Breathless Child

Question 1

What would we find from End of bed and PIPPA of a child with; acute severe asthma?

Answer 1

End of bed - Wheeze, unwell appearance, tripod position
P - Tripod
I - Severe recession (SC and IC), Tracheal tug
P - Hyperexpansion of the chest, symmetrical expansion, poor expansion in severe cases
P - Resonant but equal
A - Air entry symmetrical, if poor entry this signifies an increasing severity

Question 2

What would we find from End of bed and PIPPA of a child with; severe pneumonia?

Answer 2

End of Bed - Wet cough, grunting
P
I - Resp distress with recession and tracheal tug
P - Expansion may be unsymmetrical in unilateral pneumonia
P - Dullness over consolidation
A - Reduced air entry +/- crackles

Question 3

What would we find from End of bed and PIPPA of a child with; pneumothorax?

Answer 3

I - Signs of IWOB; recession and asymmetrical chest expansion
P - Asymmetrical chest expansion. Tension pneumothorax may see cardiac apex displacement and tracheal deviation away from the side
P - Hyper-resonant
A - No air entry over side of pneumothorax

Question 4

What would we find from End of bed and PIPPA of a child with; Cardiac failure?

Answer 4

I - Tachypnoea, little recession
P - Symmetrical expansion. Hepatomegaly
P - Resonant, symmetrical
A - Crepitations over lung bases. Possible heart murmur

Question 5

What would we find from End of bed and PIPPA of a child with; Upper airway obstruction?

Answer 5

End of bed - stridor, hoarse voice, drooling
I - Respiratory distress with recession and tracheal tug
P - Symmetrical expansion
P - Resonant, symmetrical
A - Transmitted sounds