Case 3 - George - Paediatrics Flashcards
What is aspiration pneumonia?
An infection of the lungs caused by inhaling saliva, food, liquid, vomit and even small foreign objects.
Cerebral palsy respiratory considerations/risks
Weak cough, weaker respiration and postural muscles, skeletal deformities can reduce lung capacity.
On auscultation?
Right middle lobe expiratory crackles = pneumonia
What would the CXR look like?
Whiteness, consolidation, condensation, opacity on the right middle lobe.
Respiratory distress in infants
Cyanosis, flaring nostrils, grunting, recession/retractions (intercostal or subcostal), head bobbing, stridor, weak cry, tracheal tug, tachycardia, hypoxemia, hypercabia
Positioning for George (SOBAR and low SpO2)
High SL with L Lung up
How does positioning work to reduce SpO2 in infants?
Infants have more type 2 (fatigable) fibres and use more of their diaphragm than intercostals – abdominal contents fall forward in this position, reversing effects of flattened diaphragm and putting it in a better length-tension relationship (which reduces O2 demand and WOB)
How does V/Q matching work in infants?
Due to increased chest wall compliance, (1) air takes the path of least resistance, (2) ventilation will be distributed to non-dependent lung, and (3) infants breathe more apically b/c there’s room for stretch in the upper lungs (i.e., there’s more effective ventilation in the upper lung w/ perfusion occurring at the base of the lungs.
Physiological differences in infants
- Horizontal Ribs: Reduced expansion during inspiration + underdeveloped pores of Kohn = decreased collateral ventilation.
- Smaller Diameter Trachea: Higher risk of airway obstruction. Higher risk for problems w/ gas exchange and rapid desaturation b/c of low lung volume, limited resp reserve, high metabolic rate, and O2 consumption.
Percussion precautions
May induce bronchospasms in pts w/ hyper-responsive airways
How does a nebulizer work for George?
Helps access secretions: e.g. saline nebulizer helps thin down and mobilise thick/sticky secretions. May also be used for medications. The mist can help penetrate deep into the lungs, areas that are hard to access in an infant who can not perform techniques such as huff etc
How does percussion work for infants?
More compliant (cartilaginous) ribs of infants = better transference w/ percussions/vibrations = larger impact w/ technique (also soothing/relaxing effect). Stimulates cough in babies.
What does aspiration pneumonia look like on CXR?
white spots or areas of opacity in the lungs, called infiltrates
