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.
Vital Signs
Skin
- Skin usually appears blue in patients with cyanosis.
- It is very difficult to find 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, lower palpebral conjunctiva and sites of peripheral cyanosis.
- Sites to look for peripheral cyanosis: Nose tip, ear lobules, outer aspect of lips, fingertips, nail bed, extremities.
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).
- Tachycardia/ Bradycardia
| 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.