Disseminated intravascular coagulation physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common physical examination findings of [[DIC]] include signs of spontaneous and life-threatening [[hemorrhage]], signs of subacute [[bleeding]], signs of diffuse or localized [[thrombosis]], [[bleeding]] into [[serous]] cavities, nonspecific altered [[consciousness]] or [[stupor]], transient focal [[Neurological|neurologic]] deficits, [[hypotension]], [[tachycardia]], circulatory collapse, [[pleural friction rub]], signs of [[acute respiratory distress syndrome]] (ARDS), [[hematemesis]], [[hematochezia]], signs of [[azotemia]] and [[renal failure]], [[acidosis]], [[hematuria]], [[oliguria]], [[metrorrhagia]] and [[uterine hemorrhage]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with [[DIC]] is usually remarkable for the following:<ref name="pmid29021432">{{cite journal |vauthors=Miyashima Y, Iwamuro M, Shibata M, Miyabe Y, Kawai Y, Kaihara M, Mitogawa T, Harada M |title=Prediction of Disseminated Intravascular Coagulation by Liver Function Tests in Patients with Japanese Spotted Fever |journal=Intern. Med. |volume=57 |issue=2 |pages=197–202 |date=January 2018 |pmid=29021432 |pmc=5820036 |doi=10.2169/internalmedicine.8420-16 |url=}}</ref><ref name="pmid30198317">{{cite journal |vauthors=Iba T, Arakawa M, Ohchi Y, Arai T, Sato K, Wada H, Levy JH |title=Prediction of Early Death in Patients With Sepsis-Associated Coagulation Disorder Treated With Antithrombin Supplementation |journal=Clin. Appl. Thromb. Hemost. |volume= |issue= |pages=1076029618797474 |date=September 2018 |pmid=30198317 |doi=10.1177/1076029618797474 |url=}}</ref><ref name="pmid30189766">{{cite journal |vauthors=Kilicci C, Ozkaya E, Karakus R, Sanverdi I, Abide Yayla C, Bostanci Ergen E, Mutlu S |title=Early low molecular weight heparin for postpartum hemorrhage in women with pre-eclampsia. Is it effective to prevent consumptive coagulopathy? |journal=J. Matern. Fetal. Neonatal. Med. |volume= |issue= |pages=1–5 |date=September 2018 |pmid=30189766 |doi=10.1080/14767058.2018.1494708 |url=}}</ref><ref name="pmid30185500">{{cite journal |vauthors=McBride AM |title=Clinical Presentation and Treatment of Amniotic Fluid Embolism |journal=AACN Adv Crit Care |volume=29 |issue=3 |pages=336–342 |date=2018 |pmid=30185500 |doi=10.4037/aacnacc2018419 |url=}}</ref><ref name="pmid30184540">{{cite journal |vauthors=Judkins AJ, MacQueen BC, Christensen RD, Henry E, Snow GL, Bennett ST |title=Automated Quantification of Fragmented Red Blood Cells: Neonatal Reference Intervals and Clinical Disorders of Neonatal Intensive Care Unit Patients with High Values |journal=Neonatology |volume=115 |issue=1 |pages=5–12 |date=September 2018 |pmid=30184540 |doi=10.1159/000491626 |url=}}</ref>
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
 
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
=== Hemtological: ===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Signs of spontaneous and life-threatening [[hemorrhage]]
OR
* Signs of subacute [[bleeding]]
*Chest tenderness upon palpation
* Signs of diffuse or localized [[thrombosis]]
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* Bleeding into [[serous]] cavities
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
=== Nervous: ===
* Abdominal examination of patients with [disease name] is usually normal.
* Nonspecific altered [[consciousness]] or [[stupor]]
OR
* Transient focal [[Neurological|neurologic]] deficits
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
=== Cardiovascular: ===
* Back examination of patients with [disease name] is usually normal.
* [[Hypotension]]
OR
* [[Tachycardia]]
*Point tenderness over __ vertebrae (e.g. L3-L4)
* [[Circulatory]] collapse
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
=== Respiratory: ===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Pleural friction rub]]
OR
* Signs of [[acute respiratory distress syndrome]] (ARDS)
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
=== Gastrointestinal: ===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Hematemesis]]
OR
* [[Hematochezia]]
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
=== Genitourinary: ===
* Extremities examination of patients with [disease name] is usually normal.
* Signs of [[azotemia]] and [[renal failure]]
OR
* [[Acidosis]]
*[[Clubbing]]  
* [[Hematuria]]
*[[Cyanosis]]  
* [[Oliguria]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
* [[Metrorrhagia]]
*Muscle atrophy
* [[Uterine hemorrhage]]
*Fasciculations in the upper/lower extremity


=== Skin: ===
* [[Petechiae]]
* [[Jaundice]] (liver dysfunction or hemolysis)
* [[Purpura]]
* [[Hemorrhagic]] bullae
* Acral [[cyanosis]]
* Skin [[necrosis]] of lower limbs ([[purpura fulminans]])
* Localized [[infarction]] and [[gangrene]]
* Wound [[bleeding]] and deep subcutaneous hematomas
* [[Thrombosis]]


==References==
==References==

Latest revision as of 16:22, 19 September 2018

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

Overview

Common physical examination findings of DIC include signs of spontaneous and life-threatening hemorrhage, signs of subacute bleeding, signs of diffuse or localized thrombosis, bleeding into serous cavities, nonspecific altered consciousness or stupor, transient focal neurologic deficits, hypotension, tachycardia, circulatory collapse, pleural friction rub, signs of acute respiratory distress syndrome (ARDS), hematemesis, hematochezia, signs of azotemia and renal failure, acidosis, hematuria, oliguria, metrorrhagia and uterine hemorrhage.

Physical Examination

Physical examination of patients with DIC is usually remarkable for the following:[1][2][3][4][5]

Hemtological:

Nervous:

Cardiovascular:

Respiratory:

Gastrointestinal:

Genitourinary:

Skin:

References

  1. ↑ Miyashima Y, Iwamuro M, Shibata M, Miyabe Y, Kawai Y, Kaihara M, Mitogawa T, Harada M (January 2018). "Prediction of Disseminated Intravascular Coagulation by Liver Function Tests in Patients with Japanese Spotted Fever". Intern. Med. 57 (2): 197–202. doi:10.2169/internalmedicine.8420-16. PMC 5820036. PMID 29021432.
  2. ↑ Iba T, Arakawa M, Ohchi Y, Arai T, Sato K, Wada H, Levy JH (September 2018). "Prediction of Early Death in Patients With Sepsis-Associated Coagulation Disorder Treated With Antithrombin Supplementation". Clin. Appl. Thromb. Hemost.: 1076029618797474. doi:10.1177/1076029618797474. PMID 30198317.
  3. ↑ Kilicci C, Ozkaya E, Karakus R, Sanverdi I, Abide Yayla C, Bostanci Ergen E, Mutlu S (September 2018). "Early low molecular weight heparin for postpartum hemorrhage in women with pre-eclampsia. Is it effective to prevent consumptive coagulopathy?". J. Matern. Fetal. Neonatal. Med.: 1–5. doi:10.1080/14767058.2018.1494708. PMID 30189766.
  4. ↑ McBride AM (2018). "Clinical Presentation and Treatment of Amniotic Fluid Embolism". AACN Adv Crit Care. 29 (3): 336–342. doi:10.4037/aacnacc2018419. PMID 30185500.
  5. ↑ Judkins AJ, MacQueen BC, Christensen RD, Henry E, Snow GL, Bennett ST (September 2018). "Automated Quantification of Fragmented Red Blood Cells: Neonatal Reference Intervals and Clinical Disorders of Neonatal Intensive Care Unit Patients with High Values". Neonatology. 115 (1): 5–12. doi:10.1159/000491626. PMID 30184540.


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