Pulmonary embolism physical examination
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Pulmonary Embolism Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Overview
The decision to do medical imaging is usually based on clinical grounds, i.e. the medical history, symptoms and findings on physical examination, followed by an assessment of clinical probability.
Appearance of the Patient
The patient may appear anxious because of difficulty in breathing. More severe cases may be associated with cyanosis (bluish discoloration, usually of lips and fingers).
Vital Signs
Temperature
Patient is generally afebrile.
Pulse
Rate
Tachycardia may be present
Rhythm
The pulse may be regular.
Strength
The pulse may be bounding and strong
Symmetry
The pulses may be symmetric.
Respiratory Rate
Tachypnea may be present.
- Lowered SpO2 level on room air.
Blood Pressure
The patient is generally hypotensive.
Without immediate intervention it might lead to shock or even collapse. About 15% of all cases of sudden death are attributable to PE.
Skin
Cyanosis may be present depending upon the severity of PE.
Neck
Patients with Submassive PE present with signs of RV dysfunctions, which are as follows:
- Distended neck veins.
Heart
Parasternal heave may be present.
Auscultation
- Prominent second heart sound (P2).
- Murmur of tricuspid regurgitation.
However, these signs have poor sensitivity.
Thorough assessment should be made for the presence of a deep vein thrombosis.