► Inspiration composes approximately one-third of the respiratory cycle and expiration the remaining two-thirds. ► It is easiest to hear breath sounds during inspiration and expiratory sounds are less well heard. ► The intensity of breath sounds depends on the location of auscultation and on the bodyshape. auscultation and on the bodyshape. ► They are loudest where the large airways are closest to the body surface, and they are more distant in obese individuals body surface, and they are more distant in obese individuals than thin ones. than thin ones. ► They also tend to be louder in children than in adults. NORMALNORMAL BREATH SOUND
Bronchial breath sounds Bronchial breath sounds Bronchial breath sounds Bronchial breath sounds ► These sounds are louder than normal breath sounds. ► They are heard when there is consolidation of lung tissue with bronchi that open into the consolidation, such as occurs in pneumonia. ► The consolidation leads to better transmission of sound than when the lungs are filled with air.
► Noisy breath sounds produced by the obstruction of the extrathoracic airway. STRIDOR
Grunting Grunting ► Grunting is an abnormal breath sound heard during expiration from the closing of the glottis in respiratory distress of a small infant. ► This grunting was recorded with a microphone in front of the mouth of a premature baby girl with respiratory distress 7 hours after birth
CREPITATION COARSE CREPITATION FINE CREPITATION
Wheezing ► Wheezes are loud sounds that originate in the small airways. ► These sounds have a longer duration than crackles and also have a musical quality. ► They are often detected more easily with forced expiration and are heard in patients with asthma or other obstructive diseases.
Heart rate ► HR < 60/min. is considered to be bradycardia ► HR > 220/min. in infancy or > 180/min. in older children is considered to be tachycardia
5 th Percentile for Blood Pressure ► Neonate60 ► 1 month – 1 year 70 ► 1+ year70 + (2 X age in years)
Weight ► At birth 3 Kg ► The first 4 monthsBW + (month X 0.8) ► The second 4 monthsBW + (month X 0.7) ► The third 4 monthsBW + (month X 0.6) Infants normally double their birthweight by 5 months and triple their birthweight by 1 year ► Between 1-9 years (4 + years) X 2 ► Between 9-12 yearsYears X 3
Length ► At birth 50 cm ► At 6 months65 cm ► At 1 year75 cm ► At 2 years85 cm ► At 3 years95 cm ► At 4 years 100 cm Infants normally double their height by 4 years old ► Over the next 8 years there is an annual increase of 5.5 cm/year