Examination of the Respiratory System
INSPECTION
* Key to the respiratory exam of an infant or toddler
Do not undress/disturb the child until the following have been
established;
- the respiratory rate (count for 60 sees, watch chest/abdo movements)
- the presence or absence of cyanosis
- the work of breathing : nasal flaring or visible recession (suprasternal)
- stridor or wheeze (airway obstruction ) [ Listen]
Then expose the top half of the child
Older child - introduce and explain while inspecting
? looks well/sick, ? thin, ? in air/on oxygen ? sputum container,
? dyspnoea, ? nebuliser/PEFR
Hands - Clubbing
Face - Cyanosis ( lips & stick out the tongue)
Neck - Suprasternal recession
N.B Do not undress adolescent female to waist
Chest inspection
- pectus carinatum/excavatum
- Harrison's sulci
- accessory muscles
- hyperinflation
- movement [compare sides]
- BCG scar
Look at the back - scoliosis / scars
Scars - sternotomy, thoracotomy , previous chest drains.
Palpation
- Feel apex beat
- trachea
- cervical nodes
- assess expansion (using thumbs - 3-4cm)
- Tactile vocal fremitus [ or V.R.later]
Percuss :
explain, 2 taps, upper border liver
Listen — 6 positions
Breath sounds - ? normal
? increased/decreased/? bronchial
? added sounds (conducted/ rhonci /creps )
- Vocal Resonance
Then sit up and do palpn ., percussion & auscultation at the back
At the end offer to examine the ears and throat, check PEFR, examine sputum