Pneumonia physical examination

Pneumonia Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Pneumonia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Diagnostic Algorithm
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
Other Imaging Findings
Treatment
Medical Therapy
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pneumonia physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Pneumonia 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 Pneumonia physical examination
CDC onPneumonia physical examination
Pneumonia physical examination in the news
Blogs on Pneumonia physical examination
Directions to Hospitals Treating Pneumonia
Risk calculators and risk factors for Pneumonia physical examination

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]

Overview

Persons with symptoms of pneumonia need medical evaluation. 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.

Listening to the lungs with a stethoscope (auscultation) can reveal several things. 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). The physical examination, though not very sensitive and specific in diagnosis of community acquired pneumonia, helps in determining the severity of illness and ruling out other differentials. Vital signs are useful in determining the severity of illness and have predictive values. However, a high degree of suspicion should be kept in elderly as the presentation could be subtle in them.

Physical examination

Vital signs

• Decreased oxygen saturation
• Fever
• Hypotension < 90 mm Hg
• Tachycardia > 125 beats/min
• Tachypnea

Palpation

• Increased tactile fremitus

Percussion

• Dullness on percussion

Auscultation

• Decreased breath sounds
• Bronchial breath sounds
• Rhonchi
• Crackles, Rales
• Increased volume of whispered (vocal fremitus).

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.:

• 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%