Localization of respiratory distress by physical findings

Upper airway obstruction

Sniffing position: neck is flexed with head extended to open airway

Nasal flaring: also seen with lower airway disease

Prolonged inspiration

Retractions: supraclavicular, suprasternal

Abnormal voice: hoarseness, hot potato voice

Stridor

Barking cough

Transmitted upper airway sounds (stertor)

Lower airway disease

Retractions: intercostal, subcostal

Nasal flaring: also seen with upper airway obstruction

Prolonged expiration

Wheezing: intrathoracic airway obstruction

Grunting: may indicate severe respiratory distress or severe pain from an intraabdominal process

Rales (crackles)

Pleural rub

Bronchophony

Pulsus paradoxus: caused by severe lower airway obstruction or cardiac tamponade

Cardiac disease

Gallop

Cardiac murmur

Rales (crackles)

Jugular venous distention

Hepatomegaly

Peripheral or periorbital edema

Pulsus paradoxus: caused by cardiac tamponade or severe lower airway obstruction

Central nervous system

Abnormal respiratory pattern (Cheyne-Stokes, or ataxic)

Metabolic

Kussmal respirations

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