Respiratory medicine
Disorders of the respiratory tract
account for a major part of paediatric medicine both in hospital and in general
practice. There are 5 key common presentations that the practitioner should be
familiar with and we will focus on these first. Next, we will discuss the
investigations we use in the care of children. Last, we provide a
mini-catalogue of diseases and condi-tions that you will need to know about,
and be able to treat.
We have discussed the general
approach to history and examination for patients with respiratory illness. Here
are some additional points that you will need to take note of during your
consultation.
·
General information: neonatal period and any prior
endotracheal intubations; growth and
general body proportions; weight loss; immunizations.
·
Age of
onset of symptoms or problem.
·
Have
there been any triggers to this illness?
·
What
makes the problem worse? Exercise (e.g. asthma), sleep (e.g. adenotonsillar
hypertrophy and snoring)?
·
What
makes the problem better? (Bronchodilators in asthma.)
·
Other symptoms: haemoptysis; cough; sputum
production; choking; gastro-oesophageal
reflux; apnoea; coryza; chest/abdominal pain.
·
General information: growth parameters; clubbing;
lymphadenopathy; temperature; level
of consciousness; colour; and arterial pulse oximetry saturation; pulse rate.
·
Rate,
pattern of breathing (episodic, periodic, apnoea), duration of expiration, and
use of accessory muscles (+/– recession).
·
Nose and speech: crease across the bridge of the
nose and nasal discharge (e.g.
allergic rhinitis); hyponasal speech (e.g. palate and nasal problems); nasal or
mouth breather; nasal flaring.
·
Facial appearance: size of midface, lower jaw, tongue
(e.g. craniofacial syndrome).
·
Tonsillar
hypertrophy.
·
Cough
(paroxysms, barking, high-pitched).
·
Neck
retraction and external compressive mass.
·
Breathing cycle: inspiratory stridor indicates
extrathoracic airway obstruction;
expiratory prolongation or wheeze indicates intrathoracic airway obstruction.
·
Breath
sounds.
·
Chest
appearance (Harrison’s sulcus), and percussion.
·
Sputum
pot.
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