Community-acquired pneumonia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
[[Physical examination]] by a health care provider may reveal [[fever]] or sometimes [[hypothermia|low body temperature]], an [[tachypnea|increased respiratory rate]], [[hypotension|low blood pressure]], a [[tachycardia|fast heart rate]], or a low [[oxygen saturation]], which is the amount of oxygen in the blood as indicated by either [[pulse oximetry]] or [[arterial blood gas|blood gas analysis]]. People who are struggling to breathe, who are confused, or who have [[cyanosis]] (blue-tinged skin) require immediate attention. A lack of normal breath sounds, the presence of crackling sounds ([[rales]]), or increased loudness of whispered speech (whispered pectoriloquy) can identify areas of the lung that are stiff and full of fluid, called "consolidation." The examiner may also feel the way the chest expands ([[palpation]]) and tap the chest wall ([[Percussion (medicine)|percussion]]) to further localize consolidation. The examiner may also palpate for increased vibration of the chest when speaking (tactile fremitus).<ref name=metlay>Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. ''JAMA'' 1997; 278:1440. PMID 9356004</ref> | |||
==Physical Examination== | ==Physical Examination== | ||
Revision as of 20:30, 11 December 2014
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Community-Acquired Pneumonia Microchapters |
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Differentiating Community-acquired pneumonia from other Diseases |
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Diagnosis |
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Community-acquired pneumonia physical examination On the Web |
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Community-acquired pneumonia physical examination in the news |
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Directions to Hospitals Treating Community-acquired pneumonia |
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Risk calculators and risk factors for Community-acquired pneumonia physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]
Overview
Physical examination by a health care provider may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. People who are struggling to breathe, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention. A lack of normal breath sounds, the presence of crackling sounds (rales), or increased loudness of whispered speech (whispered pectoriloquy) can identify areas of the lung that are stiff and full of fluid, called "consolidation." The examiner may also feel the way the chest expands (palpation) and tap the chest wall (percussion) to further localize consolidation. The examiner may also palpate for increased vibration of the chest when speaking (tactile fremitus).[1]
Physical Examination
Vital Signs
- 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 volume of whispered (vocal fremitus).[3]
Combining Findings
One study created a prediction rule that found the five following signs best predicted infiltrates on the chest radiograph of 1134 patients presenting to an emergency room.[2]:
- Temperature > 37.8 degrees Celsius (100 degrees F)
- Pulse > 100 beats/min
- Crackles
- Decreased breath sounds
- Absence of asthma
The probability of an infiltrate in two separate validations was based on the number of findings:
- 5 findings - 84% to 91% probability
- 4 findings - 58% to 85%
- 3 findings - 35% to 51%
- 2 findings - 14% to 24%
- 1 findings - 5% to 9%
- 0 findings - 2% to 3%
References
- ↑ Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997; 278:1440. PMID 9356004
- ↑ Heckerling PS, Tape TG, Wigton RS; et al. (1990). "Clinical prediction rule for pulmonary infiltrates". Ann. Intern. Med. 113 (9): 664–70. PMID 2221647.