Simplified system based physical examination in Paediatrics RESPIRATORY SYSTEM

1.INTRODUCE YOURSELF -Listen to any hoarseness of voice -Remove your watch/rings etc -Wash your hands -Position the patient. Initially standing then sitting . -Adequate exposure of patient. Ask parents or patient to undress exposing their chest. 2.GENERAL INSPECTION Stand back and inspect for: --well or unwell -any dysmorphism -any obvious respiratory distress -any attachments e.g IV canula (any IV drip), pulse oximeter (mention the saturation), ECG electrodes -Nutritional status-offer that you want to measure the height and weight to plot on anthropometric chart -pink vs central cyanosis -Any respiratory distress-rate, noise, chest deformity 3.Upper limbs Hands -Clubbing -peripheral cyanosis Pulse -rate, volume, rhythm, -collapsing pulse -radio-radial, radio-femoral delay, peripheral pulses Offer to measure blood pressure 4.HEAD AND NECK Face -central cyanosis 5.CHEST Inspection -surgical scars Palpation -localise apex beat-any displacement -parasternal heave -palpable P2 -Displace trachea Chest expansion -equal vs inequal -tactile fremitus Percussion -compare both sides Auscultation -compare both sides -vocal fremitus ***remember to palpate, percuss and auscultate the back 6.OTHERS Lymphadenopathy Peak flow meter reading