Acute respiratory distress syndrome physical examination

Acute respiratory distress syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Acute respiratory distress syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic study of choice
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Mechanical Ventilation Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Acute respiratory distress syndrome physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute respiratory distress syndrome physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute respiratory distress syndrome physical examination
CDC on Acute respiratory distress syndrome physical examination
Acute respiratory distress syndrome physical examination in the news
Blogs on Acute respiratory distress syndrome physical examination
Directions to Hospitals Treating Acute respiratory distress syndrome
Risk calculators and risk factors for Acute respiratory distress syndrome physical examination

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 pathognomonic physical exam findings of ARDS. The most notable physical exam findings include respiratory distress as well as findings indicative of the underlying illness, injury, 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

Vital Signs

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)

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

References

Template:WikiDoc Sources