Chapter 4 Airway & Breathing Flashcards
name four things that will increase the respiratory drive
1) acidosis
2) shock
3) poisoning (salicylates)
4) Anxiety/panic attack
Name four things that will decrease the respiratory drive
1) coma
2) convulsions
3) raised ICP
4) poisoning
Name three cause of upper airway obstruction
1) Croup
2) Epiglottitis
3) Foreign body
Name three causes of lower airway obstruction
1) Tracheitis
2) Asthma/viral wheeze
3) Bronchiolitis
Name two disorders that affect the lungs parenchyma and can cause breathing difficulties
1) Pneumonia
2) Pulmonary oedema
Name three disorders around the lung that can cause breathing difficulties
1) Pneumothorax
2) Pleural effusion or empyema
3) Rib fracture
What disease(s) can cause respiratory muscle weakness?
1) Neuromuscular disorder
2) paralysis/envenomation
What disorders below the diaphragm can cause breathing difficulties?
1) Peritonism
2) Abdominal distension
Regarding a neonante or very young infant, what is meant by paradoxical inhibition of respitatory drive
Occurs during infection and instead of increase respiratory drive apnoea and hypoventilation can be seen
What is the difference in sound and implied area of obstruction for stridor and stertor
Stridor: high pitched usually on inspiration, due to obstruction of larynx or trachea
Stertor: lower pitched inspiratory noise, suggest poor airway position or pharyngeal obstruction
Name some features that suggest respiratory difficulties are due to cardiac cause
1) cyanosis not correcting with O2
2) Tachycardia out of proportion to respiratory difficulty
3) Raised JVP
4) Gallop rhythm/murmu
5) Enlarged liver
6) Absent femoral pulses
Why is it important to consider a fluid bolus in a child with respiratory distress?
Fluid intake has often been suboptimal and the child may be dehydrated. Especially important if considering intubation and positive pressure ventilation.
Name the airway disease most fitting with these features:
coryzal
barking cough
mild fever
hoarse voice
croup - viral laryngotrachobronchitis
Name the airway disease most fitting with these features:
sudden onset, history of choking
foriegn body
Name the airway disease most fitting with these features:
drooling, muffled voice, septic appearance, absent cough
epiglottits
Name the airway disease most fitting with these features:
harsh cough, chest pain, septic appearance
bacterial tracheitis
Neck swelling, crepitus, bruising
traumatic damaged to airway
Name the airway disease most fitting with these features:
drooling, septic appearance
retropharyngeal abscess or peritonsillar abscess
What is the dose of adrenaline in croup (as per APLS)
400 microg/kg max 5mg adrenaline
How long till nebulised adrenaline works and how long does it last?
onset 10-30 minutes
lasts 2 hours
Does nebulising adrenaline provide a long lasting effect/cure?
no, it’s used to buy time for steroids to work or to set up for intubation
If a child fails to respond to nebulised adrenaline, what are the other diagnoses to consider?
bacterial tracheitis
epiglottitis
inhaled foreign body
does nebulised adrenaline help with epiglottitis?
Unclear. If it upsets the child, stop immediately
How quickly do steroids start to work when given for croup?
Within 30 minutes
If the child cannot take oral dexamethsone, and you don’t have a IVC.
What is the dose of budesonide?
2mg nebulised
Cover eyes and wash face after
What organisms cause bacterial tracheitis?
Staphylococcus aureus
Haemophilus influenzae B
Roughly how many children with bacterial tracheitis need intubation?
What antibiotics do you use?
80%
Ceftriaxone or cefotaxime + flucloxacillin
What is the clinical course/features of epiglotitits
Most common aged 2-6 (can occur in infants and adults)
Acute onset with high fevers, lethargy, soft inspiratory stridor, rapidly increasing respiratory difficult over 3-6 hours
Name a few feature that distinguish epiglottits from croup or bacterial tracheits
In contrast to croup, epiglottitis has no or minimal cough, child sits immobile with chin slightly raised, mouth open, drooling. Toxic looking, most are septicaemic with high fever. Throat pain prevents talking or swallowing saliva.
In contrast to bacterial tracheitis, epiglottitis has very abrupt onset and deterioration (hours) and little to no cough
What is the treatment for diptheria?
1) pencillin
2) steroids
3) antitoxin
What treatments may assist with upper airway obstruction of tonsillitis or infectious mononucleosis?
Steroids
Nasopharyngeal airway
What is the treatment for a retropharyngeal abscess?
1) IV augmentin
2) surgical drainage
What are the signs of life threatening asthma?
Exhaustion
Poor respiratory effort
Silent chest
Hypotension
Depressed LOC/agitation
consider whether this could be anaphylaxis
When would you get a chest xray in the setting of asthma?
Severe dyspnoea
Uncertainty about diagnosis
Asymmetry of chest
Signs of severe infection
When providing a nebule with > 6L O2 running, how does this affect drug delivery?
More of the drug can be lost from the facemask
What is the bolus dose of IV salbutamol?
< 2 years = 5 microg/kg
> 2 years = 15 microg/kg
What are the indications for intubation in the setting of respiratory distress?
Increasing exhaustion
Progressive deterioration in
-clinical condition
- SpO2 decreasing/O2 requirement increasing
- pCO2 increasing
What is the dose of nebulised ipratroprium?
Age < 6 =250 mcg
Age > 6 = 500 mcg
Every 20 minutes for 3 doses then 125mcg every 6 hours
What is the loading dose of hydrocoritsone?
4mg/kg IV
What is the treatment for bronchioloitis?
Supportive.
Fluid replacement as oral intake has often been poor (NG or IVF but remember NG partially occludes the airway)
Gentle suction of nasal secretions
O2 or HFPN 1-2L/kg/min
What is the antibiotic of choice for pneumonia, oral and IV options?
Oral: amoxycillin 25mg/kg if > 1 month (consider cefotaxime if < 1 month)
IV moderate: benzylpenicillin 60mg/kg
IV severe: cefotaxime 50mg/kg
IV empyema or life threatning: add on lincomycin 15mg/kg
A child is dyspnoeic and you suspect myocarditis. On the CEWT chart what observation is most likely to be abnormal?
Marked tachycardia supports myocarditis diagnosis
