Evaluation of respiratory alkalosis

acute-onset dyspnea, pleuritic chest pain, hemoptysis may be present; typically, in the presence of prolonged immobilization, trauma, prior thromboembolic disease, or malignancy

jugular venous distension present, loud pulmonic sound (if pulmonary hypertension or right ventricular strain); hypotension or pulseless electrical activity in severe pulmonary embolism (PE)

symptoms may be nonspecific (particularly in older adults), such as fever, chills, rigors, weakness, confusion, anxiety; may be focal infective symptoms (e.g., dysuria, urinary frequency with urinary tract infection [UTI]); identifiable nidus of infection (e.g., UTI, central venous line, foley catheter, prosthetic joints, heart valves); may be history of risk factors, such as recent surgery, uncontrolled diabetes, other immunocompromise, or immunosuppression

temperature >100.4°F (>38°C) or <96.8°F (<36°C) (although temperature can be normal); tachycardia; altered mental status; warm peripheries; tachypnea; reduced urine output; may be focal signs of infection: meningeal signs suggest meningitis; cardiac murmur suggests endocarditis; abdominal exam with ascites should raise suspicion for spontaneous bacterial peritonitis; Murphy sign in cholecystitis or cholangitis; peritoneal signs in acute abdomen with perforated viscus; flank tenderness with UTI, pyelonephritis; joint effusion, pain, erythema suggest septic joint

dyspnea and hypoxemia, progressing to acute respiratory failure

critically ill patient, frothy sputum, increased respiratory rate, bilateral inspiratory crackles on auscultation

dyspnea with pleuritic chest pain, and hypoxemia

productive cough and fever, frothy sputum, increased respiratory rate, bilateral inspiratory crackles on auscultation

chest pain, altered cognition and agitation, history of cardiac disease

hypotension, tachycardia, pallor, cyanosis, cool extremities, flaccid paralysis of lower limbs, quiet or absent heart sounds, slow capillary refill

dyspnea, orthopnea, diaphoresis, anxiety, history of congestive heart failure

frothy sputum, tachypnea, auscultatory end-expiratory rales, third heart sound (S3), peripheral edema

acute focal neurologic symptoms, including motor, sensory, speech, and visual; risk factors present (e.g., age, atrial fibrillation, diabetes mellitus type 2, smoking, obstructive sleep apnea)

altered mental status and focal neurologic signs; atrial fibrillation, valvular murmur, carotid bruits

acute focal neurologic symptoms, including motor, sensory, speech, and visual, altered mental status and headache; risk factors of age, hypertension, coagulopathy, head trauma, cocaine, methamphetamine use, anticoagulation therapy

altered mental status, focal neurologic signs

recent salicylate ingestion; gastrointestinal symptoms early (e.g., abdominal pain, nausea, vomiting, diarrhea, and bleeding), progressing to obtundation, classic complaint of tinnitus

hyperventilation, diaphoresis, tachycardia with confusion, seizures, coma, and hypotension (hypotension suggests severe toxicity)

cardiopulmonary resuscitation

severe arrhythmia, pulseless electrical activity or asystole

history of sexual activity with absent contraception, missed last menstrual cycle; nausea and vomiting may be present in first trimester; also weight gain, uterine enlargement; fetal movements by 18 weeks of gestation, uterine contractions present in third trimester

mild tachypnea; uterine enlargement, and gestational age estimated on abdominal exam by measuring fundal height

recurrent episodes of shortness of breath, chest tightness, wheezing, or coughing

exam could be normal or demonstrate an expiratory wheeze

acute- or subacute-onset wheeze and respiratory distress; symptoms and signs vary depending on age of the child

audible wheeze on auscultation of chest, tachypnea, cough, tachycardia

consistent with underlying disorder causing hypoxia, agitation, confusion

tachypnea, cyanosis, tachycardia, findings of underlying disorder

fatigue, weight loss (malnutrition) or gain (ascites), confusion, decreased libido, may elicit history of alcohol abuse

abdominal distension, jaundice, melena, altered mental status, spider angiomata, hepatosplenomegaly

postoperative cardiopulmonary bypass in rewarming phase, persisting into ICU admission

no definitive physical signs

pleuritic chest pain and dyspnea, respiratory decompensation with elevated peak inspiratory airway pressure in patients on mechanical ventilation

decreased breath sounds and hyper-resonance to percussion on the side of the pneumothorax, tracheal deviation away from the side of the pneumothorax, ipsilateral hyperinflation may be present; hemodynamic instability may be present

headache, lethargy, and altered mental status; immunocompromised state

fever, meningismus, lethargy, seizures

fever, headache, lethargy, and altered mental status; immunocompromised state

altered mental status, motor and sensory deficits, or focal neurologic findings; seizures

progressive headache and focal neurologic symptoms; altered mental status may be present, weight loss, malaise, and other nonspecific symptoms; history of prior or current malignancy

altered mental status and focal neurologic signs

witnesses of the trauma or individuals who know patient may be helpful in establishing details and patient information

hemotympanum, periorbital ecchymosis, postauricular ecchymosis, CSF leakage (rhinorrhea or otorrhea), associated spinal injury, spinal tenderness, or paresthesias

may be accidental or therapeutic (e.g., intracranial hypertension, neonatal pulmonary hypertension)

inappropriate settings of tidal volume, respiratory rate

ascension to altitude, headache, poor sleep, anorexia, fatigue, nausea, and vomiting

chest auscultation with crackles due to pulmonary edema

excessive anxiety and worry, panic attack, comorbid psychiatric disorders including substance abuse; muscle tension, memory loss, insomnia

may find signs of past sexual, physical, and emotional abuse, or emotional neglect

age 20 to 50 years, dyspnea, syncope, chest pain; family member with disease

cyanosis, accentuated pulmonic component (P2) to second heart sound, tricuspid regurgitation murmur, peripheral edema

progressive dyspnea, persistent nonproductive cough

rales and high-pitched rhonchi on chest auscultation, clubbing of the fingers

insomnia, complaints of poorly restorative sleep, daytime sleepiness

repetitive apnea or hypopnea, absent or diminished respiratory effort during sleep occurring >5 times an hour

altered cognition, agitation, recent traumatic or surgical event

hypotension, tachycardia, cool extremities, quiet heart sounds, oliguria, slow capillary refill

decreased exercise tolerance, dyspnea with exercise, fatigue

pallor, tachycardia; underlying disorder may manifest as adenopathy; hepatomegaly, splenomegaly, night sweats

blunt or explosive trauma, chest pain, hemoptysis

cyanosis, hypotension, chest tenderness, rales, or diminished breath sounds

typically after stroke, head trauma, brain tumor

obtunded patient, rapid deep breaths leading to hypocapnia

deep or rapid breathing, paresthesias of hands, periorbital areas; dizziness frequently observed, may have associated panic attack

tachypnea or excessively deep inspiration, normal auscultative findings of chest

exposure to elevated ambient temperature, high fever

increasing respiratory frequency and tidal volume, body core temperature >98.6°F (37°C)

agitation, cyanosis; may be asymptomatic (pink variant)

hyperpnea, heart murmur; may exhibit systolic thrill

suggestive family and ethnic history in thalassemia; persistent pain in skeleton, chest, and/or abdomen in sickle cell

lethargy, small stature and weight, chipmunk facies in thalassemia, dactylitis in sickle cell

use of efficient extracorporeal techniques

no definitive physical signs

confusion

tachypnea, altered mental status, icterus; liver size may be normal or enlarged

chronic liver disease, dyspnea

spider nevi, tachypnea, platypnea (shortness of breath in the upright position that is relieved when assuming supine position), orthodeoxia (oxygen desaturation in the upright position, and improves in supine position)

dyspnea, fatigue, confusion, decreased libido; may elicit history of alcohol abuse

tachypnea, icterus, abdominal distension (ascites), fluid wave, hepatosplenomegaly, spider angiomata

recent intake of exogenous agent that spurs hyperventilation

tachypnea

acute onset, inciting stressful event, somatic complaints not explained by other diagnostic workup

tachypnea, tachycardia, anxiety, diaphoresis, signs of injury or other inciting event