Acute respiratory distress syndrome physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
There are no physical exam findings specific to or [[pathognomonic]] of ARDS. The most notable physical exam findings tend to be those of the underlying illness or injury, as well as those of [[respiratory distress]], [[critical illness]], [[shock]], and [[end | There are no physical exam findings specific to or [[pathognomonic]] of ARDS. The most notable physical exam findings tend to be those of the underlying illness or injury, as well as those of [[respiratory distress]], [[critical illness]], [[shock]], and [[end organ damage]]. | ||
The first signs of ARDS typically present within 24 to 48 hours of the precipitating [[illness]] or [[injury]] and progress over the course of 1 to 2 weeks. The early clinical features of ARDS include: | The first signs of ARDS typically present within 24 to 48 hours of the precipitating [[illness]] or [[injury]] and progress over the course of 1 to 2 weeks. The early clinical features of ARDS include: | ||
*[[Hypoxemia]] (a declining peripheral blood oxygen saturation [SpO<sub>2</sub>] on [[pulse oximetry]] or a declining partial pressure of oxygen | *[[Hypoxemia]] (a declining peripheral blood oxygen saturation [SpO<sub>2</sub>] on [[pulse oximetry]] or a declining partial pressure of oxygen (PaO<sub>2</sub>) on [[arterial blood gas]] analysis) requiring high concentrations of supplemental oxygen (i.e., a higher [[fraction of inspired oxygen]] (FIO<sub>2</sub>)) or positive pressure ventilation (i.e., a higher [[continuous positive airway pressure]] (CPAP) or a higher [[positive end-expiratory pressure]] (PEEP)) in order to maintain acceptable blood oxygenation | ||
*[[Tachypnea]] | *[[Tachypnea]] | ||
*[[Dyspnea]] | |||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*Signs | *Signs that suggest worsening of the underlying illness | ||
==Physical Examination== | ==Physical Examination== | ||
===Vitals=== | ===Vitals=== | ||
The presence of the following signs of [[shock]] or [[infection]] on physical examination are highly suggestive of ARDS: | |||
*[[Temperature|'''Temperature (Temp, T)''']]: [[Hyperpyrexia]] ≥ | *[[Temperature|'''Temperature (Temp, T)''']]: [[Hyperpyrexia]] ≥ 38°C or 100.4°F) or low temperature < 36°C or 96.8°F | ||
*[[Blood pressure|'''Blood pressure (BP)''']]: inappropriately low, with a low [[Mean arterial pressure|mean arterial pressure (MAP)]] | *[[Blood pressure|'''Blood pressure (BP)''']]: inappropriately low, with a low [[Mean arterial pressure|mean arterial pressure (MAP)]] | ||
*[[Heart rate|'''Heart rate (HR)''']]: rapid ([[tachycardia]] > 100 beats/minute), normal, or slow ([[bradycardia]] < 60 beats/minute) | *[[Heart rate|'''Heart rate (HR)''']]: rapid ([[tachycardia]] > 100 beats/minute), normal, or slow ([[bradycardia]] < 60 beats/minute) | ||
*[[Respiratory rate|'''Respiratory rate (RR)''']]: [[Tachypnea]] > 20 breaths/minute or [[bradypnea]] < 12 breaths/minute | *[[Respiratory rate|'''Respiratory rate (RR)''']]: [[Tachypnea]] > 20 breaths/minute or [[bradypnea]] < 12 breaths/minute | ||
* | *'''Peripheral capillary oxygen saturation (SpO<sub>2</sub>)''': low (< 90% on ambient air or a [[FiO2|fraction of inspired oxygen, (FIO<sub>2</sub>)]] of 21% at [[sea level]]) | ||
===Physical Examination=== | ===Physical Examination=== | ||
The physical exam findings of a patient with ARDS vary according to the underlying cause, however, some commonly observed findings include: | The physical exam findings of a patient with ARDS vary according to the underlying cause, however, some commonly observed findings include: | ||
*[[Respiratory distress]] | *[[Respiratory distress]] | ||
*[[Cyanosis]] due to poor [[oxygenation]] or [[pallor]] due to poor [[perfusion]] | *[[Cyanosis]] due to poor [[oxygenation]] or [[pallor]] due to poor [[perfusion]] | ||
*[[Tachycardia]] or [[bradycardia]] on heart [[auscultation]] | *[[Tachycardia]] or [[bradycardia]] on heart [[auscultation]] | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:FinalQCRequired]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 17:21, 1 July 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]
Overview
There are no physical exam findings specific to or pathognomonic of ARDS. The most notable physical exam findings tend to be those of the underlying illness or injury, as well as those of respiratory distress, critical illness, shock, and end organ damage.
The first signs of ARDS typically present within 24 to 48 hours of the precipitating illness or injury and progress over the course of 1 to 2 weeks. The early clinical features of ARDS include:
- Hypoxemia (a declining peripheral blood oxygen saturation [SpO2] on pulse oximetry or a declining partial pressure of oxygen (PaO2) on arterial blood gas analysis) requiring high concentrations of supplemental oxygen (i.e., a higher fraction of inspired oxygen (FIO2)) or positive pressure ventilation (i.e., a higher continuous positive airway pressure (CPAP) or a higher positive end-expiratory pressure (PEEP)) in order to maintain acceptable blood oxygenation
- Tachypnea
- Dyspnea
- Tachycardia
- Signs that suggest worsening of the underlying illness
Physical Examination
Vitals
The presence of the following signs of shock or infection on physical examination are highly suggestive of ARDS:
- Temperature (Temp, T): Hyperpyrexia ≥ 38°C or 100.4°F) or low temperature < 36°C or 96.8°F
- Blood pressure (BP): inappropriately low, with a low mean arterial pressure (MAP)
- Heart rate (HR): rapid (tachycardia > 100 beats/minute), normal, or slow (bradycardia < 60 beats/minute)
- Respiratory rate (RR): Tachypnea > 20 breaths/minute or bradypnea < 12 breaths/minute
- Peripheral capillary oxygen saturation (SpO2): low (< 90% on ambient air or a fraction of inspired oxygen, (FIO2) of 21% at sea level)
Physical Examination
The physical exam findings of a patient with ARDS vary according to the underlying cause, however, some commonly observed findings include:
- Respiratory distress
- Cyanosis due to poor oxygenation or pallor due to poor perfusion
- Tachycardia or bradycardia on heart auscultation
- Coarse breath sounds, rhonchi, crackles, or decreased breath sounds on lung auscultation
- Cool extremities or reduced peripheral pulses due to poor perfusion