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==Physical Examination== | ==Physical Examination== | ||
Physical exam of a suspected or confirmed case of [[COVID-19|SARS CoV2]] patient should be conducted in a private room, preferably a negative pressure one. The examiner should have [[Personal protective equipment|PPE]] that includes gloves, gowns or aprons, masks, or respirators covering the mouth and nose, goggles, and face shields.<ref name="urlwww.cdc.gov">{{cite web |url=https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf |title=www.cdc.gov |format= |work= |accessdate=}}</ref> If possible and the patient is in no respiratory distress, [[patient]] should wear a surgical mask.<ref name="urlCoronavirus (COVID-19) frequently asked questions | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Basics |title=Coronavirus (COVID-19) frequently asked questions | CDC |format= |work= |accessdate=}}</ref> | Physical exam of a suspected or confirmed case of [[COVID-19|SARS CoV2]] patient should be conducted in a private room, preferably a negative pressure one. The examiner should have [[Personal protective equipment|PPE]] that includes gloves, gowns or aprons, masks, or respirators covering the mouth and nose, goggles, and face shields.<ref name="urlwww.cdc.gov">{{cite web |url=https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf |title=www.cdc.gov |format= |work= |accessdate=}}</ref> If possible and the patient is in no [[respiratory distress]], [[patient]] should wear a surgical mask.<ref name="urlCoronavirus (COVID-19) frequently asked questions | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Basics |title=Coronavirus (COVID-19) frequently asked questions | CDC |format= |work= |accessdate=}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*General appearance of the [[patient]] [[Infection|infected]] with coronavirus depends on the severity of the [[illness]] and the presence of infection associated complications involving different organ systems. | |||
* General appearance of the [[patient]] [[Infection|infected]] with coronavirus depends on the severity of the [[illness]]. | |||
*[[Patient|Patients]] with mild [[disease]] may appear healthy. | *[[Patient|Patients]] with mild [[disease]] may appear healthy. | ||
*[[Patient|Patients]] will appear [[Illness|sick]], [[lethargic]], and [[Dyspnea|short of breath]] in severe [[disease]]. | *[[Patient|Patients]] will appear [[Illness|sick]], [[lethargic]], and [[Dyspnea|short of breath]] in severe [[disease]]. | ||
*Patient may appear [[dehydrated]] (dry skin and [[mucosa]]) due to increased [[respiratory rate]], [[nausea]] and [[vomiting]], | |||
*[[Confusion]] can be due to severe [[dehydration]], [[electrolyte]] imbalances such as in [[COVID-19-associated acute kidney injury]], [[COVID-19-associated encephalitis]], [[COVID-19-associated meningitis]] or [[COVID-19-associated stroke]]. [[Glasgow coma scale]] can gauge the conscious state of the patient. | |||
*[[Anxiety]] is an important accompanying factor with most patients visiting hospitals, provided the heterogeneous nature of the disease. A healthy patient may worry about contracting the infection while visiting the hospital or doctor's office. | |||
=== Vital Signs === | === Vital Signs === | ||
*[[Heart rate]]: A healthy asymptomatic patient may have a normal heart rate but that does not rule out infection. | *[[Pulse]]: | ||
**[[Heart rate]]: A normal heart rate is between 60 and 100 bpm with a few exceptions such as athletes. A healthy asymptomatic patient may have a normal [[heart rate]] but that does not rule out infection. [[Sinus tachycardia]], the most common type of [[arrhythmia]] in [[COVID-19]] patients can be due to [[fever]], [[hypoxia]], [[shock]] due to [[sepsis]], and [[anxiety]]. Some pathologic causes of [[arrhythmias]] include [[Ventricular arrhythmias|ventricular tachyarrhythmia]]<ref name="pmid32219356">{{cite journal| author=Guo T, Fan Y, Chen M, Wu X, Zhang L, He T | display-authors=etal| title=Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). | journal=JAMA Cardiol | year= 2020 | volume= | issue= | pages= | pmid=32219356 | doi=10.1001/jamacardio.2020.1017 | pmc=7101506 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32219356 }} </ref>, [[atrial fibrillation]] (pulse rate 100 to 175 bpm) and [[atrial flutter]] (pulse rate 150 bpm). | |||
**Rhythm: [[Sinus tachycardia]] has a regular rhythm. An irregular pulse due to a few pathologic [[arrhythmia]]s can be due to [[atrial fibrillation]] and [[Ventricular arrhythmias|ventricular tachyarrhythmia]]. | |||
**Volume: A low volume pulse indicates [[dehydration]] and the potential need to [[rehydration]] therapy. | |||
**Character: A fast but weak pulse depicts [[shock]]. A raised, full and bounding pulse can be seen due to [[fever]] or simply patient [[anxiety]]. | |||
*[[Temperature]]:[[High fever]] (>100.4°F )<ref>{{Cite web|url=https://www.cdc.gov/sars/about/fs-SARS.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> | *[[Temperature]]:[[High fever]] (>100.4°F )<ref>{{Cite web|url=https://www.cdc.gov/sars/about/fs-SARS.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> | ||
*[[Respiratory rate]]: | *[[Respiratory rate]]: Normal [[respiratory rate]] in adults is 12 to 16 breaths per minute. [[Tachypnea]](> 30 breaths/min) in [[COVID-19] positive patient is the response to lung [[inflammation]] and can be found in [[COVID-19-associated pneumonia]] and [[ARDS]]. A [[respiratory rate]] of > 28-30 / min, or dyspnea, warrant the use of oxygen by of 40% [[venturi mask]]. [[Oxygen saturation]], [[respiratory rate]], [[CXR]] and importantly [[dyspnea]] help determine the need for invasive [[mechanical ventilation]].<ref name="Tobin2020">{{cite journal|last1=Tobin|first1=Martin J.|title=Basing Respiratory Management of COVID-19 on Physiological Principles|journal=American Journal of Respiratory and Critical Care Medicine|volume=201|issue=11|year=2020|pages=1319–1320|issn=1073-449X|doi=10.1164/rccm.202004-1076ED}}</ref> | ||
*[[Oxygen saturation]]: | *[[Oxygen saturation]]: SpO2 < 93-94% warrants the use of oxygen by of 40% [[venturi mask]] and marks severe disease. In younger individuals, the arterial [[oxygen saturation]] is more important than it appears. The deterioration of [[inflammatory]] lung injury is manifested by a decrease in oxygen saturation (< 93%) first, followed by [[dyspnea]] in younger individuals with no other comorbidities.<ref name="pmid32150360">{{cite journal |vauthors=Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R |title= |journal= |volume= |issue= |pages= |date= |pmid=32150360 |doi= |url=}}</ref> | ||
*[[Blood pressure]]: | *[[Blood pressure]]: Low [[blood pressure]] can be due to [[dehydration]], [[septic shock]], [[heart failure]] or pathologic [[arrhythmias]] associated with [[COVID-19]]. [[Hypertension]] is itself a risk for severe [[COVID-19]] infection.<ref name="urlPeople Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#serious-heart-conditions |title=People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC |format= |work= |accessdate=}}</ref> | ||
===Skin=== | ===Skin=== | ||
| Line 37: | Line 43: | ||
===HEENT=== | ===HEENT=== | ||
*Head examination: | *Head examination: Patients with Fluid retention, leading edema and swelling of face and extremities | ||
*[[Eye examination]]: | *[[Eye examination]]: | ||
**[[Conjunctivitis]]: has been reported but there is no well established data regarding this manifestation.<ref name="pmid32175797">{{cite journal |vauthors=Seah I, Agrawal R |title=Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals |journal=Ocul. Immunol. Inflamm. |volume=28 |issue=3 |pages=391–395 |date=April 2020 |pmid=32175797 |pmc=7103678 |doi=10.1080/09273948.2020.1738501 |url=}}</ref> | **[[Conjunctivitis]]: has been reported but there is no well established data regarding this manifestation.<ref name="pmid32175797">{{cite journal |vauthors=Seah I, Agrawal R |title=Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals |journal=Ocul. Immunol. Inflamm. |volume=28 |issue=3 |pages=391–395 |date=April 2020 |pmid=32175797 |pmc=7103678 |doi=10.1080/09273948.2020.1738501 |url=}}</ref> | ||
| Line 47: | Line 53: | ||
===Neck=== | ===Neck=== | ||
* | *On [[inspection]], a patient with severe [[hypoxia]] will be using accessory muscles for [[respiration visible]] on the [[neck]] exam. The most direct sign of increased [[work of breathing]] is [[palpation]] of the [[sternomastoid]] and detecting the phasic contraction.<ref name="Tobin2019">{{cite journal|last1=Tobin|first1=Martin J.|title=Why Physiology Is Critical to the Practice of Medicine|journal=Clinics in Chest Medicine|volume=40|issue=2|year=2019|pages=243–257|issn=02725231|doi=10.1016/j.ccm.2019.02.012}}</ref> | ||
*[[Jugular venous pressure]]:<ref name="pmid26741580">{{cite journal |vauthors=Semler MW, Wheeler AP, Thompson BT, Bernard GR, Wiedemann HP, Rice TW |title=Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome |journal=Crit. Care Med. |volume=44 |issue=4 |pages=782–9 |date=April 2016 |pmid=26741580 |pmc=4792704 |doi=10.1097/CCM.0000000000001555 |url=}}</ref> | *[[Jugular venous pressure]]:<ref name="pmid26741580">{{cite journal |vauthors=Semler MW, Wheeler AP, Thompson BT, Bernard GR, Wiedemann HP, Rice TW |title=Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome |journal=Crit. Care Med. |volume=44 |issue=4 |pages=782–9 |date=April 2016 |pmid=26741580 |pmc=4792704 |doi=10.1097/CCM.0000000000001555 |url=}}</ref> | ||
**High JVP or [[Jugular venous pressure|Jugular Venous Distension]] (JVD) can be a sign of [[COVID-19-associated heart failure]] or [[COVID-19-associated myocarditis]]. | **High JVP or [[Jugular venous pressure|Jugular Venous Distension]] (JVD) can be a sign of [[COVID-19-associated heart failure]] or [[COVID-19-associated myocarditis]]. | ||
| Line 62: | Line 68: | ||
===Heart=== | ===Heart=== | ||
* [[Tachycardia]] | * [[Tachycardia]], [[arrhythmias]], | ||
===Abdomen=== | ===Abdomen=== | ||
Revision as of 13:05, 28 June 2020
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COVID-19 physical examination On the Web |
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American Roentgen Ray Society Images of COVID-19 physical examination |
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Risk calculators and risk factors for COVID-19 physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Syed Hassan A. Kazmi BSc, MD [3]
Overview
COVID-19 is a rapidly evolving situation and a heterogenous disease entity. A suspected or confirmed CVOVID-19 patient can have as common finding as fever and as unique yet significant finding as anosmia. Although, the most common physical examination findings in patients infected with coronavirus include fever, cough, and shortness of breath.[1] The patient may just have abdominal pain and tenderness on examination.[2] The general appearance of the patient infected with coronavirus-19 depends on the severity of the illness. High clinical suspicion and careful physical exam are they key to early diagnosis and treatment of SARS CoV2 infection.
Physical Examination
Physical exam of a suspected or confirmed case of SARS CoV2 patient should be conducted in a private room, preferably a negative pressure one. The examiner should have PPE that includes gloves, gowns or aprons, masks, or respirators covering the mouth and nose, goggles, and face shields.[3] If possible and the patient is in no respiratory distress, patient should wear a surgical mask.[4]
Appearance of the Patient
- General appearance of the patient infected with coronavirus depends on the severity of the illness and the presence of infection associated complications involving different organ systems.
- Patients with mild disease may appear healthy.
- Patients will appear sick, lethargic, and short of breath in severe disease.
- Patient may appear dehydrated (dry skin and mucosa) due to increased respiratory rate, nausea and vomiting,
- Confusion can be due to severe dehydration, electrolyte imbalances such as in COVID-19-associated acute kidney injury, COVID-19-associated encephalitis, COVID-19-associated meningitis or COVID-19-associated stroke. Glasgow coma scale can gauge the conscious state of the patient.
- Anxiety is an important accompanying factor with most patients visiting hospitals, provided the heterogeneous nature of the disease. A healthy patient may worry about contracting the infection while visiting the hospital or doctor's office.
Vital Signs
- Pulse:
- Heart rate: A normal heart rate is between 60 and 100 bpm with a few exceptions such as athletes. A healthy asymptomatic patient may have a normal heart rate but that does not rule out infection. Sinus tachycardia, the most common type of arrhythmia in COVID-19 patients can be due to fever, hypoxia, shock due to sepsis, and anxiety. Some pathologic causes of arrhythmias include ventricular tachyarrhythmia[5], atrial fibrillation (pulse rate 100 to 175 bpm) and atrial flutter (pulse rate 150 bpm).
- Rhythm: Sinus tachycardia has a regular rhythm. An irregular pulse due to a few pathologic arrhythmias can be due to atrial fibrillation and ventricular tachyarrhythmia.
- Volume: A low volume pulse indicates dehydration and the potential need to rehydration therapy.
- Character: A fast but weak pulse depicts shock. A raised, full and bounding pulse can be seen due to fever or simply patient anxiety.
- Temperature:High fever (>100.4°F )[6]
- Respiratory rate: Normal respiratory rate in adults is 12 to 16 breaths per minute. Tachypnea(> 30 breaths/min) in [[COVID-19] positive patient is the response to lung inflammation and can be found in COVID-19-associated pneumonia and ARDS. A respiratory rate of > 28-30 / min, or dyspnea, warrant the use of oxygen by of 40% venturi mask. Oxygen saturation, respiratory rate, CXR and importantly dyspnea help determine the need for invasive mechanical ventilation.[7]
- Oxygen saturation: SpO2 < 93-94% warrants the use of oxygen by of 40% venturi mask and marks severe disease. In younger individuals, the arterial oxygen saturation is more important than it appears. The deterioration of inflammatory lung injury is manifested by a decrease in oxygen saturation (< 93%) first, followed by dyspnea in younger individuals with no other comorbidities.[8]
- Blood pressure: Low blood pressure can be due to dehydration, septic shock, heart failure or pathologic arrhythmias associated with COVID-19. Hypertension is itself a risk for severe COVID-19 infection.[9]
Skin
- Skin examination of patients with COVID-19 includes the following lesions:
- Erythema multiforme-like[10] Further studies are required to evaluate exact etiology these lesions to be COVID-19, drug intake or any other conditions.
- Erythematous maculo-papular[11]: Acral eruption of erythemato‐violaceous papules and macules, with possible bullous evolution, or digital swelling can be seen.
- Urticarial[12][13]
- Chickenpox-like[12][14]
- Purpuric peri-flexural[15]
- Transient livedo reticularis[16]
- Acro-ischemic[17]: The lesion constitutes finger or toe cyanosis, skin bullae and dry gangrene.
- Chilblain-like[18]:They constitute bilateral red-purple papules on the dorsum of the fingers and diffuse erythema in the subungual area of thumb. Late in the SARS CoV2 disease course, pseudo‐chilblain pattern frequently appear.
- COVID-19 Toes: Toes and fingers turn purple or pink as happens during cold. It is mostly seen in younger patients. A patient presented with purple toes should be tested for COVID-19 virus infection.
HEENT
- Head examination: Patients with Fluid retention, leading edema and swelling of face and extremities
- Eye examination:
- Conjunctivitis: has been reported but there is no well established data regarding this manifestation.[19]
- Epiphora: Patients can have teary eyes due to conjunctivitis itself or foreign body sensation.[20]
- Although there are no reports of blurred vision but visual acuity should be accessed.
- Ear exam:
- Nasal exam:
- Throat exam:
Neck
- On inspection, a patient with severe hypoxia will be using accessory muscles for respiration visible on the neck exam. The most direct sign of increased work of breathing is palpation of the sternomastoid and detecting the phasic contraction.[21]
- Jugular venous pressure:[22]
- High JVP or Jugular Venous Distension (JVD) can be a sign of COVID-19-associated heart failure or COVID-19-associated myocarditis.
- Low JVP: shows low CVP indication low intravascular volume. In patients with COVID-19 associated ARDS, CVP guides the fluid management.
Lungs
- Coronavirus infection mimics the pulmonary examination findings of pneumonia, such as:
- Increased respiratory rate[23]
- Percussion dullness
- Bronchial or decreased breath sounds
may reveal increased work of breathing using accessory muscles, circumoral cyanosis, and/or confusion from hypoxia. Lung sounds initially are unremarkable, but the patient can develop a mild expiratory wheeze
Heart
Abdomen
- Abdominal examination of patients infected with COVID-19 is usually normal.
- Some patients report abdominal pain.[24]
Back
- Back examination of patients infected with coronavirus is usually normal.
Genitourinary
- Genitourinary examination of patients infected with coronavirus is usually normal.
Neuromuscular
- Neuromuscular examination of patients infected with coronavirus shows:
- Cranial Nerve 1 or Olfactory nerve should be examined to evaluate for anosmia. Studies suggests that anosmia can be an important clue, heping the diagnosis of COVID-19 specially in the early stages.[25] According to a study published anosmia and aguesia to be strong predictors of COVID-1 infection.[26]
Extremities
- Extremities examination of patients infected with coronavirus is usually normal.
References
- ↑ Zhu, Jieyun; Ji, Pan; Pang, Jielong; Zhong, Zhimei; Li, Hongyuan; He, Cuiying; Zhang, Jianfeng; Zhao, Chunling (2020). "Clinical characteristics of 3062 COVID‐19 patients: A meta‐analysis". Journal of Medical Virology. doi:10.1002/jmv.25884. ISSN 0146-6615.
- ↑ Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL (June 2020). "Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members". Pancreatology. 20 (4): 665–667. doi:10.1016/j.pan.2020.04.021. PMC 7199002 Check
|pmc=value (help). PMID 32387082 Check|pmid=value (help). - ↑ "www.cdc.gov" (PDF).
- ↑ Guo T, Fan Y, Chen M, Wu X, Zhang L, He T; et al. (2020). "Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. doi:10.1001/jamacardio.2020.1017. PMC 7101506 Check
|pmc=value (help). PMID 32219356 Check|pmid=value (help). - ↑ (PDF) https://www.cdc.gov/sars/about/fs-SARS.pdf. Missing or empty
|title=(help) - ↑ Tobin, Martin J. (2020). "Basing Respiratory Management of COVID-19 on Physiological Principles". American Journal of Respiratory and Critical Care Medicine. 201 (11): 1319–1320. doi:10.1164/rccm.202004-1076ED. ISSN 1073-449X.
- ↑ Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. PMID 32150360 Check
|pmid=value (help). Missing or empty|title=(help) - ↑ Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, Suarez-Valle A, Saceda-Corralo D, Moreno-Garcia Del Real C, Fernandez-Nieto D (May 2020). "Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings". Clin. Exp. Dermatol. doi:10.1111/ced.14281. PMID 32385858 Check
|pmid=value (help). - ↑ Recalcati, S. (2020). "Cutaneous manifestations in COVID‐19: a first perspective". Journal of the European Academy of Dermatology and Venereology. 34 (5). doi:10.1111/jdv.16387. ISSN 0926-9959.
- ↑ 12.0 12.1 Recalcati, S. (2020). "Cutaneous manifestations in COVID‐19: a first perspective". Journal of the European Academy of Dermatology and Venereology. 34 (5). doi:10.1111/jdv.16387. ISSN 0926-9959.
- ↑ Fernandez-Nieto, D; Ortega-Quijano, D; Segurado-Miravalles, G; Pindado-Ortega, C; Prieto-Barrios, M; Jimenez-Cauhe, J (2020). "Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies". Journal of the European Academy of Dermatology and Venereology. doi:10.1111/jdv.16470. ISSN 0926-9959.
- ↑ Tammaro, A.; Adebanjo, G.A.R.; Parisella, F.R.; Pezzuto, A.; Rello, J. (2020). "Cutaneous manifestations in COVID‐19: the experiences of Barcelona and Rome". Journal of the European Academy of Dermatology and Venereology. doi:10.1111/jdv.16530. ISSN 0926-9959.
- ↑ Jimenez-Cauhe, Juan; Ortega-Quijano, Daniel; Prieto-Barrios, Marta; Moreno-Arrones, Oscar M.; Fernandez-Nieto, Diego (2020). "Reply to "COVID-19 can present with a rash and be mistaken for dengue": Petechial rash in a patient with COVID-19 infection". Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.04.016. ISSN 0190-9622.
- ↑ Manalo, Iviensan F.; Smith, Molly K.; Cheeley, Justin; Jacobs, Randy (2020). "A dermatologic manifestation of COVID-19: Transient livedo reticularis". Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.04.018. ISSN 0190-9622.
- ↑ Fernandez-Nieto, D.; Jimenez-Cauhe, J.; Suarez-Valle, A.; Moreno-Arrones, O.M.; Saceda-Corralo, D.; Arana-Raja, A.; Ortega-Quijano, D. (2020). "Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak". Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.04.093. ISSN 0190-9622.
- ↑ Piccolo, V.; Neri, I.; Filippeschi, C.; Oranges, T.; Argenziano, G.; Battarra, V.C.; Berti, S.; Manunza, F.; Fortina, A.B.; Di Lernia, V.; Boccaletti, V.; De Bernardis, G.; Brunetti, B.; Mazzatenta, C.; Bassi, A. (2020). "Chilblain‐like lesions during COVID‐19 epidemic: a preliminary study on 63 patients". Journal of the European Academy of Dermatology and Venereology. doi:10.1111/jdv.16526. ISSN 0926-9959.
- ↑ Seah I, Agrawal R (April 2020). "Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals". Ocul. Immunol. Inflamm. 28 (3): 391–395. doi:10.1080/09273948.2020.1738501. PMC 7103678 Check
|pmc=value (help). PMID 32175797 Check|pmid=value (help). - ↑ Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K (March 2020). "Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China". JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2020.1291. PMC 7110919 Check
|pmc=value (help). PMID 32232433 Check|pmid=value (help). - ↑ Tobin, Martin J. (2019). "Why Physiology Is Critical to the Practice of Medicine". Clinics in Chest Medicine. 40 (2): 243–257. doi:10.1016/j.ccm.2019.02.012. ISSN 0272-5231.
- ↑ Semler MW, Wheeler AP, Thompson BT, Bernard GR, Wiedemann HP, Rice TW (April 2016). "Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome". Crit. Care Med. 44 (4): 782–9. doi:10.1097/CCM.0000000000001555. PMC 4792704. PMID 26741580.
- ↑ de Jongh TO, Thiadens HA (2011). "[Physical examination of the lungs in suspected pneumonia]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 155: A2656. PMID 21329538.
- ↑ Wong SH, Lui RN, Sung JJ (May 2020). "Covid-19 and the digestive system". J. Gastroenterol. Hepatol. 35 (5): 744–748. doi:10.1111/jgh.15047. PMID 32215956 Check
|pmid=value (help). - ↑ Lee Y, Min P, Lee S, Kim SW (May 2020). "Prevalence and Duration of Acute Loss of Smell or Taste in COVID-19 Patients". J. Korean Med. Sci. 35 (18): e174. doi:10.3346/jkms.2020.35.e174. PMC 7211515 Check
|pmc=value (help). PMID 32383370 Check|pmid=value (help). - ↑ Menni, Cristina; Valdes, Ana M.; Freidin, Maxim B.; Sudre, Carole H.; Nguyen, Long H.; Drew, David A.; Ganesh, Sajaysurya; Varsavsky, Thomas; Cardoso, M. Jorge; El-Sayed Moustafa, Julia S.; Visconti, Alessia; Hysi, Pirro; Bowyer, Ruth C. E.; Mangino, Massimo; Falchi, Mario; Wolf, Jonathan; Ourselin, Sebastien; Chan, Andrew T.; Steves, Claire J.; Spector, Tim D. (2020). "Real-time tracking of self-reported symptoms to predict potential COVID-19". Nature Medicine. doi:10.1038/s41591-020-0916-2. ISSN 1078-8956.