Pneumonia physical examination: Difference between revisions
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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. | 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 | ==Physical Examination== | ||
===Vital | ===Vital Signs=== | ||
* [[Decreased oxygen saturation]] | * [[Decreased oxygen saturation]] | ||
* [[Fever]] | * [[Fever]] | ||
| Line 16: | Line 16: | ||
* [[Tachycardia]] > 125 beats/min | * [[Tachycardia]] > 125 beats/min | ||
* [[Tachypnea]] | * [[Tachypnea]] | ||
===Lungs=== | |||
===Palpation=== | ====Palpation==== | ||
* Increased tactile fremitus | * Increased tactile fremitus | ||
===Percussion=== | ====Percussion==== | ||
* Dullness on percussion | * Dullness on percussion | ||
===Auscultation=== | ====Auscultation==== | ||
* Decreased breath sounds | * Decreased breath sounds | ||
* Bronchial breath sounds | * Bronchial breath sounds | ||
| Line 30: | Line 30: | ||
* Increased volume of whispered (vocal fremitus).{{ref|Metlay}} | * Increased volume of whispered (vocal fremitus).{{ref|Metlay}} | ||
===Combining | ====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.<ref name="pmid2221647">{{cite journal |author=Heckerling PS, Tape TG, Wigton RS, ''et al'' |title=Clinical prediction rule for pulmonary infiltrates |journal=Ann. Intern. Med. |volume=113 |issue=9 |pages=664-70 |year=1990 |pmid=2221647 |doi=}}</ref>: | 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.<ref name="pmid2221647">{{cite journal |author=Heckerling PS, Tape TG, Wigton RS, ''et al'' |title=Clinical prediction rule for pulmonary infiltrates |journal=Ann. Intern. Med. |volume=113 |issue=9 |pages=664-70 |year=1990 |pmid=2221647 |doi=}}</ref>: | ||
*Temperature > 37.8 degrees Celsius (100 degrees F) | *Temperature > 37.8 degrees Celsius (100 degrees F) | ||
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{{reflist|2}} | {{reflist|2}} | ||
[[Category: | [[Category:Pneumonia]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Pediatrics]] | |||
[[Category:Disease]] | |||
[[Category:primary care]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 15:58, 15 May 2013
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Pneumonia physical examination On the Web |
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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).[1] 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
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.