Examination of the Respiratory System

General

• greeting / introduction

• general health

• colour

  • pale

  • cyanosis

• growth, nutrition and development

• mention the obvious

Look around for

• inhalers

• sputum pot

• nasogastric tube, gastrostomy

• vascular access

• oxygen

• medications

Clinical approach

• check hands

  • clubbing

  • colour

  • perfusion - e.g. capillary refill time <2 secs

• check face

  • colour

  • anaemia

  • respiratory distress

Chest

• Inspection

  • acute signs

    • respiratory rate

    • recession / increased work of breathing

    • added noises

  • Chronic signs

    • chest shape

    • pectus carinatum / AP diameter

    • Harrison's sulci

• Percussion

  • percuss upper, mid and lower zones anterior and posterior

  • dullness over heart normal

• Auscultation

  • added noises

    • stridor

    • wheeze

    • crackles

    • crepitation

    • rub

Special notes

• evidence of atopic disease

• beware transmitted noises - ask child to cough

• percussion unhelpful under 2 and disliked - can omit and explain why

• percuss on to finger not clavicle

• downward displacement of liver indicates chest overexpanded

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