Teaching Respiratory Diseases in Teaching Respiratory Diseases in Bedside PaediatricsBedside Paediatrics

Dr. Pushpa Raj SharmaProfessor of Child Health

Institute of Medicine

Why children are brought to Kanti Children’s Hospital?

Fever Cough or difficulty in breathing. Diarrhoea/Vomiting Not feeding well Abdominal pain Rash

A child with cough or difficulty in breathing

Triage by symptoms Convulsion/drowsy Grunting Bluish spell Persistent

vomiting Inability to

swallow/drooling of saliva

Triage by signs Glasgow coma scale Stridor/chest in-

drawing/flaring of ale nasi

Cyanosis Dehydration Epiglottitis/

peritonsilar abscess/ retropharyngeal

abscess

Detailed history: Present illness Entry questions

Threading questions

Duration of symptoms Onset of symptoms Risk factors Treatments Other system

involvement

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 Recurrent

episodes Present since birth Same

precipitating factor

Drugs used Operations

IgA deficiency Congenital

anomaly Asthma

Salbutamol in asthma

Tonsillectomy

Birth history Antenatal

infection Prematurity Low birth weight Intubation Hypothermia Jaundice

Pneumonia Immature lung Pneumonia Laryngeal stenosis Surfactant

deficiency Alfpha 1

antitrypsin deficiency

Nutritional history Formula feeding Vit A deficiency Protein deficiency Adequate calorie Inadequate

calorie Cows milk Too much calorie

Asthma Pneumonia Recurrent infection Hyper catabolic

state Hypoglycaemia Haemosiderosis Diminished chest

expansion

Developmental history Delayed motor

milestones. Trisomy Mental

retardation

Recurrent infections.

IgA deficiency Aspirations

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

Inspection Respiratory rate Pattern of breathing Triage signs Red eyes/runny nose Transverse creases in

the nose Prominent maxilla Harrison's sulcus

Atopic eczema

Pneumonia Acidosis Grunting etc Viral infections Allergic rhinitis

Enlarged adenoids Recurrent obstructive

air way disease Asthma

Palpation Tenderness Displaced apex

beat movement Cervical nodes vocal fremitus Liver Shifting trachea

Trauma Pneumo/collapse Pneumonia/

effusion Lymphoma Consolidation Pneumothorax/

sepsis Effusion/collapse

Auscultation 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 Different names

Dry sounds Vesicular Bronchial Vesicular with

prolonged expiration

Moist sound: Fine crepitations Coarse crepitations Plerual rub

Snoring

stridor

Wheeze

Ronchi

Breath sound

Characteristic of moist sounds Asses with each

respiratory cycle

In respiratory tube whole inspiration and expiration

In alveoli at the beginning and end of inspiration and expiration

Auscultation Snoring Stridor Wheeze Ronchi Prolonged

expiration Vesicular Bronchial

Palatal palsy Epiglottitis Asthma/foreign

body Bronchiolitis Asthma Normal Consolidation/

collapse

Percussion Tenderness Hyper resonant Dullness

Displace upper border of liver dullness

Trauma/infection Pneumothorax Effusion/collapse/

consolidation Hyperinflation

Other system examination

VSD Juvenile

rheumatoid arthritis

Gastrooesophageal reflux

Hepatosplenomegaly

Failure to thrive

Recurrent pneumonia

Pleural effusion

Recurrent aspiration

Malignancy Cystic fibrosis