Download Cyanosis

The Clinical Respiratory Signs
Dr Mazen Qusaibaty
MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of
Syrian
health – Email: [email protected]
1
Interrogatory
Physical
Examination
Diagnosis
Complementary
Examination
2
Familial
Antecedents
Personnel
Diagnosis
Interrogatory
Main
Symptoms
Secondary
3
Diagnosis
Vital
Physical
Examination
Signs
Main
4
Laboratory
Diagnosis
Complementary
Examination
Radiology
Procedures
5
Familial
Antecedents
Personnel
Interrogatory
Main
Symptoms
Secondary
Diagnosis
Vital
Physical
examination
Signs
Main
Laboratory
Complementary
examination
Radiology
Procedures
6
Diagnosis
Vital
Physical
Examination
Signs
Main
7
8
Inspection
Observe the patient from the end
of the bed
9
10
Nor mal Br ea thing
• The r espira tor y ra te is about 1420 per min in nor mal adults
• Up to 44 per min in infants
11
Rapid superficial br ea thing
(Tachypnea)
• The causes:
Restrictive lung disease
Pleuritic chest pain
An eleva ted diaphragm
Rapid Deep Breathing (Hyperpnea,
Hyperventilation)
• The causes:
 Exercise
 Anxiety
 Metabolic
Acidosis
12
Rapid Deep Breathing (Hyperpnea,
Hyperventilation)
• In the
comatose
patient
 Infarction
 Hypoxia
 Hypoglycemia
affecting the
midbrain or
pons.
13
14
Kussmaul Breathing
• Deep breathing due to
Metabolic Acidosis.
It may be:
• Normal
• Fast rate
• Slow rate
15
Slow Br ea thing (Bradypnea)
• The causes:
 Dia betic coma
 Drug-induced respir a tor y depression
 Increased intr acr anial pressure
16
Cheyne - Stokes Br ea thing
• Periods of deep br ea thing
alterna te with periods of apnea
(no br ea thing)
17
Cheyne - Stokes Br ea thing
• Childr en and a ging people
nor mally may show this pa ttern
in sleep
18
Cheyne - Stokes Br ea thing
• Other causes include
 Hear t f ailure
 Uremia
 Drug-induced respir a tor y depression
 Br ain damage
19
Ataxic Br ea thing ( Biot`s br ea thing)
• Is characterized by unpr edictable
ir r e gularity.
• Br ea ths may be shallow or deep,
and stop for shor t periods.
• Causes include
 Respir a tor y depression
 Br ain damage, typically a t the
medullar y level.
20
Signs And Symptoms Of Respiratory
Distress
Inspect the patient's hands
21
Patient's Hands
22
Clubbing
23
• The exact mechanism of clubbing
is unclear
Megakaryocyte
Platelets
PDGF (platelet-derived
growth factor + VEGF (Vascular
Endothelial Growth Factor (
25
Thoracic
Bronchial
cancer
usually not
small cell
cancer
26
Thoracic
Chronic lung
suppuration
27
Empyema, abscess
Bronchiectasis
Cystic fibrosis
Thoracic
Fibrosing alveolitis
Mesothelioma
TB
28
Thoracic
Bronchial cancer usually not small cell cancer
Chronic lung
suppuration
Fibrosing alveolitis
Mesothelioma
TB
29
Empyema, abscess
Bronchiectasis
Cystic fibrosis
Cardiovascular:
Cyanotic congenital heart
disease
Endocarditis
Atrial myxoma
Aneurysms
Infected grafts
30
GI
Inflammatory bowel
disease (especially Crohn’s)
Cirrhosis
GI Lymphoma
Malabsorption
31
Rare
Familial
Thyroid acropachy
32
33
34
35
Cyanosis
36
37
• Is the abnor mal
Blue
Discoloration of the skin and
mucous membranes
 Increasing in the deoxygena ted
haemoglobin level to a bove 5 g/dL
Cyanosis
Central
Peripheral
38
39
• Any sever e r espira tor y disease
1. Pulmonar y oedema
2. Pulmonar y embolism
3. Decreased PO 2 of inspired air
(eg high altitude )
4. Severe pneumonia
40
5. COPD
6. Acute severe asthma,
7. Acute adult respir a tor y distress
syndr ome
41
Cyanotic congenital hear t disease
Eisenmenger's syndrome
Pulmonar y ar teriovenous fistluas .
Central Cyanosis
Abnormal Haemoglobins
Do not allow adequate oxygen uptake
Central cyanosis in adults
42
43
Methaemoglobinaemia
Central Cyanosis
Genetic
Quinones
Associated with
certain drugs
Primaquine
Sulfonamides
44
• Polycythaemia rubra vera
• Any other cause of
polycythaemia
Causes of Peripheral Cyanosis
45
• All causes of Central Cyanosis
 cause Peripheral Cyanosis
46
47
• Reduced cardiac output:
Hear t failure
Shock
48
• Peripheral vascular disease:
 Thr ombosis + - Embolism
 Ather oma
49
Causes of peripheral cyanosis
• Vasoconstriction:
 Cold exposure
 Raynaud's
phenomenon.
 Betablocker
drugs
• Vasoconstriction
 Acrocyanosis : benign, caused by
spasm of smaller skin arteries and
arterioles, causing hands and feet
to be cold and mottled .
Peripheral Cyanosis
50
51
Peripheral Cyanosis
• Venous obstruction:
Peripheral
Cyanosis
 Lower limb deep vein
thrombosis can occasionally
produce a painful blue leg
(phlegmasia cerulea dolens ).
52
53
Peripheral
Cyanosis
54
Palpation
Palpate the trachea
55
Pneumothorax / Pleural effusion
56
57
Palpation of the nodes
58
Some causes of generalized lymphadenopathy
Hematological malignancies (e.g., lymphoma,
acute, and chronic lymphatic leukemia)
Some causes of generalized lymphadenopathy
Infections
Viral (e.g., HIV, infectious mononucleosis,
cytomegalovirus [CMV])
Bacterial (e.g., tuberculosis, syphilis, brucellosis)
Some causes of generalized lymphadenopathy
Infiltrative diseases (e.g., sarcoidosis, amyloidosis)
Autoimmune diseases (e.g., systemic lupus
erythematosus [SLE], rheumatoid arthritis)
Drugs (e.g., phenytoin causes a pseudolymphoma)
Some causes of generalized lymphadenopathy
Hematological malignancies (e.g., lymphoma,
acute, and chronic lymphatic leukemia)
Infections
Viral (e.g., HIV, infectious mononucleosis,
cytomegalovirus [CMV])
Bacterial (e.g., tuberculosis, syphilis, brucellosis)
Infiltrative diseases (e.g., sarcoidosis, amyloidosis)
Autoimmune diseases (e.g., systemic lupus
erythematosus [SLE], rheumatoid arthritis)
Drugs (e.g., phenytoin causes a pseudolymphoma)
Percussion
64
Percuss the lung fields
65
66
• Nor mal lung sounds r esonant
67
68
• Dullness:
 Heard over areas of  density
• Consolidation
• Collapse
• A l ve o l a r f l u i d
• Pleural thickening
• Pe r i p h e r a l a b s c e s s
• Neoplasm
69
Auscultation
70
Auscultation
71
Adventitious Lung Sounds
• Discontinuous Sounds
 Crackles:
• Pneumonia
• CHF
• ARDS
• Fibrosis
72
Adventitious Lung Sounds
• Continuous Sounds
 Wheezes
 Rhonchi
73
WHEEZING
74
Wheezing
• Wheezing is a high-pitched
whistling sound made while
breathing.
 Most commonly wheezing occurs
during breathing out (expiration )
 But it can sometimes be related to
breathing in (inspiration )
http://www.mayoclinic.org/symptoms/wheezing/basics/causes/sym-20050764
76
Causes
http://www.mayoclinic.org/symptoms/wheezing/basics/causes/sym-20050764
• The narrowing of the airways can
be caused by:
 Inflammation (Asthma or COPD)
 Infection (Viruses , atypical
bacteria)
 Physical obstruction:
• A tumor
• Fo re i g n o b j e c t t h at ' s b e e n i n h a l e d
http://www.mayoclinic.org/symptoms/wheezing/basics/causes/sym-20050764
The most common cause of
recurrent wheezing is Asthma
79
• Possible causes of wheezing
include:
 Post Nasal drip
 Epiglottitis
 Bronchitis
 Bronchiolitis (especially in young
children) (RSV)
 Bronchitis
 Pneumonia
80
• Possible causes of wheezing
include:
 Smoking
 COPD
 Emphysema
 Sleep apnea, obstructive
81
• Possible causes of wheezing
include:
 Medications (particularly aspirin)
 Childhood asthma
82
• Possible causes of wheezing
include:
 Anaphylaxis
 Bronchiectasis
83
• Possible causes of wheezing
include:
 Foreign object inhaled
 GERD — Gastroesophageal reflux
disease
 Heart failure
 Lung cancer
84
• Possible causes of wheezing
include:
 Vocal cord dysfunction ( a c o n d i t i o n
t h at a f fe c t s vo c a l c o rd m ove m e nt )
85
Familial
Antecedents
Personnel
Interrogatory
Main
Symptoms
Secondary
Diagnosis
Vital
Physical
examination
Signs
Main
Laboratory
Complementary
examination
Radiology
Procedures