Table of Contents General Listen to breathingCough characteristics by cause NailsRespiratory rate Chest deformities Work of breathing Chest auscultation To complete Causes of stridor (ABCDEF)Try some questions Do a full adult respiratory examination with the following additional components. General Dysmorphic features Work of breathing Colour (pallor, cyanosis, mottling) Alertness and interest in surroundings Nutritional status Listen to breathing Wheezing (bronchiolitis, asthma, viral-induced wheeze) Stridor, harsh voice (croup, foreign body) Grunting (bronchiolitis, pneumonia, asthma) Secretions Cough Cough characteristics by cause Croup = Barking URTI = Dry Whooping cough = Coughing fits with inspiratory whoop Bronchiectasis = Fruity cough Nails Clubbing (CF, bronchiectasis) Respiratory rate Count for 1 minute – usually best with chest exposed (tachypnoea = respiratory distress; bradypnoea = final stages of respiratory failure) Prolonged expiration (bronchoconstriction in bronchiolitis or asthma) <1 year1-2 years2-5 years5-12 years>12 yearsResp rate30-4025-3525-3020-2515-20Heart rate110-160100-15095-14080-12060-100Normal paediatric observations Chest deformities Barrel chest (asthma) Harrison’s sulcus (permanent groove in chest wall at insertion of diaphragm in chronic asthma) Pectus carinatum Pectus excavatum Work of breathing Nasal flaring Tracheal tug Recession Supraclavicular Intercostal (in-drawing between ribs – an earlier feature in younger children because the chest wall is less firm) Subcostal Use of accessory muscles and head bobbing caused by sternocleidomastoid contractions (quite severe respiratory distress) Chest auscultation If child is crying, try to listen during inspirations Noises transmit all over chest as they are small Crepitations crackles (secretions, bronchiolitis, infection) Bronchial breathing (pneumonia) Wheeze (asthma, viral-induced wheeze) To complete Observations Growth charts Ear, nose and throat exam Causes of stridor (ABCDEF) Oops! This section is restricted to members. Try some questions What are the commonest causes of bronchiolitis, Croup and Whooping cough? Oops! This section is restricted to members. What is primary ciliary dyskinesia? Oops! This section is restricted to members. What is the cause of cystic fibrosis? Oops! This section is restricted to members. What are the non-respiratory features of cystic fibrosis? Oops! This section is restricted to members.
