CIS Resp Case 1 Flashcards
Common cause of wheezing in kids
Viral infections
What time of day is more suggestive of asthma?
Coughing that’s worse in middle of night (midnight to 3 am)
Risks for developing asthma?
RSV infection prior to 6 months of age
Family history of any atopy: allergic rhinitis, eczema
Examples of common triggers for asthma?
Virus (fever at beginning and clear rhinorrhea) Allergies Exercise Cold air Cigarette smoke exposure
Common findings on CXR in child with asthma or reactive airway disease (RAD)
Atelectasis (can be auscultated as decreased breath sounds)
Hyperinflation of both lungs
Perihilar thickening
Capillary refill in healthy child compared to child with asthma/RAD
Cap refill at 2 sec is concerning. Child isn’t heading in right direction
>2 sec MUCH more concerning
Healthy kid’s cap refill nearly instantaneously
Best way to obtain blood gases in pediatric patient? Caveats?
Capillary blood gases fairly common in children
Quicker and less distressing than arterial gas (which is more accurate for O2)
Can’t use PaO2 (oxygen) from them
Useful only for pH and CO2
Where should pt with asthma exacerbation be admitted?
PICU due to significant risk for decompensation
Options for maintenance IVF in children
1/2 NS in >1 yo or 1/4 NS in <1 yo
NS is reserved for blousing
In peds, usually potassium is added to IVF
When is it appropriate to intubate an asthmatic (specifically pediatric) pt, and what are potential treatments to add prior to intubation?
Every attempt should be made to maintain pt’s respiratory status in PICU
Add terbutaline drip, magnesium, theophylline, subcutaneous epinephrine, heliox (breathing gas that is mix of helium and oxygen, less resistance and easier to breathe), or BiPAP in order to NOT intubate
Time to intubate is between irritable and obtunded
Why do you not want to intubate asthmatics?
They can’t exhale. So you force breaths in with vent. They get fuller and fuller until they either get b/l pneumothorax or acute right heart collapse and die
Which population of asthmatics has highest mortality?
Adolescents because they don’t carry their rescue inhaler with them
Signs of respiratory distress in respiratory peds pt
INspiratory and expiratory wheezing
Nasal flaring and tachypnea
Subcostal, intercostal, and Supra stern also retractions
Stridor
Sniffing or tripod positioning
Decreased air movement (after albuterol, hear wheezing = improvement)
Treatment considerations for peds pt
Albuterol nebulizer or inhaler (“rescue inhaler,” bronchodilator, short-acting beta2 agonist)
Inhaled corticosteroids
Oral corticosteroids
Oxygen (put on first if hypoxic)
Cystic fibrosis should be in differential. What would indicate concern for CF, and what are the tests?
Poor height and weight Clubbing Foul-smelling stools (evidence of malabsorption) Recurrent pneumonia Edema Failure to thrive
Test = sweat chloride test
