Pulmonary edema physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pulmonary edema}} | {{Pulmonary edema}} | ||
{{CMG}} | {{CMG}} {{AE}} {{FKH}} | ||
==Overview== | |||
Patients with pulmonary edema usually appear agitated. Physical examination of patients with pulmonary edema is usually remarkable for [[dyspnea]], [[tachypnea]]. The presence of abnormal cardiac examination on physical examination is diagnostic of cardiogenic pulmonary edema. Patients with noncardiogenic pulmonary edema may have warm extremities, whereas patients with cardiogenic pulmonary edema may have [[cool extremities]]. | |||
==Physical Examination== | ==Physical Examination== | ||
=== | Physical examination of patients with pulmonary edema is usually remarkable for:<ref name="pmid16382065">{{cite journal |vauthors=Ware LB, Matthay MA |title=Clinical practice. Acute pulmonary edema |journal=N. Engl. J. Med. |volume=353 |issue=26 |pages=2788–96 |date=December 2005 |pmid=16382065 |doi=10.1056/NEJMcp052699 |url=}}</ref><ref name="pmid6617283">{{cite journal |vauthors=Sibbald WJ, Cunningham DR, Chin DN |title=Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients |journal=Chest |volume=84 |issue=4 |pages=452–61 |date=October 1983 |pmid=6617283 |doi= |url=}}</ref> | ||
*Anxious | * [[Dyspnea]] | ||
*Decrease in level of [[alertness]] ([[consciousness]]) | |||
*Inability to speak in full sentences | * [[Tachypnea]] | ||
<div class="center"> | |||
{| border="1" | |||
|+ '''Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema''' | |||
! Clinical examination | |||
|- | |||
! Cardiogenic pulmonary edema | |||
| Low flow state=cool periphery || S3 gallop/cardiomegaly || Jugular venous distention || Crackles(wet) | |||
|- | |||
! Noncardiogenic pulmonary edema | |||
| High flow state=warm periphery || No gallop || No jugular venous distention || Crackles(dry) || | |||
|} | |||
</div> | |||
===Appearance of the Patient=== | |||
*Patients with pulmonary edema usually appear: | |||
**[[Anxious]] | |||
**Decrease in level of [[alertness]] ([[consciousness]]) | |||
**Inability to speak in full sentences | |||
===Vital Signs=== | |||
* [[Hyperthermia]] may be present | |||
* [[Tachycardia]] with regular pulse | |||
* [[Tachypnea]] | |||
* High/low [[blood pressure]] with normal [[pulse pressure]] | |||
===Skin=== | |||
* [[Pallor]] | |||
* [[Cold and clammy]] in cardiogenic pulmonary edema | |||
* Warm extremities in noncardiogenic pulmonary edema | |||
* [[livedo reticularis]] | |||
* Peripheral [[cyanosis]] may be present | |||
===HEENT=== | ===HEENT=== | ||
*Nasal flaring | *Nasal flaring | ||
*Dilated alae nasi | |||
===Neck=== | |||
* Neck examination of patients with pulmonary edema is usually normal | |||
===Lungs=== | ===Lungs=== | ||
* | * [[Wheezing]] may be present | ||
=== | * Prolonged expiratory phase | ||
*A [[third heart sound]] ([[S3]]) may be present | * Retraction of [[intercostal muscle]] | ||
* Use of [[accessory muscles of respiration]] | |||
===Heart=== | |||
*A [[third heart sound]] ([[S3]]) may be present | |||
*[[Pulsus alternans]] | |||
*Alternating weak and strong pulse, may be a sign of [[left ventricular failure]] in [[CHF]] as underlying cause of cardiogenic pulmonary edema | |||
*Heart sounds with presence of [[S3]], [[S4]], and harsh [[murmur]] | |||
*[[JVD]] | |||
===Abdomen=== | |||
* Abdomen examination of patients with pulmonary edema is usually normal | |||
===Back=== | |||
* Back examination of patients with pulmonary edema is usually normal | |||
===Genitourinary=== | |||
* Genitourinary examination of patients with pulmonary edema is usually normal | |||
===Neuromuscular=== | |||
* Neurologic examination may reveal focal signs as [[neurogenic]] causes of pulmonary edema | |||
===Extremities=== | |||
* [[Peripheral edema]] of extremities | |||
==References== | ==References== | ||
{{ | {{reflist|2}} | ||
[[Category:Pulmonology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
Overview
Patients with pulmonary edema usually appear agitated. Physical examination of patients with pulmonary edema is usually remarkable for dyspnea, tachypnea. The presence of abnormal cardiac examination on physical examination is diagnostic of cardiogenic pulmonary edema. Patients with noncardiogenic pulmonary edema may have warm extremities, whereas patients with cardiogenic pulmonary edema may have cool extremities.
Physical Examination
Physical examination of patients with pulmonary edema is usually remarkable for:[1][2]
| Clinical examination | |||||
|---|---|---|---|---|---|
| Cardiogenic pulmonary edema | Low flow state=cool periphery | S3 gallop/cardiomegaly | Jugular venous distention | Crackles(wet) | |
| Noncardiogenic pulmonary edema | High flow state=warm periphery | No gallop | No jugular venous distention | Crackles(dry) |
Appearance of the Patient
- Patients with pulmonary edema usually appear:
- Anxious
- Decrease in level of alertness (consciousness)
- Inability to speak in full sentences
Vital Signs
- Hyperthermia may be present
- Tachycardia with regular pulse
- Tachypnea
- High/low blood pressure with normal pulse pressure
Skin
- Pallor
- Cold and clammy in cardiogenic pulmonary edema
- Warm extremities in noncardiogenic pulmonary edema
- livedo reticularis
- Peripheral cyanosis may be present
HEENT
- Nasal flaring
- Dilated alae nasi
Neck
- Neck examination of patients with pulmonary edema is usually normal
Lungs
- Wheezing may be present
- Prolonged expiratory phase
- Retraction of intercostal muscle
- Use of accessory muscles of respiration
Heart
- A third heart sound (S3) may be present
- Pulsus alternans
- Alternating weak and strong pulse, may be a sign of left ventricular failure in CHF as underlying cause of cardiogenic pulmonary edema
- Heart sounds with presence of S3, S4, and harsh murmur
- JVD
Abdomen
- Abdomen examination of patients with pulmonary edema is usually normal
Back
- Back examination of patients with pulmonary edema is usually normal
Genitourinary
- Genitourinary examination of patients with pulmonary edema is usually normal
Neuromuscular
- Neurologic examination may reveal focal signs as neurogenic causes of pulmonary edema
Extremities
- Peripheral edema of extremities
References
- ↑ Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.
- ↑ Sibbald WJ, Cunningham DR, Chin DN (October 1983). "Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients". Chest. 84 (4): 452–61. PMID 6617283.