Physical Examination
On exam, the infant was in moderate work of breathing with accessory
muscle use and tracheal tug. He was afebrile and had the heart rate of
180 beats per minute, respiratory rate of 45 breaths per minute, and a
pulse oximetry reading of 98% on room air. Auscultation of the chest
revealed air entry bilaterally with scattered inspiratory crepitation.
Heart sounds were dual with no additional sounds. The abdomen was soft
and movements were symmetrical with normal tone. The right periorbital
region was bruised and swollen. There was no obvious proptosis or
abnormal eye movements though this was difficult to assess with given
his age, so a referral to ophthalmology for further assessment was made.
There were no other suggestions for bruising or injury. A mild nappy
rash was present. Both body weight and head circumferences were around
the 15th percentile.