Hospital-acquired pneumonia physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2] Template:Ventilator-associated pneumonia

Overview

Physical examination is important in diagnosing hospital-acquired pneumonia, finding include fever, tachypnea, rhonchi, crackles and wheezes. For ventilator-associated pneumonia, a deterioration in ventilator parameters such as, tachypnea, decreased tidal volume, increased minute ventilation, or decreased oxygen saturation could be the first indicators of a new onset ventilator-associated pneumonia.

Physical Examination

Criteria for Tachypnea Age Breaths/min < 2 months > 60 2-12 months > 50 1- 5 years > 40 > 5 years > 20

Vitals

• 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 vocal fremitus