Infect. Dis. |volume=11 Suppl 1 |issue= |pages=S313–5 |year=1989 |pmid=2928649 |doi= |url=}}</ref> | |||
===Appearance of the Patient=== | |||
*TSS is presented by its [[shock]] symptoms. | |||
*May be ill appearing in the early stages of the disease, progress to confusion and change in mental status by disease progress. | |||
===Vital Signs=== | ===Vital Signs=== | ||
* [[Hypotension]] | * High grade [[Fever]] | ||
* [[ | * [[Hypotension]] | ||
* | **[[Systolic blood pressure]] of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to [[Fluid balance|fluid infusion]] even large amounts of [[isotonic]] [[intravenous fluids]] | ||
* [[Tachycardia]] | |||
**As a result of [[shock]] and [[hypotension]] | |||
* [[Tachypnea]] | |||
**May be pressent as a result of [[pulmonary edema]] secondary to [[shock]] | |||
* [[ | |||
* | |||
* [[ | |||
===Skin=== | |||
===Skin | |||
* Diffuse [[Pruritic disorders|pruritic]] [[maculopapular]] [[rash]] with palm and soles [[desquamation]] | * Diffuse [[Pruritic disorders|pruritic]] [[maculopapular]] [[rash]] with palm and soles [[desquamation]] | ||
* [[Erythroderma]] | * [[Erythroderma]] | ||
* Superficial [[Ulcer|ulcerations]] | * Superficial [[Ulcer|ulcerations]] | ||
* [[ | * [[Petechiae]] | ||
* [[Vesicles]] | |||
* Bullae (specially in Streptococcal TSS) | |||
* [[Skin]] [[desquamation]] (apears weeks after disease onset) | |||
* [[Edema|Non-pitting edema]] | * [[Edema|Non-pitting edema]] | ||
* Hair and nail loss | * Hair and nail loss | ||
* | *[[Cyanosis]] | ||
===HEENT=== | |||
*Ophthalmoscopic exam may be abnormal with findings of [[Conjunctiva|conjunctival]]-[[Sclera|scleral hemorrhage]] | |||
*[[Hyperemia]] of [[oropharyngeal]] [[mucosa]] | |||
===Lungs=== | |||
*[[Rale|Wet rales]] due to [[pulmonary edema]] complication | |||
===Heart=== | |||
*Possibly a [[diastolic]] [[Gallops and Extra Heart Sounds|gallop]] ([[S3]]) due to [[pulmonary edema]] | |||
===Extremities=== | |||
*[[Edema|Non-pitting edema]] | |||
**Can develop as a result of increases in [[interstitial fluid]] | |||
===Neuromuscular=== | |||
*Patient is usually oriented but if the disease is not diagnosed, it can lead to altered [[mental status]] and [[confusion]] | |||
*[[Hyporeflexia]] can be seen as a result of associated [[hypocalcemia]]/ [[hypophosphatemia]] | |||
*[[Muscle cramps|Muscle cramps]] (as a result of [[hypocalcemia]], a contributing complication of [[renal failure]]) | |||
*[[Seizure]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Syndromes]] | [[Category:Syndromes]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 00:27, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Patients with toxic shock syndrome (TSS) usually present with shock. Physical examination of patients with TSS is usually remarkable for hypotension, fever, and diffuse erythroderma. The presence of desquamation on physical examination is highly suggestive of TSS.
Physical Examination
Physical exam in TSS patients usually include these findings:[1][2][3]
Appearance of the Patient
- TSS is presented by its shock symptoms.
- May be ill appearing in the early stages of the disease, progress to confusion and change in mental status by disease progress.
Vital Signs
- High grade Fever
- Hypotension
- Systolic blood pressure of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of isotonic intravenous fluids
- Tachycardia
- As a result of shock and hypotension
- Tachypnea
- May be pressent as a result of pulmonary edema secondary to shock
Skin
- Diffuse pruritic maculopapular rash with palm and soles desquamation
- Erythroderma
- Superficial ulcerations
- Petechiae
- Vesicles
- Bullae (specially in Streptococcal TSS)
- Skin desquamation (apears weeks after disease onset)
- Non-pitting edema
- Hair and nail loss
HEENT
- Ophthalmoscopic exam may be abnormal with findings of conjunctival-scleral hemorrhage
- Hyperemia of oropharyngeal mucosa
Lungs
- Wet rales due to pulmonary edema complication
Heart
- Possibly a diastolic gallop (S3) due to pulmonary edema
Extremities
- Non-pitting edema
- Can develop as a result of increases in interstitial fluid
Neuromuscular
- Patient is usually oriented but if the disease is not diagnosed, it can lead to altered mental status and confusion
- Hyporeflexia can be seen as a result of associated hypocalcemia/ hypophosphatemia
- Muscle cramps (as a result of hypocalcemia, a contributing complication of renal failure)
- Seizure
References
- ↑ "Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books".
- ↑ Chesney RW, Chesney PJ, Davis JP, Segar WE (1981). "Renal manifestations of the staphylococcal toxic-shock syndrome". Am. J. Med. 71 (4): 583–8. PMID 7282746.
- ↑ Olson RD, Stevens DL, Melish ME (1989). "Direct effects of purified staphylococcal toxic shock syndrome toxin 1 on myocardial function of isolated rabbit atria". Rev. Infect. Dis. 11 Suppl 1: S313–5. PMID 2928649.