Neonatal air-leak syndromes — branching viva

Branch 1 — The bedside assessment

Examiner: "You are called to the cot-side. Talk me through your assessment." [9]

• Airway first: confirm ETT position at the lips and patency — the commonest cause of acute desaturation is a displaced or blocked tube. [1]
• Chest movement and symmetry: look for asymmetry — the full, less-moving left hemithorax is the clue. [9]
• Air entry: auscultate both axillae — reduced on the left. [9]
• Heart sounds and apex: assess for muffling and apical shift (shifts away from a left tension leak toward the right). [9]
• Perfusion and blood pressure: capillary refill, blood pressure, pulse pressure — narrowing pulse pressure and hypotension signal tension. [1]
• Transilluminate: cold-light fibreoptic over the left anterior chest wall in a darkened room — a bright halo confirms the pneumothorax. [9]