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PE of the CHEST

Overview • Upper respiratory tract • Lower respiratory tract • Observe the pattern of breathing and the rate of breathing • Note the type of cough • Does the infant display frothiness or flaring of the alae nasi? • Can he cope with a feed? • What is his color like? .

grunting. fever • Severe: rapid respiratory. stridor. restlessness • One should attempt to correctly sequence from the onset of symptoms (ex: cough for 4 days. wheeze. fever for 2 days. cyanosis. poor feeding. dyspnea for 1 day) .History • Presence or combination of cough. poor feeding for 2 days.

the cough or the wheeze?  Is he getting progressively worse?  Has he maintained a good color?  Can he manage a bottle or feed? .History • It may be important to ask:  Which came first.

History • Presence of sputum: expectoration of sputum is a relative rarity in young children • Even though a cough may correctly be called productive in infancy. sputum is not seen since it is swallowed.” . • Evanson & Maunsell (1838): “The young child almost always swallows any matter expectorated and therefore this can scarcely become an object of diagnosis.

RR .Inspection 1. What is his position of comfort? 4.what is normal for a given age? . How the child is coping: is he comfortable? Is he in respiratory distress? Is he unstable with very labored breathing? 3. Color 2.

Defining tachypnea (WHO criteria) • Infants <2 months old • Infants >2-12 mos old • >12 months old >60 cycles/min >50 cycles/min >40 cycles/min .

nasal flaring. Chest movement: Is it symmetrical? 6. Presence of frothiness. grunting .Inspection 5. Chest shape: barrel-shaped? Hollow chest (pectus excavatum)? Pigeon chest (pectus carinatum)? Harrison’s sulcus (indrawing of lower chest with rib flaring) 7. Pursing of lips in expiration? 8.

Inspection 9. intercostal & subcostal retractions *** Increased rate and work of respiration are the most important signs of pneumonia in infants. increased work of respiration shown by suprasternal. Dyspnea? Increased respiratory effort “at rest”.Type of respiratory movement: normal respiration is a quiet in-out movement of the chest 10. .

upper airway obstruction • Intercostal & subcostal retractions lower airway obstruction • Apnea vs periodic breathing .Inspection • Head bobbing and suprasternal retractions .

Palpation • Comment on chest expansion • Vocal fremitus can be assessed by palpation of the infant’s chest when crying • Transmitted sounds may be palpated .

consolidation .Palpation  Vocal fremitus: hand detects distinct vibrations of equal intensity • Decreased VF – atelectasis or pleural effusion • Increased VF .

Percussion • Compare both sides & performed gently • Percussion note: resonant • Not particularly useful in infants and toddlers .

lung consolidation.Percussion • Asymmetric dullness: atelectasis. or fluid accumulations in the pleural space • Symmetric dullness: often occurs in the lung bases with a viral illness • Unilateral hyperresonance: pneumothorax or unilateral airway obstruction • Symmetric hyperresonance: asthma .

Auscultation • Bell of the stethoscope is better because it is smaller. esp. if frothy.often heard in infants & toddlers. allows less surface noise. coming from the secretions in the oropharynx to the chest . warmer. better attuned to receive low-pitched chest sounds • Transmitted sounds .


heard all over both lungs esp.Vesicular – soft and low-pitched. over the axilla & infrascapular areas . continues without pause through expiration (I>E).  Normal breath sounds: 1.Auscultation  Listen directly over the chest wall without intervening clothes.

Bronchovesicular – I & E sounds about equal in length. heard best on the 1st & 2nd interspaces anteriorly and in between the scapula .Auscultation 2.

Adventitious breath sounds: Wheeze Stridor Crackles Rhonchi .Auscultation • 1. 3. 2. 4.