export_pediatric thorax and lung exam Flashcards
Chest wall in infants and children
Rib cage is more circular than adult
AP diameter to lateral diameter decreases significantly during the first three years
Diaphragm in the infant and child
Horizontal, decreased contraction efficiency
Muscles of inspiration become less fatigued as a child ages
Lungs in infants and children
Alveolar multiplication after birth continues up to two years old
Alveolar size continues to increase until thoracic growth is complete
Where do you start for a pediatric lung exam?
ABCs
Airway
Breathing
Circulation
Respiratory rate for a newborn
40-60 bpm
Infant breathing patterns
Obligate nasal breathers
Periodic breathing
When assessing respiratory rate, must take it for one full minute
Periodic breathing
Breathing pattern for infants within the first month of life, where they will breathe rapidly for several seconds, then not breath for up to 20 seconds afterwards
Anything longer than 20 seconds is APNEA
Things to monitor in lung exam
Respiratory rate and effort
Retractions
Types of retractions
Suprasternal
Subcostal
Intercostal
Auscultation of the infant lungs
Differentiated lung sounds from heart sounds can be a challenge
Sounds transmit easier in the infant than they do in an adult
How do you get a quiet infant?
Feed them
Pacify them
Have parent hold them
Get them to fall asleep
What is included in the cardiac exam?
Heart auscultation
Lung exam
Liver exam
Skin
Pulses
Acrocyanosis
Peripheral cyanosis
Normal finding in a neonate and is not worrisome
Central cyanosis
Abnormal at any age
Can be pulmonary or cardiovascular in etiology
How can you differentiate between cardiac and pulmonic causes of central cyanosis?
Hyperoxitest:
Check ABG, provide 100% O2 for 10 minutes, recheck ABG
If pO2 rises > 100 mmHg, the cause is likely pulmonary
Where is the newborn apical impulse?
In the 4th or 5th intercostal space just medial to the midclavicular line
What would cause the apical impulse to shift?
Pneumothorax
Dextrocardia
Diaphragmatic hernia
Normal newborn heart rate
120-160 bpm
If a baby has a “machinery murmur”, what does this indicate?
Patent ductus arteriosis
What blood pressure would indicate a hypertensive infant?
> 80/50
Innocent murmurs
Common from 3-7 years old
Maximally audible at mid left sternal border
Midsystolic
Heard better when supine and least when standing/holding breath
Pathologic murmur
Abnormal cardiac size or ECG
Diastolic murmur
Cyanosis
Abnormally weak or strong pulses
Loud, with thrill, or transmits through thorax
Normal capillary refill time
1-2 seconds
