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214 Cards in this Set
- Front
- Back
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Which diameter should be bigger, lateral or AP?
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The lateral diameter of the chest generally exceeds teh AP diameter in adults.
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What do the external intercostal muscles do?
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Increase the AP chest diameter during expiration
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What do the internal intercostals do?
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Decrease the lateral diameter during expiration
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When are the accessory muscles of respiration used?
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During exercise or when there is pulmonary compromise.
(SCM and trapezius and pec minor) |
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What special structure does the left upper lobe have?
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Lingula, an inferior tongue-like projection which is a counterpart of the right middle lobe.
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What does the lesser horizontal fissure divide?
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Upper portion of the right lung into upper and middle lobes
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What level is the lesser horizontal fissure?
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5th rib in axilla
4th rib midclavicular |
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How many aveoli does an adult have?
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300 million
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How far does the apex extend beyond the first rib?
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4cm above first rib into the base of the neck.
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What level do the apexes of the lungs rise?
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T1
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What level do the lower boarders descend to on inspiration, and expiration?
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Inspiration: T12
Expiration: T9 |
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How long/wide is the trachea?
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10-11cm long
2cm diameter Anterior to esophagus, posterior to isthmus of thyroid. |
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Where does the trachea divide?
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Level of T4-T5 (angle of louis)
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What is different about hte right bronchus compared to the left?
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The right is wider, shorter, and more vertically placed. It will also divide into three branches.
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Where do the bronchial arteries branch from?
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Thoracic aorta
Intercostal arteries |
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Where is the bronchial vein formed?
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Hilum of the lung
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Through what system is most of the pulmonary blood returned to the heart?
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Pulmonary veins, moreso than the bronchial veins.
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What is the level of the horizontal fissure of the right lung?
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5th rib in the midaxilla - 4th rib at the sternum
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What level is the diagonal fissure on both sides of the lungs?
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5th rib at the axilla - 6th rib ad midclavicular line
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In the posterior view of the body, what levels do the lower lobe of the lungs span?
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T3 to T10/T12
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The lungs on the right and left lateral sides extend to what ribs?
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From peak of axilla to 7 or 8th ribs
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On the right lateral view the upper lobe of the lung is demarcated by?
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Level of 5th rib midaxilary
6th rib anteriorly |
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On the left lateral view the oblique fissure spans what levels?
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3rd rib medially - 6th rib anteriorly
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What topographic markers on the chest are used to describe findings?
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1) nipples
2) angle of Louis 3) suprasternal notch 4) costal angle (<90 degrees) (ribs @ 45 degree angles) 5) Vertebra prominens 6) clavicles |
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At what point in gestation is the lung a groove on the ventral wall of the gut?
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4 weeks gestation
It evolves from a simple sac to an involuted structure of tubules and spaces |
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What are the passive respiratory movements throughout much of gestation?
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Preparation for the infant to respond to postnatal chemical and neurologic respiratory stimuli.
They do not open the alveoli or move the lung fields. |
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What is fetal gas exchange mediated by?
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The placenta
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What does the decrease in pulmonary pressure after birth cause?
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Closure of the foramen ovale within minutes.
Increased oxygen tension in the arterial blood closes ductus arteriosus |
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What are the dimensions of a newborn's chest?
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AP is close to the lateral diameter
Circumference is equal to head until 2 years old. Xiphoid process is more prominent and more movable |
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When does the number of aveoli increase?
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At a very rapid rate in the first 2 years of life.
Slows down by 8 years. |
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What happens to the chest dimensions during pregnancy?
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Lower ribs flare.
Increase in the lateral diameter of 2cm Increase in circumference of 5-7cm Subcostal angle increases from 68.5 degrees to 103.5 degrees in later pregnancy. |
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What happens to the diaphragm at rest during pregnancy?
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It rises as much as 4cm above its usual resting position
Movement increases so major work of breathing is done by the diaphragm. |
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What happens to ventilation in pregnancy?
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Minute ventilation increases due to increased tidal volume
Respiratory rate is unchanged |
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Why do older adults get a barrel chest?
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From loss of muscle strength in the thorax and diaphragm
Loss of lung resiliency Dorsal curve of the Tspine is larger, so AP diameter gets bigger. Stiffening and decreased expansion of chest wall |
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What happens to the aveoli with age?
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Become less elastic and relatively more fibrous.
Loss of interalveolar folds => decreases the alveolar surface available for gas exchange |
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Why do older adults become underventilated?
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Decreased alveolar surface area
Loss of tensile strength in the muscles of respiration This keeps older adults from having a good tolerance during exertion |
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What is the net result of lung changes in the older adult?
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Overall the net result is a decrease in vital capacity and in an increase in residual volume
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What happens to mucous membranes with aging?
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Become drier, people have problems clearing the mucous.
This encourages bacterial growth and predisposes the older adult to respiratory infection. |
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What is dyspnea?
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Difficult and labored breathing with shortness of breath.
Increases with severity of the underlying condition. |
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When do you see dyspnea?
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With pulmonary or cardiac compromise.
Sedentary lifestyle, obesity. |
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What questions tell you about the amount and kid of effort that produces dyspnea?
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Present even when patient is resting?
How much walking? On level surface? Up stairs? Do you need to stop and rest when climbing stairs? What other activities of daily life does dyspnea begin? What level of physical demand? |
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What is orthopnea?
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SOB that begins or increases when patient lies down
Ask if patient needs to sleep on more than one pillow |
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What is paroxysmal nocturnal dyspnea?
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Sudden onset of SOB after a period of sleep.
Sitting upright alleviates it |
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What is platypnea?
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Dyspnea that increases in the upright posture
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When is chest pain not from the heart?
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Constant achiness that lasts all day.
Non-radiating It is made worse by pressing on the precordium. Fleeting-needle-like jab that lasts only a second or two In shoulders or between shoulder blades int he back |
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What characteristics of a cough should you inquire about during a history?
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Dry, moist, wet, hacking, barking, whooping, bubbling, productive, nonproductive
Sputum production/characteristics Pattern/severity of cough |
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What are the associated symptoms of a cough?
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SOB, chest pain/tightness with breathing, fever, coryza, stuffy nose, noisy respirations, hoarseness, gagging, choking, stress
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When should you ask about sleeping and sleeping position?
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When you are inquiring about SOB complaint.
Also ask if it is harder to inhale/exhale |
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What should you ask about chest pain?
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Associated with trauma, coughing, infection, if they have had anesthesia recently, history of thrombophlebitis
Associated symptoms: shallow breathing, fever, cough, anxiety, radiation of pain to neck/arms Do you do cocaine!? |
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What issues in past medical history should you ask about when presented with pulmonary problems?
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Trauma, surgery, hospitalizations
Oxygen breathing devices CPAP BiPAP TB, bronchitis, emphysema, bronchiectasis, asthma, cystic fibrosis Cardiac, cancer, blood clotting disorders Allergy testing, pulmonary fxn testing, TB tets, chest xrays Immunizations (particularly Strep pneumoniae/ influenza) |
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What things in the family history are important to ask about with pulmonary issues?
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TB
CF Emphysema Allergy, Asthma, Atopic dermatitis Malignancy Bronchiectasis Bronchitis Clotting disorders |
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What should you always ask about with severe, acute chest pain?
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Drug use, particularly cocaine.
Causes tachycardia, HTN, coronary arterial spasm (with infarct) and pneumothorax Severe acute chest pain is the result of this. |
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What is the sequence of steps in the examination of the chest?
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Inspection
Palpation Percussion Auscultation |
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When is dullness on percussion present?
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Pleural effusion - breath sounds absent/ tactile fremitus absent
Lobar pneumonia - bronchial breath sounds/ increased fremitus present |
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What questions should you ask in a personal/social history?
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Employment: exposure to lung irritants
Home environment: CO detectors, mold, allergens Tobacco use Exposure to infection Nutrition Use of alternate therapies Travel Hobbies (owning birds, animals, woodwork, welding) Use of alcohol/drugs Exercise tolerance |
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In children, what specific things should you probe for during a pulmonary history?
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Low birth weight
Issues if baby was premature Coughing Aspiration of small object, toy, food Ingestion of kerosine, antifreeze or hydrocarbons in cleaners Apneic episodes: cyanosis, breath holding, post-tussive emesis, history of SIDS infamily Swallowing dysfunctions History of immunizations |
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What questions do you ask a pregnant women presenting with pulmonary issues?
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Weeks of gestation
Multiple fetuses Polyhydraminios Large uterus displacing diaphragm Exercise Exposure to infections |
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What questions should be emphasized in older adults?
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Smoking history
Cough, dyspnea on exertion, breathlessness Blood-tinged or yellow/green sputum Fatigue Weight change Fever, night sweats (weather, infections, immobilization, alteration of daily living due to respiratory problems) |
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How should a patient be positioned during a pulmonary exam?
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So that the light source comes at different angles and may accentuate findings.
Pulsations, retractions, deformities. |
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What is barrel chest?
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Results from compromised respiration: chronic asthma, emphysema, CF
Ribs horizontal Kyphotic spine Prominent sternal angle Posterior displacement of trachea |
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What is the "thoracic ratio"?
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.7-.75
AP should be less than the lateral diameter. |
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What thoracic ratio indicates a chronic condition?
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The ratio does increase with age, but a ratio of 1 or great indicates a chronic condition
Chest wall contour can also change with structural problems of the spine |
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What are the two common structural problems of the chest?
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Pectus carinatum (pigeon chest) = protrusion of sternum
Pectus excavatum (funnel chest) = indentation of lower sternum above xiphoid process |
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What is a malodorous odor of the breath indicate?
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Intrathoracic infection
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What are supernumerary nipples a clue for?
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Congential abnormalities
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What is a superficial venous pattern over the chest a sign of?
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Heart disorders or vascular obstruction
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What does the underlying fat and prominence of the ribs give a clue for?
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General nutrition
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What is the normal respiratory rate?
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12-20 per minute
Depends on the age of the individual and the degree of exertion (note behavior before taking respirations) |
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What is the ratio of respirations to heart beat?
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1:4
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Why does tachypnea occur?
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Hyperventilation
Noticing the physician counting breaths Protective splinting from pain Massive liver enlargement Abdominal acites (prevents decent of diaphragm) |
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What causes bradypnea?
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Neurologic or electrolyte disturbance
Infection Protect against pain or irritation Indicates cardiorespiratory fitness, large lung capacity. |
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What causes hyperpnea?
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Deep breathing:
Exercise Anxiety CNS disease Metabolic disease = Kussmaul breathing |
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When does hypopnea occur?
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Pleuritic pain limits excursion
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What is Cheyne-Stokes respiration?
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Regular periodic pattern of breathing, intervals of apnea followed by a crescendo/decrescendo sequence of respiration.
Can happen during sleep Most of the time people with brain damage (cerebral) or drug-associated respiratory compromise demonstrate this type of breathing. |
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What are sighs associated with?
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Emotional distress, or an incipient episode of more severe hyperventilation.
However, it is a normal respiratory sound |
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What is air trapping?
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The result of a prolonged but inefficient expiratory effort.
Rate of respiration increases to compensate, the effort becomes more shallow, the amount of trapped air increases, and the lungs inflate. This leads to a barrel chest. |
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What is biot respiration?
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Irregular respirations that vary in depth and are interrupted by apnea
Lack the repetitive pattern of periodic respiration. Occasionally: respirations are regular but apneic periods are irregular. |
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What is biot respiration usually associated with?
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Severe and persistent increased intracrainial pressure
Respiratory compromise from drug poisoning Brain damage at the level of the medulla Referred to as "ataxic" in its more extreme expression. |
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The rate and depth of breathing will increase with?
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Acidosis (metabolic)
CNS lesions (pons) Anxiety Aspirin poisoning Oxygen need (hypoxemia) Pain |
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The rate and depth of breathing will decrease with?
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Alkalosis (metabolic)
CNS lesions (cerebrum) Myasthenia gravis Narcotic overdoses Obesity (extreme) |
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What is apnea?
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Absence of spontaneous respiration.
Seizures, CNS trauma, hypoperfusion, infections, drug ingestions, obstructive sleep disorders can all cause apnea. |
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What is a self-limited condition that is not uncommon after a blow to the head, noted immediately after birth of a newborn?
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Primary Apnea
The infant will breathe spontaneously after CO2 builds up |
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What is a normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea that one associate with REM sleep?
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Periodic apnea of newborn
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When irritating and nausea-provoking vapors or gases are inhaled the temporary halt to respiration that occurs is?
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Reflex apnea
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When breathing stops and it will not begin spontaneously, so that resuscitative measures are needed is what type of apnea?
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Secondary
Severely limits the absorption of oxygen into the bloodstream |
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What type of apnea is characterized by periods of an absence of breathing and oxygenation during sleep?
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Sleep apnea
Obstruction airflow is not maintained through the nose and mouth |
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What type of apnea has long inspirations?
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Apneustic breathing.
Expiration apnea - neural center in pons is affected and breathing becomes gasping because inspirations are so prolonged that expiration becomes contrained. |
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What can chest asymmetry be associated with?
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unequal expansion and respiratory compromise caused by a collapsed lung or limitation of expansion by extrapleural air, fluid, or a mass.
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What is unilateral/bilateral bulging a sign of?
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Reaction of the ribs and interspaces to an obstruction.
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What is a prolonged expiration and bulging on expiration caused by?
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Outflow obstruction or the valvelike action of compression by a tumor, aneurysim or enlarged heart.
Costal angle widens beyond 90 degrees. |
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What are retractions?
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Chest wall caves at the sternum, between the ribs, at the suprasternal notch, above the clavicles and at the lowest costal margins.
Obstruction to inspiration at any point in the respiratory trackt. |
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What happens as intrapleural pressure increases in the negative direction?
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The musculature pulls back in an effort to overcome blockage.
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What is breathing characterized by when an obstruction is high in the respiratory tree?
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Stridor
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What is paradoxic breathing?
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Inspiration = lower thorax drawn in
Expiration = lower thorax blown out Negative intrathoracic pressure is transmitted to the abdomen by a weak, poorly functioning diaphragm; obstructive airway disease; or during sleep when there is an obstruction present |
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What does a foreign body in a bronchus cause?
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Unilateral retractions = suprasternal notch not involved.
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What is going on when there is retraction of the lower chest?
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Asthma
Bronchiolitis |
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What does clubbing indicate? Does it hurt?
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It suggests significant disease, may also be congenital. Chronic fibrotic changes in lung, emphysema, lung cancer, cyanosis of CHF, cystic fibrosis.
It is symmetric and painless. |
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What does flaring of the nares indicate?
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Air hunger
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What is crepitus?
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Crackly/crinkly sensation - palpated and heard
-Indicates air in the subcutaneous tissue from a rupture somewhere in the respiratory system -Infection with gas producing organism -Localized or wide area that can spread to face ALWAYS requires attention! |
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What does a palpable, coarse, grating vibration on inspiration suggest?
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Pleural friction rub
Inflammation of pleural surfaces. |
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Where do you evaluate thoracic expansion during respiration?
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Behind the patient, thumbs on SP @ level of 10th rib.
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What is tactile fremitus?
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Palpable vibration of the chest wall that results from speech or other verbalizations.
Best felt parasternally at the second intercostal space at the level of the bifurcation of the bronchi. |
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What signs indicate a severe obstructed airway?
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Stridor on both I & E
Barking cough Retractions of suprasternal notch + subcostal + intercostal spaces Cyanosis |
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What signs indicate the obstruction is above the glottis?
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Muffled voice
Quiet stridor Difficult swallowing No cough Head and neck position awkward |
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What signs indicate the obstruction is below the glottis?
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Stridor louder, more rasping
Hoarse voice Swallowing not affected Cough harsh & barking |
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What causes decreased/absent fremitus?
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Excess air in the lungs
Emphysema Pleural thickening Effusion Massive pulmonary edema Bronchial obstruction |
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What causes increased fremitus?
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Presence of fluids
Solid mass Lung consolidation Bronchial secretions Compressed lung tumor |
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What can cause gentile, more tremulous fremitus?
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lung consolidation
Inflammatory/infectious processes |
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Which side does the trachea normally deviate to?
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The right.
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What can an anterior mediastinal mass cause?
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Compression of the trachea posteriorly.
This can compromise respiration, you will hear stridor and the patient may sit up and lean forward to alleviate it. |
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What pulls the trachea toward an affected lung?
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Volume loss (fibrosis/atelectasis/tumor/adenopathy) pulls trachea away from affected side
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What does pneumothorax do to the trachea?
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Goes either way, but with tension pneumothorax there is a deviation away from the
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What happens to the trachea with a collapsed lung?
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Deviates towards affected side
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What happens to the trachea with mediastinitis?
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Trachea may be pushed forward
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What intervals should one percuss in?
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4-5cm intervals over the interspaces, moving from superior to inferior and medial to lateral
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Where is resonance heard? What does it sound like?
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Over all areas of the lungs
Loud Low pitch Long duration Hollow |
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When is hyperresonance heard? What does it sound like?
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Hyperinflation: emphysema, pneumothorax, asthma
Very loud Very low pitch Longer duration Booming |
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When is dullness or flatness heard? What do they sound like?
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Pneumonia, atelectasis, pleural effusion, pneumothorax, asthma
Flat: (heard over muscles/bones) -Soft -High pitch -Short duration -Very dull Dull: -Medium -Medium to high pitch -Medium duration -Dull thud |
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When is tympany heard? What does it sound like?
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Associated with percussion over the abdomen (gastric bubble)
Loud High pitch Medium length Drumlike |
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What can limit the diaphragmatic excursion?
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Emphysema
Abdominal = massive acites/tumor/pain |
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What should the excursion distance be?
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3-5(6) cm
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What does sweet,fruity breath indicate?
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Diabetic ketoacidosis
Starvation ketosis |
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What is halitosis caused from?
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Tonsilitis
Gingivitis Respiratory infections Vincent angina Gastroesophogeal reflux |
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What does cinnamon breath mean?
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Pulmonary TB
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What does a fishy/stale smell to the breath indicate?
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Uremia (trimethylamines)
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What does a foul/putrid odor indicate?
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nasal/sinus pathology: infection, foreign body, cancer
Respiratory infections: empyema, lung abscess, bronchiectasis |
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What does an ammonia-like breath smell indicate?
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Uremia (ammonia)
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What does a foul/feculent odor do the breath indicate?
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Intestinal obstruction
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What does a musty fish/clover smell to the breath indicate?
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Fector hepaticus: hepatic failure, portal vein thrombosis, portacaval shunts
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Where do most pulmonary pathologic conditions occur?
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Lung bases = examine these first before the person gets fatigued
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If the patient may have CHF where should you begin auscultation?
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Base of lungs
Detect crackles that may disappear with continued exaggerated respiration |
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Where are the middle lobe of the Rt lung, and the lingula on the left best heard?
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Axillae
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What breath sounds are low-pitched, low-intensity sounds heard over lung tissue?
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Vesicular
Inspiration > expiration Soft, short expirations. More prominent in a thin person/child Diminished in overweight/muscular people |
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What breath sounds are heard over the major bronchi and are moderate in pitch and intensity?
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Bronchovesicular
Abnormal if heard over peripheral lung tissue Heard UPPER RIGHT posterior lung field Expiration = inspiration |
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What sounds are the highest in pitch/intensity?
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Bronchial sounds - only heard over the trachea
Expiration > inspiration Abnormal if heard over peripheral lung tissue |
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What is amphoric breathing and when is it heard?
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Blowing across the mouth of a bottle sounding.
Heard with large, stiff-walled pulmonary cavity, tension pneumothorax, bronchopleural fistula |
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What is cavernous breathing?
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Sounds like its coming from a cave.
Heard over pulmonary cavity where there is a rigid wall. |
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What pulmonary conditions do people with sickle cell disease have?
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Infarction, pulmonary crisis.
Among other signs, the patient will also arch the back as they attempt to breathe more comfortably |
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What are adventitious sounds?
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Crackles (discontinuous),
rhonchi, wheezes (continuous) friction rubs |
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What is a fine crackle?
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High-pitched
Discrete Discontinuous Not cleared by a cough Heard at END of INSPIRATION |
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What are medium crackles?
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Lower
More moist Not cleared by a cough Heard at MIDSTAGE of INSPIRATION |
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What are coarse crackles?
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Loud
Bubbly Not cleared by cough Heard during INSPIRATION |
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What causes crackles?
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Disruptive passage of air through the small airways in the respiratory tree.
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What are high pitched crackles termed?
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sibilant
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What are low-pitched crackles termed?
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sonourous
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Where do dry, crisp crackles occur?
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Higher in the respiratory tree.
Can be heard with an open mouth |
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What are ronchi?
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Sonorous wheeze
Loud/Low Coarse/Continuous Snoring sound Cough MAY clear Heard CONTINUOUSLY through INSPIRATION or EXPIRATION (more pronounced here) |
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What causes rhonci?
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Passing of air through an obstructed airway by thick secretions, muscular spasm, new growth, or external pressure.
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Where do more sibilant, high-pitched rhonci come from? Low pitched?
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High: smaller bronchi (asthma)
Low: Larger bronchi (tracheobronchitis) Sometimes you can feel them. |
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What is a sibilant wheeze?
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Musical noise = squeak
Louder during EXPIRATION (can be heard during both) |
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What causes wheezing?
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High-velocity air flow through a narrowed/obstructed airway.
Longer/higher pitch = worse obstruction |
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What is occurring if a wheeze is heard bilaterally?
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Bronchospasm of asthma (reactive airway disease)
Acute/chronic bronchitis |
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What does a sharp unilateral localized wheeze come from?
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Foreign body
Tumor = consistent wheeze |
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What is a pleural friction rub?
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Dry, rubbing, grating sound = outside respiratory tree
Machine like quality Inflammation of pleural surfaces cause it. Loudest over LOWER LATERAL ANTERIOR surface Heard during both I &E |
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What areas are significant if a rubbing sound is heard?
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Over liver/spleen = none
Over heart = inflamed surfaces rubbing together Over pericardium = pericarditis Over Lungs = pleurisy Disappears when breath is held (respiratory) Cardiac never goes away |
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What is Hamman sign?
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Medistinal crunch (crackles, clicking, gurgling sounds) found with mediastinal emphysema.
Synchronous with heartbeat and not respiration. More pronounced towards the END of EXPIRATION Easiest to hear when patient leans to left or lies down on LEFT |
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What naturally lends to an intensity of vocal resonance?
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A man's low pitched voice
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Where is vocal resonance heard best?
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Medially (usually muffled and indistinct though)
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What is greater clarity and increased loudness of spoken sounds?
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Bronchophony
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What does it mean if broncophony is extreme?
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Consolidation of the lungs
Also with whisper, and egophony |
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When does vocal resonance diminish?
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When there is loss of tissue within the respiratory tree
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What is the mechanism of a cough?
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Deep inspiration => closure of glottis => contraction of chest, abdominal, pelvic muscles => spasmotic expiration => sudden opening of glottis
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What is the 4th leading cause of death in the US?
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COPD
From cigarettes, 20% die have never smoke though. |
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What causes a moist cough?
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Infection => sputum production
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What causes a dry cough?
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Allergies
Cardiac problems |
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What does an acute onset of cough with a fever suggest?
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Infection
Without fever: foreign body, inhaled irritants |
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What does an infrequent cough indicate?
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Allergens/environment
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When is a regular, paroxysmal cough heard?
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In pertussis
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When does an irregular cough occur?
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Smoking
Early CHF Foreign body/irritant Tumor compressing bronchial tree |
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What causes a "brassy" cough? A hoarse cough?
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Compression of respiratory tree
Croup |
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What type of illness causes a whoop at the end of a cough?
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Pertussis (whooping cough!)
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Where do snoring and gurling tend to arise?
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Nasopharynx
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Where does stridor tend to arsie?
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Glottis
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Where does wheezing normally arise?
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Lower respiratory tree
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What types of infections can cause respiratory sounds?
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Peritonsillar abscess
Retropharyngeal abcess Epiglotttitis Laryngitis Trachetitis Bronchitis Bronchiolitis Viral croup |
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What types of irritants/allergen can cause respiratory sounds?
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Asthma
Rhinitis Angioneurotic edema |
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What can compress the airway from the outside?
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Esophageal cysts
Foreign body Tumors Lymphadenopathy |
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What types of congenital malformations/abnormalities cause respiratory sounds?
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Vascular rings
Laryngeal webs Laryngomalacia Tracheomalacia Hemangiomas Stenosis Cystic fibrosis |
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What acquired abnormalities of the airway cause sounds?
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Excessive use of voice
Nasal polyps Hypertrophied tonsils Foreign body Corrosive ingestion Intraluminal tumors Bronchiectasis Burns, thermal injury, smoke inhalation Post intubation |
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What neurogenic disorder can cause respiratory sounds?
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Vocal cord paralysis
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What kind of sputum does a bacterial infection cause?
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yellow, green, rust (bloody)
Clear, transparent Purulent Blood-streaked Mucoid, viscid |
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What kind of sputum does a viral infection cause?
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Mucoid, viscid
Blood streaked (not common) |
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What kind of sputum does a chronic infection cause?
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All colors.
Abundant in AM, occasionally large amounts of blood |
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What kind of sputum does a carcinoma cause?
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Slight, persistent, intermittent blood streaking
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What kind of sputum does an infarction cause?
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Blood clotted
Large amounts of blood |
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What kind of sputum does a tuberculous cavity cause?
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Occasional large amounts of blood
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What APGAR score would an infant have if the respirations are inadequate?
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1 or 0 on heart rate, muscle tone, response to catheter, or color
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What can depress a newborns respiratory rate?
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Maternal stuff: sedatives, compromised blood supply
Mucosal obstruction |
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What is the chest circumference in a full term infant?
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30-36 cm (2-3cm smaller than head)
IUGR: smaller chest Diabetes: Larger chest |
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What is the expected respiratory rate the first few hours after birth?
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40-60 respirations per minute, a rate of 80 is not uncommon
C-section babies have more rapid respirations |
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What is periodic breathing?
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Vigorous respiratory efforts followed by apnea as long as 10-15 seconds
If baby turns blue = concerning! As baby approaches term status the frequency of this apnic breathing will decline. In a term baby this breathing should wane a few hours after birth |
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What respiratory movements are normal in a newborn?
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Coughing is rare = problem
Sneezing = normal Hiccups = frequent (silent) Frequent hiccups = seizures, drug withdrawal, encephalopathy |
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What respiratory muscle do infants rely primarily on?
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Diaphragm
Gradually add the intercostals, and commonly use abdominal msucles. Paradoxic breathing (collapsing chest wall on inspiration) is common during sleep |
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If the chest wall expansion in an infant is asymmetric what should one suspect?
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Compromise of the baby's ability to fill one of the lungs.
Pneumothorax Atelectasis Diaphragmatic hernia |
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What does an APGAR score of 0 indicate?
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Heart rate: absent
Respiratory effort: absent Muscle tone: limp Catheter in nostril: no response Color: blue or pale |
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What does an APGAR score of 1 indicate?
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Heart rate: slow <100
Respiratory effort: Slow/irregular Muscle tone: Flexon of extremities Catheter in nostril: grimace Color: body pink, extremities blue |
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What does an APGAR score of 2 indicate?
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Heart rate: > 100 bpm
Respiratory effort: Good crying Muscle tone: Active motion Catheter in nostril: Cough or sneeze Color: totally pink |
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When is finding crepitus normal in an infant?
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After a fractured clavicle from a rough delivery.
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What breath sounds are common after birth?
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Crackles and rhonchi = fetal fluid has not been completely cleared
If not symmetric expect aspiration (possibly of meconium) |
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What must be suspected if GI gurgling sounds are heard in the chest of an infant?
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Diaphragmatic hernia, but this can sometimes be deceptive.
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When can stridor not be dismissed in an infant?
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When inspiration is 3-4x longer than expiration (3:1 or 4:1)
When accompanied by a cough, hoarseness, and retraction, stridor signifies a serious problem on teh trachea or larynx. Floppy epiglottis, congenital defect, croup, edematous response to an infection, allergen, smoke, chemicals, aspirated foreign body |
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What can cause stridor in an infant?
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Narrow tracheal lumen from compression by a tumor, abscess, double aortic arch.
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Retraction at the supraclavicular notch and contraction of the SCM indicates?
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Significant respiratory distress.
Also flaring of the alae nasi. |
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What is grunting?
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Mechanism by which infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels.
When persistent = concern |
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When do children use the intercostal musculature for respiration?
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6-7 years old.
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When do breathing rates of children vary the most?
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Within the first 2 years of life
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What are the respirations per minute for: Newborn? 1 year? 3 years? 6 years? 10 years? 17 years?
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N: 30-80
1: 20-40 3: 20-30 6: 16-22 10: 16-20 17: 12-20 |
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If a young child's chest does not assume the adult shape past 2 years old, what may be occuring?
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Chronic obstructive pulmonary problem: cystic fibrosis
Barrel chest at 5/6 years can be ominous. |
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How do you manage children and doing a pulmonary exam?
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Take advantage of crying
Ask child to "blow out a candle," when looking for an expiration. Ask child to run around and then auscultate to hear deeper breath sounds |
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What does a thin chest wall of a child bring about?
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Louder, harsher sounds
Sound more bronchial. Bronchiovesicular sounds can be heard in all chest areas. Common hyperresonance |
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If a kid presents with wheezing, what is your first DD?
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Foreign body
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What are alternative symptoms of pneumonia other than crackles?
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Flaring of nasal alae
Tachypnea Productive cough (without crackles) |
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What is an unexplained but persistant tachycardia an indicator of?
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Minimal pneumothorax
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What are important observations of respiratory effort?
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Loss of synchrony btwn Lt and right?
Lag in movement? Stridor? Croup or epiglottitis? Retraction at suprasternal notch? Xiphoid process? Dilated and flaring nares? Audible grunt? |
