Pneumonia physical examination and management

Pneumonia physical examination and managementCreated OnMay 29, 2020Last Updated OnMay 29, 2020byadmin You are here: Main Clinical Examination Pneumonia physical examination and management < All Topics Table of Contents General examination: Vital signs Temperature of __ (febrile/afebrile) Pulse rate of tachycardia/bradycardia (rate,rhythm,volume) Respiratory rate of >30 breath/min if severe Blood pressure systolic ≤ 90mmHg, diastolic ≤ 60 mmHg (normotensive? Hypotensive if severe pneumonia) SpO2 <95 % Observation Assess the level of consciousness – Indicate the severity Note the build of the patient, thin build, muscle wasting may suggest malignancy (Mesothelioma(rare), secondary metastasis) or Tuberculosis Note whether patient can speak in words/ phrases/ sentences/ couldn’t speak Dyspnea, count respiratory rate Observe for any signs of distress Pleuritic chest pain Respiratory distress Diaphoresis Cyanosis Current oxygen therapy – Nasal prongs/ Simple face mask/ High flow mask/ Venturi mask, connected to oxygen (how many litre/min) Bedside Sputum culture container – suspected TB Waste bin to look for hemoptysis Chills and rigor (severe indicate sepsis) Extrapulmonary features: Myalgia, arthralgia, malaise Myocarditis and pericarditis Headache Abdominal pain and vomiting Face Central cyanosis Any facial puffiness? Jaundice – Liver pathology Temperature – Elevated in case of infection Eyes Pallor Jaundice Neck Look for lymphadenopathy Any increase in JVP Finger Peripheral cyanosis Warm peripheries Clubbing (TRO bronchiectasis, malignancy) Hand Pulse (Rate, rhythm) – Tachycardia Blood pressure Pulse oximetry Peripheral cyanosis/ Pallor Systemic examination: Right pulmonary consolidation (pneumonia) Inspection Decreased movement at the right side of chest Chest tube scar Look for BCG scar** Palpation Tracheal centrally located Apex normal Chest expansibility reduced Vocal fremitus increased Percussion Woody dullness Auscultation Bronchial breath sound at consolidation area Vocal resonance increases Coarse crepitation Pleural rub **ask patient to cough, if crepitation does not decrease, means it’s not heart failure** Assessment of severity of CAP: CURB-65   C: Confusion U: (plasma) urea > 7mmol/L R: Respiratory rate > 30/min 65 BP: ≤ 90mmHg (systolic), ≤ 60mmHg (diastolic) age > 65   1 point each Score: 1: Treat as outpatient 2: Admit to the hospital 3+: Often required ICU care    ** CURB – 65 need to be assessed in suspected pneumonia especially in primary care setting and used in management of CAP Investigation: All patients admitted to hospital must have a chest x-ray, blood tests and microbiological tests Chest x-ray Look for consolidation To identify lobar or bronchopneumonia To look for complications: parapneumonic effusion, intrapulmonary abscess or empyema Blood tests: FBC (neutrophilic leucocytosis in bacterial pneumonia) urea, electrolytes (classify for severity) biochemistry CRP Sputum culture and sensitivity Direct gram stain (gm +ve diplococci: S.pneumoniae) Ziehl Neelsen stain (TRO TB) blood culture frequently positive in pneumococcal pneumonia Pulse oximetry and ABG HIV ** if given consent   X-rays findings: Strep pneumoniae: Consolidation with air bronchograms, effusions and collapse due to retention of secretions can all be seen Mycoplasma: Usually one lobe is involved but infection can be bilateral and extensive Legionella: Lobar and multi-lobar shadowing, with occasional small pleural effusion. Cavitation is rare. PCP pneumonia: diffuse bilateral alveolar and interstitial shadowing beginning in the perihilar regions and spreading out in butterfly pattern Aspiration pneumonia: dense consolidation on the right lung. (aspirated content usually goes to the right lung) **refer to anatomy for the reason why right lung is more prone to it ** General management...

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