The respiratory examination is performed as part of a physical examination, in response to respiratory symptoms such as signs of respiratory depression, shortness of breath, coughs. The four steps of the respiratory exam are inspection, palpation, percussion, and auscultation of respiratory sounds.
Inspection
You will need to adapt the exam accordingly! Generally, you could put the children into three categories depending on their age: 0-6months, 6-24 months and 2 years+
Is the child awake and alert? Are they running around? Do they seem generally ill or distressed? Who is with them? Are they sat on their parents knee? Are there any medications around?.
We evaluate the respiratory pattern and its changes: dyspnoea, tachypnoea, apnea, hyperpnea, bradypnea, Cheyne-Stokes respiration, Biot respiration, Kussmal respiration.
Palpation
Chest Expansion – in young children, only need to check one, usually on the front. In older children, with a larger thorax, you should check 4 times – twice on the front, and twice on the back – at the top, right under the axilla, and at the bottom of the thorax. Measure chest expansion with tape measure – measure at full inspiration and full expiration. (not often performed in practice. Heart – feel the location of the apex beat, checking for displacement.
Percussion
Is not commonly performed on newborns and infants, as it will not yield great results in very small children (under 2). Should be performed in older children. Same technique as adult
Over the healthy lungs the tap is full, clear percussion is hollow or shortened above the airless lungs (atelectasia, pneumonia).
Auscultation
Same technique as adult – just make sure you compare sides and listen to all lobes, including under the axilla and to the apices above the clavicle.
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