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3: Paeds Y3/4 - Paediatrics [15] > [12] Apnoea > Flashcards

[12] Apnoea Flashcards

1
Q

Define apnoea

A

Cessation of respiratory airflow for 20 seconds or longer

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2
Q

What are the 3 main categories of apnoea?

A
  • Central
  • Obstructive
  • Mixed
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3
Q

What happens in central apnoea?

A

Inadequate medullary response leading to no or poor muscle co-ordination for breathing

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4
Q

What can cause central apnoea?

A
  • Cessation of output from the central respiratory centres

- Inability of efferent peripheral nerves or respiratory muscles to process or receive signals from the brain

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5
Q

What is obstructive apnoea?

A

When there is an obstruction of the airways and therefore poor to no air exchange

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6
Q

How is the inspiratory effort affected in obstructive apnoea?

A

It is usually vigorous but has no effect against the obstruction

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7
Q

Which type of apnoea is most common in children?

A

Obstructive

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8
Q

What is mixed apnoea?

A

Where there is an episode with combinations of central and obstructive apnoea

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9
Q

What are the common causes of apnoea?

A
  • Apnoea of prematurity
  • Infections
  • Cardiovascular
  • Pain
  • CNS
  • Respiratory
  • GI
  • Metabolic
  • Drugs
  • Head and neck positioning
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10
Q

When does apnoea of prematurity occur?

A

2-7 days of life

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11
Q

What are the infective causes of apnoea?

A
  • Sepsis
  • Necrotising enterocolitis
  • Meningitis
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12
Q

What are the cardiovascular causes of apnoea?

A
  • Anaemia
  • Hypo/hypertension
  • PDA
  • Cardiac failure
  • Hypovolaemia
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13
Q

What are the pain causes of apnoea?

A
  • Acute

- Chronic

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14
Q

What are the CNS causes of apnoea?

A
  • Intraventricular haemorrhage
  • Seizures
  • Hypoxic injury
  • Neuromuscular disorders
  • BRainstem infarction or anomalies
  • Congenital malformations
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15
Q

What are the respiratory causes of apnoea?

A
  • Pneumonia
  • Intrinsic or extrinsic mass or lesions causing airway obstruction
  • Upper airway collapse
  • Atelectasis
  • Phrenic nerve palsy
  • RDS
  • Pneumothorax
  • Hypoxia
  • Malformations of chest
  • Pulmonary haemorrhage
  • Aspiration
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16
Q

What are the GI causes of apnoea?

A
  • Oral feeding
  • Bowel movement
  • Oesophagitis
  • Intestinal perforation
  • GORD
  • Abdominal distension
17
Q

What are the metabolic causes of apnoea?

A
  • Hypoglycaemia
  • Hypocalcaemia
  • Hyperammonaemia
18
Q

What drugs can cause apnoea?

A
  • Maternal drugs e.g. narcotics
  • Opiates
  • Sedatives or GA
19
Q

What is the main risk factor for central apnoea in children?

A

Prematurity

20
Q

What are the risk factors for obstructive apnoea?

A
  • Overweight
  • Boys
  • Other conditions
21
Q

What other conditions can increase risk of obstructive apnoea?

A
  • Mucopolysaccharoidosis
  • Trisomy 21
  • Craniofacial abnormalities
22
Q

How do patients with central apnoea present?

A

No respiratory effort

23
Q

What investigations can be undertaken in apnoea?

A
  • Pulse oximetry
  • Cardiorespiratory monitoring
  • Apnoea monitor for chest wall movement
24
Q

What must be done if the apnoea is not phyisiological?

A

Must investigate to identify underlying cause

25
Q

What are the differentials for apnoea?

A
  • Periodic breathing

- Subtle seizures

26
Q

What is periodic breathing?

A

Three or more periods with no respiratory effort lasting 3 seconds or more in a 20 second period

27
Q

Is periodic breathing a problem?

A

No, it is a normal neonatal breathing pattern

28
Q

What does periodic breathing not involve?

A

Change to colour or heart rate

29
Q

How is acute apnoea managed?

A
  • Ensure head and neck in the right position
  • Tactile stimulation
  • Clear the airway
  • CPAP or mechanical ventilation
30
Q

What is tactile stimulation?

A

Gentle rubbing of the soles of the feet or the chest wall

31
Q

How may the airway be cleared?

A

Suction of the mouth and nostrils

32
Q

What are the potential complications of apnoea?

A

Permanent brain damage and death

3: Paeds Y3/4 - Paediatrics [15] (115 decks)

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