Clinical Part 6: Respiratory Distress in Children (Newman)

Question 1

What are the 3 components of cardiopulmonary arrest in children?

Answer 1

1. Respiratory (O2)
2. Cardiac (pump, perfusion, BP)
3. Circulatory volume (perfusion, BP)

Question 2

What are the 3 components of the pediatric assessmen triangle which is used for the first, from the door, general assessment?

Answer 2

1. Appearance
2. Breathing
3. Circulation

Question 3

What does a somnolent or lethargic appearance in child with respiratory distress suggest?

Answer 3

SEVERE hypoxia, hypercapnia, and/or respiratory fatigue

Question 4

What does a restless, anxious, and combative child in respiratory distress suggest?

Answer 4

Hypoxia

Question 5

The development of which breathing pattern in child w/ respiratory distress is an ominous sign?

Answer 5

Slower, irregular respiratory pattern

Question 6

Which cause of a sore throat, dysphagia and local pain/swelling in a child is an ENT emergency?

Answer 6

Retropharyngeal and peritonsillar abscess

Question 7

What is the most common cause of infectious airways obstruction in kids age 6-36 months?

Answer 7

Croup (acute laryngotracheobronchitis)

Question 8

Croup in a child is most often due to what etiology, but in some cases may also be due to what?

Answer 8

• Most often viral (parainfluenza virus)
• Less often allergic (spasmodic croup)

Question 9

When you hear stridor in a child you should think about what underlying cause?

Answer 9

Croup

Question 10

Which secondary bacterial infection most often arise from croup?

Answer 10

Tracheitis (kids are febrile, really sick)

Question 11

What are 5 known triggers of asthma?

Answer 11

• Infection
• Exercise
• Enviornmental irritants
• Stress
• GERD

Question 12

When there is respiratory compromise what is inititally seen with the HR and when the ability to compensate is exceeded how is the HR affected?

Answer 12

• When compromised, will initially see tachycardia to compensate
• When ability to compensate is exceeded, will see bradycardia (bad sign)

Question 13

What are the hallmarks and PE findings of tension pneumothorax?

Answer 13

• Severe respiratory distress
• Ipsilateral chest hyperexpansion
• Decreased or absent breath sounds on the side of the collapsed lung
• Shift of mediastinal structures, deviation of trachea AWAY
• HYPER-resonance to percussion over the collapsed lung

Question 14

What is Beck’s triad of cardiac tamponade?

Answer 14

• Jugular venous distention
• Muffled heart sounds
• Hypotension

Question 15

What is the drug of choice as an immediate intervention for anaphylaxis?

Answer 15

Epinephrine I.M.

Question 16

Differentiate aspiration of a foreign body into the trachea vs. lower foreign bodies in terms of signs/sx’s

Answer 16

• Trachea –> sudden, dramatic, cough; stridor, drooling, choking
• Lower foreign bodies –> coughing/choking when FB is first ingested –> delayed sx’s i.e., recurrent pneumonia, chronic cough

Question 17

Which household item is a choking hazard and also may lead to corosion of the esophageal mucosa?

Answer 17

Button batteries

Question 18

Aspiration of a foreign body into the right main bronchus leads to what effect during inspiration/expiration?

Answer 18

• “Ball valve” effect
• Air can flow into lung around the object on inspiration, but cannot flow out during expiration

Question 19

In child with neuromuscular disease the initial respiratory compromise is most often due to what?

Answer 19

Chronic hypoventilation

Question 20

What disease is seen in a child with sickle cell disease presenting with sudden onset respiratory distress, chest pain, fever, and a new infiltrate in CXR?

Answer 20

Acute Chest Syndrome

Question 21

wheezing can be from a multitude of causes, not just asthma. What is the cause of wheezing in high achieving adolescent females?

What does the inspiratory loop look like?

Answer 21

Vocal Cord Dysfunciton

Truncated inspiratory loop (basically looks like a triangle with a flat base)

Question 22

Intermittent asthma symptoms (<2’s) puts the patient in which level of the AAP?

when classifying asthma patients, what two categories must be examined?

Answer 22

The green zone!

Severity of symptoms and risk (determines if intermittent or persistent)

Question 23

When asthma sx become >2’s, what needs to happen?

Generally, what is the mainstays of treating an acute asthma exacerbation?

Answer 23

They need their regimen updated with another agent

Albuterol, Steroids and O2

Question 24

What is the most notorious cause of Broncholitis?

Answer 24

RSV

Question 25

Most common cause of PNA in infants/children?

Answer 25

S. Pneumoniae, Obviously

Question 26

Meconium ileus is often associated with Hirschprung’s but can also be due to what?

Answer 26

Cystic Fibrosis

Question 27

Which ethnic group has the highest rate of CF?

Answer 27

Ashkenazi Jew

Question 28

What pathogens are common in CF patients as infants/children?

How about as 20-30s?

Answer 28

S. Aureus and H. INfluenzae

Pseudomonas

Question 29

CF patients have a hard time digesting what compounds?

Answer 29

ADEK vitamins

Question 30

Newborns are screened for CF after birth. What does a positive screen required?

Answer 30

A confirmatory test

Remember, early detection=early intervention