Case 31: Physical Exam

Case 31 Index

Vital Signs: (prior to intubation) Temperature 98°F, Blood Pressure 90/60 mmHg, Heart Rate 115 beats/min, Respiratory Rate 24 breaths/min
General Appearance: Intubated, unresponsive without sedation
HEENT: Normal conjunctiva, no scleral icterus, moist mucous membranes, clear oropharynx. Pupils round and reactive to light.
Lymph: No cervical lymphadenopathy
Cardiovascular: Jugular venous distension (JVD) appreciated, tachycardic, split S2 with respiratory variation;
Pulmonary: Diminished breath sounds bilaterally, no wheezes, rhonchi, or rales
Abdominal: Soft, non-distended, non-tender
Extremities: No peripheral edema in extremities, extremities warm, no cyanosis
Neurologic: Unresponsive without sedation
Skin: Warm, dry, no rash
Access: Right femoral tunneled dialysis catheter with clean exit site; No drainage present; Multiple upper extremity arteriovenous accesses (AVF, AVG) bilaterally without thrill or bruit.

Before we move on…what’s at the top of your differential diagnosis? Choose 3!
Volume overload
Pulmonary embolism
Chronic obstructive pulmonary disease (COPD) exacerbation
Toxic alcohol ingestion
Drug overdose
Cerebrovascular accident
Severe hyperkalemia
Hypovolemic shock

Click here to move on!

Case 31 Index
Case 31 Introduction