Transcript Teaching Respiratory Diseases in Bedside Paediatrics

Teaching Respiratory Diseases in
Bedside Paediatrics
Dr. Pushpa Raj Sharma
Professor of Child Health
Institute of Medicine
Why children are brought to Kanti
Children’s Hospital?
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Fever
Cough or difficulty in breathing.
Diarrhoea/Vomiting
Not feeding well
Abdominal pain
Rash
A child with cough or difficulty in
breathing
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Triage by symptoms
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Convulsion/drowsy
Grunting
Bluish spell
Persistent vomiting
Inability to
swallow/drooling of
saliva
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Triage by signs
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Glasgow coma scale
Stridor/chest indrawing/flaring of ale
nasi
Cyanosis
Dehydration
Epiglottitis/peritonsil
ar abscess/
retropharyngeal
abscess
Detailed history: Present
illness
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Entry questions
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Threading questions
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Duration of symptoms
Onset of symptoms
Risk factors
Treatments
Other system
involvement
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Does your child can lie
flat while sleeping?
Which side s/he prefers
to lie down?
Hours, days, months.
Preceding runny nose
Mother smoker, biomass
fuel for cooking
Nebuliser
Mental retardation
Detailed history: Past illness
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Recurrent episodes
Present since birth
Same precipitating
factor
Drugs used
Operations
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IgA deficiency
Congenital anomaly
Asthma
Salbutamol in
asthma
Tonsillectomy
Birth history
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Antenatal infection
Prematurity
Low birth weight
Intubation
Hypothermia
Jaundice
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Pneumonia
Immature lung
Pneumonia
Laryngeal stenosis
Surfactant deficiency
Alfpha 1 antitrypsin
deficiency
Nutritional history
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Formula feeding
Vit A deficiency
Protein deficiency
Adequate calorie
Inadequate calorie
Cows milk
Too much calorie
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Asthma
Pneumonia
Recurrent infection
Hyper catabolic
state
Hypoglycaemia
Haemosiderosis
Diminished chest
expansion
Developmental history
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Delayed motor
milestones.
Trisomy
Mental retardation
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Recurrent infections.
IgA deficiency
Aspirations
Family/social history
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Over crowding
Similar disease
Smoker
Domestic smoke
Carpet worker
Change of place
Sleeping with coal
heat
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Recurrent infections
Tuberculosis
Cough
Cough
Tuberculosis/asthma
Asthma
CO poisoning
Inspection
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Respiratory rate
Pattern of breathing
Triage signs
Red eyes/runny nose
Transverse creases in
the nose
Prominent maxilla
Harrison's sulcus
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Atopic eczema
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Pneumonia
Acidosis
Grunting etc
Viral infections
Allergic rhinitis
Enlarged adenoids
Recurrent obstructive
air way disease
Asthma
Palpation
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Tenderness
Displaced apex beat
movement
Cervical nodes
vocal fremitus
Liver
Shifting trachea
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Trauma
Pneumo/collapse
Pneumonia/effusion
Lymphoma
Consolidation
Pneumothorax/sepsi
s
Effusion/collapse
Auscultation
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Turbulent air flow through the
respiratory tube causes vibration of its
wall
Sound generated by this vibration is
transmitted through different media to
the ear drum then to cortex
Inspiration and expiration will have
different quality
Changes in the wall and conducting
media changes the quality of sound
Types of respiratory sound
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Different names
Snoring
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Dry sounds
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stridor
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Wheeze
Vesicular
Bronchial
Vesicular with
prolonged expiration
Ronchi
Breath sound
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Moist sound:
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Fine crepitations
Coarse crepitations
Plerual rub
Characteristic of moist sounds
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Asses with each
respiratory cycle
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In respiratory tube
whole inspiration
and expiration
In alveoli at the
beginning and end
of inspiration and
expiration
Auscultation
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Snoring
Stridor
Wheeze
Ronchi
Prolonged expiration
Vesicular
Bronchial
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Palatal palsy
Epiglottitis
Asthma/foreign body
Bronchiolitis
Asthma
Normal
Consolidation/
collapse
Percussion
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Tenderness
Hyper resonant
Dullness
Displace upper
border of liver
dullness
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Trauma/infection
Pneumothorax
Effusion/collapse/
consolidation
Hyperinflation
Other system examination
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VSD
Juvenile rheumatoid
arthritis
Gastrooesophageal
reflux
Hepatosplenomegaly
Failure to thrive
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Recurrent pneumonia
Pleural effusion
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Recurrent aspiration
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Malignancy
Cystic fibrosis