Hospital-acquired pneumonia physical examination: Difference between revisions

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Latest revision as of 18:03, 18 September 2017

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

Overview

Physical examination is important in diagnosing hospital-acquired pneumonia, finding include fever, tachypnea, rhonchi, crackles and wheezes. For ventilator-associated pneumonia, a deterioration in ventilator parameters such as, tachypnea, decreased tidal volume, increased minute ventilation, or decreased oxygen saturation could be the first indicators of a new onset ventilator-associated pneumonia.^[1]

Physical Examination

**Criteria for Tachypnea**^[2]
Age	Breaths/min

< 2 months	> 60
2-12 months	> 50
1- 5 years	> 40
> 5 years	> 20

Vitals

Lungs

Palpation

Increased tactile fremitus

Percussion

Dullness on percussion

Auscultation

Decreased breath sounds
Bronchial breath sounds
Rhonchi
Crackles, Rales
Increased vocal fremitus

References

↑ Koenig, S. M.; Truwit, J. D. (2006). "Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention". Clinical Microbiology Reviews. 19 (4): 637–657. doi:10.1128/CMR.00051-05. ISSN 0893-8512.
↑ Russell, G. (2001). "Community acquired pneumonia". Archives of Disease in Childhood. 85 (6): 445–446. doi:10.1136/adc.85.6.445. ISSN 0003-9888.

Template:WH Template:WS

[KoenigTruwit2006-1] Koenig, S. M.; Truwit, J. D. (2006). "Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention". Clinical Microbiology Reviews. 19 (4): 637–657. doi:10.1128/CMR.00051-05. ISSN 0893-8512.

[Russell2001-2] Russell, G. (2001). "Community acquired pneumonia". Archives of Disease in Childhood. 85 (6): 445–446. doi:10.1136/adc.85.6.445. ISSN 0003-9888.

[1]

[2]

@@ Line 1: / Line 1: @@
+__NOTOC__
+{{CMG}}; {{AE}} {{AL}}
 {{Hospital-acquired pneumonia}}
-'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com]
 ==Overview==
+Physical examination is important in diagnosing  hospital-acquired pneumonia, finding include [[fever]], [[tachypnea]], [[rhonchi]], [[crackles]] and [[wheezing|wheezes]].  For [[ventilator-associated pneumonia]], a deterioration in ventilator parameters such as, [[tachypnea]], decreased [[tidal volume]], increased [[minute ventilation]], or decreased oxygen saturation could be the first indicators of a new onset ventilator-associated pneumonia.<ref name="KoenigTruwit2006">{{cite journal|last1=Koenig|first1=S. M.|last2=Truwit|first2=J. D.|title=Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention|journal=Clinical Microbiology Reviews|volume=19|issue=4|year=2006|pages=637–657|issn=0893-8512|doi=10.1128/CMR.00051-05}}</ref>
+==Physical Examination==
+{|style="float:right"
+|
+{| style="border: 0px; font-size: 85%; margin: 3px; width:200px;" align=center
+|valign=top|
+|+ '''Criteria for Tachypnea'''<ref name="Russell2001">{{cite journal|last1=Russell|first1=G.|title=Community acquired pneumonia|journal=Archives of Disease in Childhood|volume=85|issue=6|year=2001|pages=445–446|issn=00039888|doi=10.1136/adc.85.6.445}}</ref>
+! style="background: #4479BA; color:#FFF;  width: 100px;" | Age
+! style="background: #4479BA; color:#FFF;  width: 100px;" | Breaths/min
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  < 2 months
+| style="padding: 5px 5px; background: #F5F5F5;" | > 60
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  2-12 months
+| style="padding: 5px 5px; background: #F5F5F5;" | > 50
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  1- 5 years
+| style="padding: 5px 5px; background: #F5F5F5;" | > 40
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  > 5 years
+| style="padding: 5px 5px; background: #F5F5F5;" | > 20
+|}
+|style="width: 600px"|
+|}
+===Vitals ===
+* [[Decreased oxygen saturation]]
+* [[Fever]]
+* [[Hypotension]] < 90 mm Hg
+* [[Tachycardia]] > 125 beats/min
+* [[Tachypnea]]
+===Lungs===
+====Palpation====
+* Increased tactile fremitus
+====Percussion====
+* Dullness on percussion
+====Auscultation====
+* Decreased breath sounds
+* Bronchial breath sounds
+* [[Rhonchi]]
+* Crackles, [[Rales]]
+* Increased [[vocal fremitus]]
 ==References==
 {{reflist|2}}
-[[Category:Diseaase]]
+[[Category:Disease]]
 [[Category:Pulmonology]]
-[[Category:Infectious disease]]
 [[Category:Pneumonia|Pneumonia]]
 [[Category:Emergency medicine]]