Respiratory Flashcards
What pieces of information can you gather before undressing the infant
RR, colour, nasal flaring, use of accessory muscles
stridor
what are you looking at on general inspection
general health
dysmorphic features
extras- oxygen supplementation, saturation monitor s, sputum pots, peak flow meters
what are you looking for on inspection of the hands
clubbing
what are you looking for in the face
cyanosis, traumatic petechia on the eyelids, face and neck following severe paroxysms of coughing
what are you looking for on the neck
tracheal tug, swelling, lymph nodes, cystic hygroma, thyroid
what are you looking for on inspection of the shape of the chest
undress the top half of the child looking for
shape (asymmetry or deformity)
pectus excavatum (sunken) or carinatum (prominence)
hyperinflation (barrel chest- chronic asthma, emphysema, CF)
harrisons sulcus (chronic airway obstruction ddx: left to right cardiac shunt)
rachitic rosary (swelling of the costochodral junctions- rickets)
absent clavicles
absent pectoralis (Polands syndrome
movement (full expiration then inspiration)
what does intercostal recession mean
airway obstruction or decreased lung compliance
subcostal recession means
airway obstruction or decreased lung compliance
what does a right thoractomy scar mean
possible oesophageal surgery
BT shunt
lobectomy
when counting the rate on breathing what else are you thinking about
nasal flaring
grunting on expiration (positive end exp pressure)
use of accessory muscles (sternocleidomastoids)
chest wall recession
see saw chest movement
difficulty with speaking or feeding
what is the normal breathing rate for a neonate
30-60
what is the normal breathing rate for an infant
20-40
respiratory rate for 1-3 year old
20-30
normal RR for a 4-10 year old
15-25
if you are greater than 10 what is the normal respiratory rate
15-20
in a young child when is palpation and percussion useful
degree of hyperinflation
upper liver border detection
to confirm consolidation, collapse, or effusion
in an older child what are you feeling for on palpation of the mediastinum
trachea (single finger) and localisation of the apex beat
steps of palpation in an older child
mediastinum position
chest expansion
tactile vocal fremitus
if the apex and trachea are pushed away that means
there may be a pleural effusion or pneumothorax
if the apex and trachea are pulled towards the effected side
it is either a collapse or fibrosis
if only the trachea is shifted
then it is an upper lobe pathology
when only the apex is shifted
think pectus excavatum, scoliosis, dextrocardia, cardiomegaly 9think cor pulmonale)
what is normal chest expansion
4 cm and should be symmetrical
how do you test for vocal fremitus
place hand on either side of the upper chest and ask the child to say 99 compare left and right anterior and posterior
with increased vocal fremitus what is the pathology
consolidation
with decreased vocal fremitus what is the underlying pathology
collapse, pleural thickening
with absent vocal fremitus what does that mean
pleural effusion
what does hyper-resonance mean pathology wise
pneumothorax or emphysema
what does a dull percussion note mean
consolidation, collapse, pleural thickening, fibrosis
what does stony dullness mean on percussion
pleural effusion
the right lung has how many lobes
three (upper, middle and lower lobe)
what re the three questions you should ask yourself while auscultating the lungs
are the breath sounds normal
are there added sounds
are these in inspiration, expiration or both
what are the characteristics of normal breath sounds
low pitches rustle, increased intensity in inspiration, faded quickly in the first third of expiration
what does bronchial breathing sound like
there is a pause between inspiration and expiration
the duration of inspiration and expiration is equal
and the quality and intensity is the same
what does diminished or absent breath sounds mean
collapse, pleural effusion, pneumothorax, pleural thickening, emphysema, obstruction
what does bronchial breathing mean
consolidation or fibrosis
what causes prolonged expiration
asthma or emphysema (to prevent closure of alveoli
what are wheezes due to
they are due to partial obstruction or narrowing of the bronchi or bronchioles
asthma or bronchiolitis (also has creps)
what are crackles
the are non musical sounds generally heard during inspiration
what do fine crackles indicate
they are normally found at the base of the lung
pulmonary edema
fibrosiing alveolitis
what does coarse crackles indicate
bubbly secretions in the bronchioles
pneumonia
bronchiectasis
what does a pleural rub indicate
leathery sound caused by movement of visceral pleura over parietal pleura when the surfaces are roughened by fibrous exudate (uncommon)
what is a pneumothorax click?
rhythmical sound, synchronous with cardiac systole
caused by shallow left pneumothorax between the two layers overlying the heart
