Bronchiolitis physical examination: Difference between revisions
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===Lung=== | ===Lung=== | ||
Rapid changes in respiratory signs are characteristic of bronchiolitis. | * Rapid changes in respiratory signs are characteristic of bronchiolitis. | ||
====Inspection==== | ====Inspection==== | ||
*Chest retractions: | *Chest retractions: | ||
:*Intercostal retractions | :*[[Intercostal]] [[Retraction|retractions]] | ||
:*Substernal retractions | :*Substernal retractions | ||
*Nasal flaring in infants | *[[Nasal]] flaring in infants | ||
====Auscultation==== | ====Auscultation==== | ||
*[[Wheezing]] | *[[Wheezing]] | ||
*[[Rales]] ( | *[[Rales]] (crackles) | ||
*Decreasing [[respiratory sounds]] may indicate a progression in the airway obstruction which may evolve to [[respiratory failure]].<ref name="pmid14757603">{{cite journal| author=Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L et al.| title=Diagnosis and testing in bronchiolitis: a systematic review. | journal=Arch Pediatr Adolesc Med | year= 2004 | volume= 158 | issue= 2 | pages= 119-26 | pmid=14757603 | doi=10.1001/archpedi.158.2.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14757603 }} </ref> | *Decreasing [[respiratory sounds]] may indicate a progression in the [[airway obstruction]] which may evolve to [[respiratory failure]].<ref name="pmid14757603">{{cite journal| author=Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L et al.| title=Diagnosis and testing in bronchiolitis: a systematic review. | journal=Arch Pediatr Adolesc Med | year= 2004 | volume= 158 | issue= 2 | pages= 119-26 | pmid=14757603 | doi=10.1001/archpedi.158.2.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14757603 }} </ref> | ||
The association between [[cyanosis]] and [[rales]] has been shown as a predictor of severity.<ref name="pmid1971330">{{cite journal| author=Mulholland EK, Olinsky A, Shann FA| title=Clinical findings and severity of acute bronchiolitis. | journal=Lancet | year= 1990 | volume= 335 | issue= 8700 | pages= 1259-61 | pmid=1971330 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1971330 }} </ref><ref name="pmid16859512">{{cite journal| author=Eisenhut M| title=Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. | journal=Crit Care | year= 2006 | volume= 10 | issue= 4 | pages= R107 | pmid=16859512 | doi=10.1186/cc4984 | pmc=1751022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16859512 }} </ref> | The association between [[cyanosis]] and [[rales]] has been shown as a predictor of severity.<ref name="pmid1971330">{{cite journal| author=Mulholland EK, Olinsky A, Shann FA| title=Clinical findings and severity of acute bronchiolitis. | journal=Lancet | year= 1990 | volume= 335 | issue= 8700 | pages= 1259-61 | pmid=1971330 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1971330 }} </ref><ref name="pmid16859512">{{cite journal| author=Eisenhut M| title=Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. | journal=Crit Care | year= 2006 | volume= 10 | issue= 4 | pages= R107 | pmid=16859512 | doi=10.1186/cc4984 | pmc=1751022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16859512 }} </ref> | ||
===Heart=== | ===Heart=== | ||
In rare cases of bronchiolitis, cardiovascular manifestations may be detected. These signs include:<ref name="pmid8021780">{{cite journal| author=Donnerstein RL, Berg RA, Shehab Z, Ovadia M| title=Complex atrial tachycardias and respiratory syncytial virus infections in infants. | journal=J Pediatr | year= 1994 | volume= 125 | issue= 1 | pages= 23-8 | pmid=8021780 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8021780 }} </ref><ref name="pmid16859512">{{cite journal| author=Eisenhut M| title=Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. | journal=Crit Care | year= 2006 | volume= 10 | issue= 4 | pages= R107 | pmid=16859512 | doi=10.1186/cc4984 | pmc=1751022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16859512 }} </ref> | In rare cases of bronchiolitis, [[cardiovascular]] manifestations may be detected. These signs include:<ref name="pmid8021780">{{cite journal| author=Donnerstein RL, Berg RA, Shehab Z, Ovadia M| title=Complex atrial tachycardias and respiratory syncytial virus infections in infants. | journal=J Pediatr | year= 1994 | volume= 125 | issue= 1 | pages= 23-8 | pmid=8021780 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8021780 }} </ref><ref name="pmid16859512">{{cite journal| author=Eisenhut M| title=Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. | journal=Crit Care | year= 2006 | volume= 10 | issue= 4 | pages= R107 | pmid=16859512 | doi=10.1186/cc4984 | pmc=1751022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16859512 }} </ref> | ||
*[[Atrial tachycardia]] | *[[Atrial tachycardia]] | ||
*[[Second degree heart block]] | *[[Second degree heart block]] | ||
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===Neuromuscular=== | ===Neuromuscular=== | ||
Neurological manifestations can | Neurological manifestations can also occur in cases of [[RSV]] bronchiolitis. These signs include: | ||
*[[Seizures]] | *[[Seizures]] | ||
*Central [[apnea]] | *Central [[apnea]] | ||
Revision as of 15:05, 31 July 2017
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Bronchiolitis physical examination On the Web |
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Risk calculators and risk factors for Bronchiolitis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]Ahmed Elsaiey, MBBCH [3]
Overview
Patients infected with bronchiolitis have a toxic appearance and may be cyanotic. Fever is one of the signs of the disease but the lack of it does not exclude the diagnosis. Lung examination shows abnormalities in inspection and auscultation. On inspection, intercostal and substernal retractions can be observed. On auscultation, wheezing and crackles can be clearly heard with a decrease in the respiratory sounds. Extrapulmonary manifestations can occur as well like pharyngitis, conjunctivitis, arrhythmias, tachycardia, and seizures.
Physical Examination
General appearance
- Ill or toxic appearance
- Cyanosis
Vitals
- Fever may or may not be present at the moment of the examination. The lack of fever does not exclude bronchiolitis.
Skin
- Cyanosis may be associated with bronchiolitis.
HEENT
In some cases of bronchiolitis the following may be observed:[1]
Lung
- Rapid changes in respiratory signs are characteristic of bronchiolitis.
Inspection
- Chest retractions:
- Intercostal retractions
- Substernal retractions
- Nasal flaring in infants
Auscultation
- Wheezing
- Rales (crackles)
- Decreasing respiratory sounds may indicate a progression in the airway obstruction which may evolve to respiratory failure.[2]
The association between cyanosis and rales has been shown as a predictor of severity.[3][4]
Heart
In rare cases of bronchiolitis, cardiovascular manifestations may be detected. These signs include:[5][4]
Neuromuscular
Neurological manifestations can also occur in cases of RSV bronchiolitis. These signs include:
References
- ↑ Andrade MA, Hoberman A, Glustein J, Paradise JL, Wald ER (1998). "Acute otitis media in children with bronchiolitis". Pediatrics. 101 (4 Pt 1): 617–9. PMID 9521943.
- ↑ Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L; et al. (2004). "Diagnosis and testing in bronchiolitis: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 119–26. doi:10.1001/archpedi.158.2.119. PMID 14757603.
- ↑ Mulholland EK, Olinsky A, Shann FA (1990). "Clinical findings and severity of acute bronchiolitis". Lancet. 335 (8700): 1259–61. PMID 1971330.
- ↑ 4.0 4.1 Eisenhut M (2006). "Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review". Crit Care. 10 (4): R107. doi:10.1186/cc4984. PMC 1751022. PMID 16859512.
- ↑ Donnerstein RL, Berg RA, Shehab Z, Ovadia M (1994). "Complex atrial tachycardias and respiratory syncytial virus infections in infants". J Pediatr. 125 (1): 23–8. PMID 8021780.