Cyanosis physical examination

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

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3]

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

• Physical examination of patients with [disease name] is usually normal.

OR

• Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
• The presence of [finding(s)] on physical examination is diagnostic of [disease name].
• The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

• Appearance of patients with cyanosis will vary depending to the underlying condition.
  • Lips, tongue, buccal mucosa, hands, and feet will appear blue in patients with cyanosis.

Vital Signs

• Fever
• Tachypnea
• Tachycardia
• Bradycardia
• Hypertension / hypotension

Skin

• Skin usually appears blue in patients with cyanosis.
  • It is very difficult to find bluish discoration in dark-skinned individuals and in poor lighting conditions.
• Sites to look for central cyanosis: Tongue, inner aspect of lips, gums, soft palate, buccal mucosa, and sites of peripheral cyanosis.
• Sites to look for peripheral cyanosis: Nose tip, ear lobules, outer aspect of lips, fingertips, nail bed, extremities.

HEENT

• Evidence of head trauma

Neck

• Jugular venous distension
• Hepatojugular reflex

Heart

• Cardiovascular examination of patients with cyanosis will show:
  • Tachycardia/ Bradycardia
    • Bradycardia is an ominous sign for imminent cardiovascular collapse.
    • Paradoxic pulse: Acute airway obstruction, Pulmonary embolism, cardiac tamponade, and asthma.
  • Auscultate for abnormal (loud, single or widely split S2) and additional heart sounds and murmurs (Grade, timing, location, radiation, intensity).

	S2	Murmur
TOF	single	systolic
Tricuspid atresia	single	with or with out systolic
Ebstein's anomaly	split	systolic
TGA	single	none
Truncus arteriosus	single	systolic murmur/ with or with out diastolic murmur
Pulmonary stenosis	single	systolic
Pulmonary atresia	single	systolic
TAPVC	split	systolic
HLHS	single	with or with out systolic
Tricuspid atresia	single	with or with out systolic

• Measure blood pressure in both upper and lower extremities

Lungs

• Tachypnea is seen in patients with respiratory and cardiac diseases presenting with cyanosis.
• Nasal flaring, grunting, intercostal and substernal retractions, and prolonged breathing may indicate respiratory distress.
• Traumatic injury involving chest wall or lung will show following abnormalities:
  • Chest wall movement abnormalities
  • Chest wound (eg, open or sucking)
  • Abrasions
  • Ecchymosis
  • Focal tenderness can be elicited on palpation over ribs, sternum, or scapula.
  • Deviation of Trachea
  • Subcutaneous air with crepitus
• Stridor, voice changes, suprasternal retractions, drooling and prolonged inspiration can be found in patients with upper airway obstruction.
• Wheezing, rales / crackles and assymmetric breath sounds will suggest Intrinsic lung diseases.
• Tactile fremitus:
  • Increased: Consolidation by pneumonia ,atelactasis
  • Decresed: Pleural effusion, pneumothorax
• Lung sounds may be clear on auscultation in patients with
  • Cyanotic congenital heart disease
  • Methemoglobinemia
  • Neurologic conditions associated with hypoventilation (eg, muscle weakness, coma, and seizures)
  • Pulmonary embolism

Extremities

• Clubbing is seen in some patients presenting with cyanosis.
  • Congenital heart diseases
  • Pulmonary diseases: COPD, bronchiectasis, cystic fibrosis, pulmonary fibrosis, pulmonary arteriovenous malformations.
• edema of lower extremities due to congestive heart failure and pulmonary embolism, pulmonary edema, pulmonary hypertension.

References

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