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Teaching Respiratory Diseases in

Bedside Paediatrics

Dr. Pushpa Raj SharmaProfessor of Child HealthInstitute of Medicine

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Why children are brought to Kanti

Childrens Hospital? Fever

Cough or difficulty in breathing.

Diarrhoea/Vomiting

Not feeding well

Abdominal pain Rash

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A child with cough or difficulty in

breathing Triage by symptoms

Convulsion/drowsy

Grunting Bluish spell

Persistent vomiting

Inability to

swallow/drooling ofsaliva

Triage by signs Glasgow coma scale

Stridor/chest in-drawing/flaring of alenasi

Cyanosis

Dehydration

Epiglottitis/peritonsilar abscess/

retropharyngealabscess

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Detailed history: Present

illness Entry questions

Threading questions

Duration of symptoms

Onset of symptoms

Risk factors

Treatments

Other systeminvolvement

Does your child can lieflat while sleeping?

Which side s/he prefersto lie down?

Hours, days, months.

Preceding runny nose

Mother smoker,biomass fuel for cooking

Nebuliser

Mental retardation

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Detailed history: Past illness Recurrent episodes

Present since birth

Same precipitatingfactor

Drugs used

Operations

IgA deficiency

Congenital anomaly

Asthma

Salbutamol in

asthma Tonsillectomy

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Birth history Antenatal infection

Prematurity

Low birth weight

Intubation

Hypothermia

Jaundice

Pneumonia

Immature lung

Pneumonia

Laryngeal stenosis

Surfactant deficiency

Alfpha 1 antitrypsindeficiency

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Nutritional history Formula feeding

Vit A deficiency

Protein deficiency

Adequate calorie

Inadequate calorie

Cows milk Too much calorie

Asthma

Pneumonia

Recurrent infection

Hyper catabolicstate

Hypoglycaemia Haemosiderosis

Diminished chestexpansion

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Developmental history Delayed motor

milestones.

Trisomy Mental retardation

Recurrent infections.

IgA deficiency

Aspirations

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Family/social history Over crowding

Similar disease

Smoker

Domestic smoke

Carpet worker

Change of place Sleeping with coal

heat

Recurrent infections

Tuberculosis

Cough

Cough

Tuberculosis/asthma

Asthma CO poisoning

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Inspection Respiratory rate

Pattern of breathing

Triage signs Red eyes/runny nose

Transverse creases inthe nose

Prominent maxilla Harrison's sulcus

Atopic eczema

Pneumonia

Acidosis

Grunting etc Viral infections

Allergic rhinitis

Enlarged adenoids

Recurrent obstructiveair way disease

Asthma

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Palpation Tenderness

Displaced apex beat

movement

Cervical nodes

vocal fremitus

Liver Shifting trachea

Trauma

Pneumo/collapse

Pneumonia/effusion

Lymphoma

Consolidation

Pneumothorax/sepsis

Effusion/collapse

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Auscultation Turbulent air flow through the

respiratory tube causes vibration of its

wall Sound generated by this vibration is

transmitted through different media tothe ear drum then to cortex

Inspiration and expiration will havedifferent quality

Changes in the wall and conducting

media changes the quality of sound

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Types of respiratory sound Different names Dry sounds

Vesicular

Bronchial Vesicular with

prolonged expiration

Moist sound: Fine crepitations

Coarse crepitations

Plerual rub

Snoring

stridor

Wheeze

Ronchi

Breath sound

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Characteristic of moist sounds Asses with each

respiratory cycle In respiratory tube

whole inspiration

and expiration In alveoli at the

beginning and endof inspiration and

expiration

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Auscultation Snoring

Stridor

Wheeze

Ronchi

Prolonged expiration

Vesicular Bronchial

Palatal palsy

Epiglottitis

Asthma/foreign body

Bronchiolitis

Asthma

Normal Consolidation/

collapse

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Percussion

Tenderness

Hyper resonant

Dullness

Displace upper

border of liverdullness

Trauma/infection

Pneumothorax

Effusion/collapse/

consolidation

Hyperinflation

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Other system examination

VSD

Juvenile rheumatoid

arthritis Gastrooesophageal

reflux

Hepatosplenomegaly Failure to thrive

Recurrent pneumonia

Pleural effusion

Recurrent aspiration

Malignancy Cystic fibrosis