Sudden infant death syndrome physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) usually appear normal. In nearly 50% of the patients the physical examination is totally normal. WHile doing a physical examination on sudden infant death syndrome (SIDS) patients physicians must take care to examine any signs of obstruction of the external airways, head entrapment, or any other environmental risk factors | Patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) usually appear normal. In nearly 50% of the patients the physical examination is totally normal. WHile doing a physical examination on [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) patients physicians must take care to examine any signs of obstruction of the external airways, head entrapment, or any other environmental risk factors. | ||
==Physical Examination== | ==Physical Examination== | ||
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===HEENT=== | ===HEENT=== | ||
* Feeding difficulties may be present in some patients | * Feeding difficulties may be present in some patients | ||
* Evidence of trauma | * Evidence of trauma | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with [ | * Neck examination of patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) is usually normal. | ||
*Check for any signs of obstruction | |||
* | |||
===Lungs=== | ===Lungs=== | ||
* [[Breathing difficulties]] in 50% of the patients may be present | *[[Breathing difficulties]] in 50% of the patients may be present | ||
*Any signs of respiratory infections should be evaluated | *Any signs of respiratory infections should be evaluated | ||
* Physicians must take care to examine any signs of obstruction of the external airway | * Physicians must take care to examine any signs of obstruction of the external airway | ||
===Heart=== | ===Heart=== | ||
Revision as of 15:22, 18 May 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Patients with sudden infant death syndrome (SIDS) usually appear normal. In nearly 50% of the patients the physical examination is totally normal. WHile doing a physical examination on sudden infant death syndrome (SIDS) patients physicians must take care to examine any signs of obstruction of the external airways, head entrapment, or any other environmental risk factors.
Physical Examination
Physical examination in 50% of the patients with sudden infant death syndrome (SIDS) is usually completely normal.
Appearance of the Patient
- Patients with sudden infant death syndrome (SIDS) usually appear normal.
Vital Signs
- High-grade or low-grade fever may be present in 25% of the patients with SIDS
- Infection may be present in 25% of the patients with SIDS
- Look for any signs of choking or gasping of the infant
Skin
Apparent life-threatening events (ALTEs) are usally episodes of apnea that are associated with skin colour changes, which include the following:[1][2][3][4]
HEENT
- Feeding difficulties may be present in some patients
- Evidence of trauma
Neck
- Neck examination of patients with sudden infant death syndrome (SIDS) is usually normal.
- Check for any signs of obstruction
Lungs
- Breathing difficulties in 50% of the patients may be present
- Any signs of respiratory infections should be evaluated
- Physicians must take care to examine any signs of obstruction of the external airway
Heart
- Cardiovascular examination of patients with SIDS may or may not be present with the following and should be evaluated:
- Any signs of valvular disease
- Arrhythmias
- Cardiomyopathy signs
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with [disease name] is usually normal.
OR
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Back examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Abnormal limb movements in 35% of the patients in SIDS may be noted.
- Should look for any changes in muscle tone
- Seizures
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
References
- ↑ Fu, L. Y.; Moon, R. Y. (2007). "Apparent Life-threatening Events (ALTEs) and the Role of Home Monitors". Pediatrics in Review. 28 (6): 203–208. doi:10.1542/pir.28-6-203. ISSN 0191-9601.
- ↑ Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S (2005). "Epidemiology of apparent life threatening events". Arch Dis Child. 90 (3): 297–300. doi:10.1136/adc.2004.049452. PMC 1720328. PMID 15723922.
- ↑ Kiechl-Kohlendorfer, U (2005). "Epidemiology of apparent life threatening events". Archives of Disease in Childhood. 90 (3): 297–300. doi:10.1136/adc.2004.049452. ISSN 0003-9888.
- ↑ Brand DA, Altman RL, Purtill K, Edwards KS (2005). "Yield of diagnostic testing in infants who have had an apparent life-threatening event". Pediatrics. 115 (4): 885–93. doi:10.1542/peds.2004-0847. PMID 15805360.