Nus paeds 20220903 resp

Always acknowledge both child and parent. Request chaperone and permission to undress.

Always comment on height and weight

Hyperinflation and Harrison’s sulci below nipples T6 to T8 where diaphragm atttaches
Exposure!
Central sternotomy usually cardiac

Check side and back

Idiopathic, chronic respiratory condition, post cardiac surgery. Or secondary to scoliosis!
Chronic suppurative e.g. cystic fibrosis. Empyema and lung abscess may develop quickly

Reversed interphalangeal and distal phalangeal depth ratio.

Put both hands on chest, then remove irrelevant hand?
Below 4 just inspect will do. Older child – just do at one level. Thumbs must be loose while rest of
fingers tight, “breathe out ALL THE WAY. Now breathe in ALL THE WAY.” (tidal volume not enough)

Sometimes chronic lung collapse

Going to tap like a drum

Anteriorly Lungs end at T6 just below nipple

If not sure whether hyperresonant or resonant, Air entry is reduced on pathological side.
Monophonic means turbulence usually large calibre e.g. FB, trachoemalacia. Polyphonic means
airway narrowing throughout.

Wheeze is usually expiratory and means intrathoracic pathology. Inspiratory sound usually
secretions or ENT.
Paradoxical breathing/see saw may be present in airway obstruction. Diaphragm goes up and chest
sinks in.
Signs of consolidation
Pleural rub is present throughout respiratory cycle.
Asthma always look for hyperinflation, harrison’s sulci, nose for enlarged inferior turbinates, eczema

Bronchiectasis – clubbed. Crackles. CF. sometimes FTT check height and weight

Chronic lung disease of prematurity – height weight growth chest shape

Laryngomalacia – chronic stridor in infant.

Don’t give running commentary for resp, synthesize then present