Pulmonary edema physical examination: Difference between revisions
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* [[Cool extremities|cold and clammy]] | * [[Cool extremities|cold and clammy]] | ||
* [[livedo reticularis]] | * [[livedo reticularis]] | ||
* Peripheral [[cyanosis]] may be present | |||
===HEENT=== | ===HEENT=== | ||
*Nasal flaring | *Nasal flaring | ||
* | *Dilated alae nasi | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with pulmonary edema is usually normal. | |||
===Lungs=== | ===Lungs=== | ||
* | * [[Wheezing]] may be present | ||
* Prolonged expiratory phase | |||
* Retraction of [[intercostal muscle]] | |||
* Use of [[accessory muscles of respiration]] | |||
===Heart=== | ===Heart=== | ||
*A [[third heart sound]] ([[S3]]) may be present | *A [[third heart sound]] ([[S3]]) may be present | ||
*[[Pulsus alternans]] | |||
*Alternating weak and strong pulse, may be a sign of [[left ventricular failure]] in [[CHF]] as underlying cause of cardiogenic pulmonary edema | |||
*Heart sounds with presence of [[S3]], [[S4]], and harsh [[murmur]] | |||
*[[JVD]] | |||
===Abdomen=== | ===Abdomen=== | ||
* Abdomen examination of patients with pulmonary edema is usually normal. | |||
===Back=== | ===Back=== | ||
* Back examination of patients with pulmonary edema is usually normal. | |||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with pulmonary edema is usually normal. | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neurologic examination may reveal focal signs as neurogenic causes of pulmonary edema | |||
===Extremities=== | ===Extremities=== | ||
Peripheral edema of extremities | |||
==References== | ==References== | ||
Revision as of 19:56, 22 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
Overview
Physical Examination
Physical examination of patients with pulmonary edema is usually remarkable for:[1]
| Clinical examination | |||||
|---|---|---|---|---|---|
| Cardiogenic pulmonary edema | Low flow state=cool periphery | S3 gallop/cardiomegaly | Jugular venous distention | Crackles(wet) | |
| Noncardiogenic pulmonary edema | High flow state=warm periphery | No gallop | No jugular venous distention | Crackles(dry) |
Appearance of the Patient
- Patients with pulmonary edema usually appear :
- Anxious
- Decrease in level of alertness (consciousness)
- Inability to speak in full sentences
Vital Signs
- Hyperthermia may be present
- Tachycardia with regular pulse
- Tachypnea
- High/low blood pressure with normal pulse pressure
Skin
- Pallor
- cold and clammy
- livedo reticularis
- Peripheral cyanosis may be present
HEENT
- Nasal flaring
- Dilated alae nasi
Neck
- Neck examination of patients with pulmonary edema is usually normal.
Lungs
- Wheezing may be present
- Prolonged expiratory phase
- Retraction of intercostal muscle
- Use of accessory muscles of respiration
Heart
- A third heart sound (S3) may be present
- Pulsus alternans
- Alternating weak and strong pulse, may be a sign of left ventricular failure in CHF as underlying cause of cardiogenic pulmonary edema
- Heart sounds with presence of S3, S4, and harsh murmur
- JVD
Abdomen
- Abdomen examination of patients with pulmonary edema is usually normal.
Back
- Back examination of patients with pulmonary edema is usually normal.
Genitourinary
- Genitourinary examination of patients with pulmonary edema is usually normal.
Neuromuscular
- Neurologic examination may reveal focal signs as neurogenic causes of pulmonary edema
Extremities
Peripheral edema of extremities
References
- ↑ Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.