Paediatric - Respiratory System

6:53:00 PM

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PAEDIATRIC RESPIRATORY EXAMINATION GUIDE

(CHILDREN ARE NOT JUST LITTLE ADULTS)

MRCPCH Clinical Exam Revision

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Approach to the child

Around the child – oxygen, inhalers, creon, other tubing, wheelchair, monitors, sputum pot, peak flow
General Overview of child
-       Nutritional status
-       Growth
-       Respiratory effort – RR, WOB, stridor, audible wheeze,
-       Colour
-       Dysmorphism – T21, Pierre Robin
-       Ex-Prem appearance
Hands
Fingers – Clubbing, peripheral cyanosis
Hands – cannulation scars, tremor
Pulse
Face
-       Pallor
-       jaundiced sclera
-       central cyanosis
-       central hypoplasia
ENT – Perform at END of examination if needed
-       Ears – shape and size / dimorphic
-       Nose – Polyps, deformity, deviated septum
-       Throat – cleft palate/ tonsillar hypertrophy
-       Consider cervical lymph node examination
Neck – trachea – central/deviated /tracheostomy/ tracheostomy scar

CHEST
-Inspection
-       Respiratory Rate
-       Chest wall symmetry / shape and movement
-       Scars – front and back
  1. Chest drain
  2. Lobectomy
  3. Diaphragmatic hernia repair
  4. PDA repair
-       Central Lines – Picc Line site, Ports (look under bra strap in teenage girls), Hickman lines
-       Work of breathing
-       Harrisons Sulci / Pectus Excavatum / Pectus Carinatum
-       Spine – Kyphosis and Scoliosis
Palpation
-       Apex
-       Chest Wall expansion – not in infants
-       Huff at this point (if CF likely)
Percussion
warn child first
percuss over same zones as auscultated
-dullness/ hyper-resonance
Auscultation
Listen to 6 zones including axillae
o   Wheeze/decreased air entry/ crepitations / bronchial breathing
o   Vesicular breath sounds / Prolonged expiratory phase
o   Vocal Resonance – ‘99’ (only in older children)
Repeat process on back with child sat up
-check for back scars at this point is not done already

To complete my examination I would like to:
-ENT
-Plot height and weight on growth chart
-Peak flow if indicated
-Oxygen saturations / BP
-Abdominal examination if indicated (liver/spleen)
-Cardiac Examination if indicated
Authors: Abigail Whitehouse and Cecilia Ng

Download PAEDIATRIC HISTORY & PHYSICAL EXAM 



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