Respiratory failure physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with respiratory failure usually appear distressed with altered mental status. Physical examination of patients with respiratory failure is usually remarkable for dyspnea, stridor, and tachypnea.

Physical Examination

Physical examination of patients with respiratory failure is as follows:^[1]^[2]

Appearance of the Patient

Patients with respiratory failure usually appear distressed with altered mental status

Vital Signs

Skin

Cyanosis
Bruises
- May be due to insult to the neck or thorax
Clubbing
Rashes
- May suggest atopy

HEENT

Evidence of trauma
Ophthalmoscopic exam may be abnormal with findings of papilledema
Flared nares
Nasal polyps
- May suggest atopy or aspirin-induced asthma

Neck

Bruises
Elevated jugular venous pulse

Lungs

Fine crackles upon auscultation of the lung bases bilaterally
Evidence of preexisting lung disease may also be present such as:
- Paradoxical thoraco-abdominal breathing
- Wheeze
  - Typically absent and secondary to severe airway obstruction, representing a silent chest
- Persistent scattered rhonchi
- Prolonged expiration
- Diffusely decreased breath sound
- Coarse crackles with inspiration

Neuromuscular

Altered mental status
Clonus
- May be present

Extremities

Cyanosis
Peripheral edema

References

↑ Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA (November 1999). “Interobserver variability in applying a radiographic definition for ARDS”. Chest. 116 (5): 1347–53. PMID 10559098.
↑ Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (July 1986). “Adult respiratory distress syndrome profiles by computed tomography”. J Thorac Imaging. 1 (3): 25–30. PMID 3298678.

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[pmid10559098-1] Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA (November 1999). “Interobserver variability in applying a radiographic definition for ARDS”. Chest. 116 (5): 1347–53. PMID 10559098.

[pmid3298678-2] Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (July 1986). “Adult respiratory distress syndrome profiles by computed tomography”. J Thorac Imaging. 1 (3): 25–30. PMID 3298678.

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