Respiratory Examination Guide

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

7 comments on “Respiratory Examination Guide
  1. Hanna says:

    What is a huff for CF? Thanks

  2. iqbal says:

    excellent work

  3. Adrian Watson says:

    Why Examine ENT during the respiratory examination

  4. sahbaa says:

    ask about pain before you start examination and explain each step to child before you do it , also to complete my examination sputum examination

  5. marwa kandora says:

    I think LN examination is Important alsi in Respiratory case

  6. Simran says:

    Huffing
    Huffing, also known as huff coughing, is a technique that helps move mucus from the lungs. It should be done in combination with another ACT. It involves taking a breath in, holding it and actively exhaling. Breathing in and holding it enables air to get behind the mucus and separates it from the lung wall so it can be blown out. Huffing is not as forceful as a cough, but it can work better and be less tiring. Huffing is like exhaling onto a mirror or window to steam it up.

    The Huff Coughing Technique:

    Sit up straight with chin tilted slightly up and mouth open.
    Take a slow deep breath to fill lungs about three quarters full.
    Hold breath for two or three seconds.
    Exhale forcefully, but slowly, in a continuous exhalation to move mucus from the smaller to the larger airways.
    Repeat this maneuver two more times and then follow with one strong cough to clear mucus from the larger airways.
    Do a cycle of four to five huff coughs as part of your airway clearance.

  7. antara says:

    Would be helpful to indicate what percussion dullness or hyperresonance means – liver, heart, fluid, consolidation, pnuemothorax, etc

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