Chapter 5 Flashcards
Why are children more susceptible to respiratory failure?
Lack of aquired immunity
Small, more easily obstructed airways
Compliant chest wall which provides less support for maintenance of lung volumes
Tendancy to dynamic small airway collapse
Fewer alveoli
Muscular pulmonary vasculature more prone to vasoconstriction leading to right to left shunting, ductal opening and VQ mismatch
Paradoxical inhibition of respiratory drive in first months of life
Fetal haemoglobin present until 4-6 months lf age causing O2 dissociation curve to shift to the left
What are the clinical features of croup?
Coryzal with low grade fever for 1-2 days followed by development of barking cough, hoarse voice and stridor often at night.
What are the clinical features of foreign body aspiration?
Sudden onset stridor
Witnessed choking episode
What are the clinical features of epiglottitis?
Toxic appearance
Drooling
Muffled voice
Absent cough
What are the clinical features of bacterial tracheitis?
Harsh cough
Chest pain
Septic appearance
How is croup managed?
Do not upset child
Oral dexamethasone or prednisolone - can be repeated at 12hrs
Nebulised adrenaline
Humidifed oxygen
How is foreign body aspiration managed?
Do not upset child
Contact anaesthetics +/- ENT
In cases of extremis perform direct laryngoscopy and remove with magils forceps
How is epiglottis managed?
Do not upset child
Contact senior anaesthetics and ENT
Needs gas induction and intubation
Once anaesthetised needs cannulation and Iv antibiotics
What are the features of acute severe asthma?
Too breathless to feed or talk
Resp rate >30 in >5 and >50 in 2-5
Tachycardia
What are the features of life threatening asthma?
Exhaustion Poor resp effort Silent chest Hypotension decreased conscious level
How is acute asthma managed?
Beta agonists via MDI or nebuliser if hypoxic
If receiving nebuliser give combineb or meganeb if >2
Oral of IV steroids
If not responding IV mag sulph of aminophylline
What are the indications for intubation in acute asthma?
Increasing exhaustion
Progressive deterioration in clinical condition or gases
What level of maintenance fluids should be given in asthma or bronchiolitis?
Two thirds maintenace
How is bronchiolitis managed?
Oxygen - high flow, HFNC, CPAP
Suctioning
Feeding support - IV or NG
What are the indications for intubation in bronchiolitid?
Recurrent apnoea
Exhaustion
Severe hypercapnoea or hypoxia
