CLIPP 12 Flashcards
can kids without asthma have wheezing with cold sx?is wheezing always associated with asthma?
yes - but may be more likely to develop asthma later on, no
3 characteristics of astham
airway inflammation, mucus hypersecretion, reversible airflow obstruction due to revesible bronchoconstriciton
asthma sx in kids
often wheezing or coughing responsive to beta-agonists (bronchodilators) and steroids
peds asthma dx
A child with symptoms of asthma who responds to therapy for asthma and has no other identifiable cause for wheezing has asthma by definition, regardless of age.
RAD vs asthma
many kids w wheezing early in life don’t wheeze beyond age 2-3yo so docs call them RAD bc they don’t want to stick them w/ an asthma dx for life if they have hyperresosibness of asthma but not quite definite asthma. controversial.
normal 10 month old RR
30
how can blood gas be used in asthma
As a child begins to tire and can no longer maintain adequate ventilation, the PCO2 may normalize and even become elevated despite continued normal oxygenation.
Thus, blood gas analysis can be helpful in distinguishing compensated from uncompensated asthma, and in predicting impending respiratory failure.
5 signs of resp distress
head bobbing, nasal flaring, grunting, retractions, paradoxical breathing
head bobbing
pt head bobs up and down due to accessory muscle use
nasal flaring
nares enlarge in inspiration to try to increase air entry
gruntign
glottis closes w/ expiration, helps infants generate positive pressure to stent airways open
retractions
inspiratory depression of soft tissue in relation to cartilaginous or bony thorax
paradoxical breathing
asynchrony of chest and abdominal wall motion during respiration (chest wall draws in during inspiration instead of moving outward with the same motion as the abdominal wall)
clue to worst resp distress
paradoxical breahting - force of diaphragm exceeds ability of chest wall muscles to expand in inspiration
important connection between resp muscle fatigue and resp distress
respiratory muscle fatigue will reduce the signs of respiratory distress even though a patient’s condition is in fact deteriorating.
hypopnea vs hyperpnea
hyper - increased depth, that, if occurring in situation w/o resp distress , could imply things like non pulmonary like acidosis , fever or panic attack
hypopnea - less TV thus can result in hypo vent regardless of RR
tx of resp distress in hypoxemic pt who depends on hypoxemia to stim resp drive
still give o2, but only as much as they need for maintaining reasonable saturation, and monitor
4 of most common and 3 less common causes ofcough/wheezing in kid
bronchiolitis, asthma, fb, gerd
tachomalasia, extrinsic compression like vascular ring, CF
wet vs dry coufh
wet -bronchiectasis, viral, post nasal drip, gerd
dry - chonic ashtmia
cough with liquids
suggests aspiration
dysphagia w liquid/solid
narrowing of posterior oropharyx or esophagus
barky cough
croup - laryngeotrachoebronchitis due to virus most often parainfluenza that starts w/ vague uri sx and progresses to some degree of airway obstruction and inspiratory stridor.
wheeze vs stridor
stridor most likely to be inspiratory while wheeze often expiatory but if severe, can have both in either
-strdor mor likely in croup
what resp disorder are partially or non immunized kids more prone to
pertussis
pertussis course and complications and vaccine efficacy
catarrhal: 1-2 weeks, uri sx
paroxysmal: 4-6 weeks, forceful whooping cough tho infants don’t get whoop due to relatively weaker inspiratory effort
resolution/convalescent stage: episodic cough can peristn for months but overall severity/freq drops
-efficacy is 70-90%, immunity wanes so get reimmunzied as teen
something to consider in pt w/ chronic cough or hard to control astham
secondhand smoke exposure
2 key findings in epiglottitis presentation
severe rsep distress and stirodr
typically when does chlamryida teach. passed down from mother present in baby
within first 6 months
course that wheezing can take
initally w expiratation, then biphasis, then can disappear if obstruct nsevere
poly vs monophonic wheeze
Polyphonic wheeze is characterized by multiple pitches and is typical of asthma; monophonic wheeze is characterized by only a single pitch and is typical of focal airway obstruction.
rhonchi
Coarse, low-pitched rattling sounds heard best in expiration. . Rhonchi are coarse, low-pitched, rattling sounds due to secretions and airway narrowing and are typically heard in the setting of bronchitis or pneumonia.
Thought to be due to secretions and narrowing of airways
crackles
Finer breath sounds heard on inspiration.
Associated with either fluid in the alveoli or with opening and closing of stiff alveoli (as in interstitial disease).
Sometimes described as either coarse or fine. (Coarse crackles are usually thought to be associated with purulent secretions in the alveoli as with pneumonia; fine crackles are often associated with pulmonary edema or interstitial lung disease.
air entry
The amount of air entry should be noted during every lung exam.
Decreased air entry can be a sign of consolidation, atelectasis, pneumothorax, pleural effusion or airway obstruction.
Bronchial breath sounds
Lower in pitch and more hollow-sounding than normal breath sounds.
Caused by air moving through areas of consolidated lung.
asymmetric breath sounds, cogh, tachypneia, and focal (one sided) wheeze esp w/o fever
consider FB aspiration
good initial tests in FB aspiration wrokup
pa and lateral cxr and bilat decubitus or inspir/expir films
-for bilat decubitus, look for asymmetric deflation of dependent lung -both should deflate but if one doesn’t, suggest obstruction. for expire/inspir films, loo for asymm expiration deflation
rigid vs flex bronhc
rigid - only thru mouth , can examine large airways, forceps pass thru
flex - mouth or nose, can look at more distal smaller airways, forceps don’t pass
most common cause of infant wheezing
bronchiolitis- bronchiolar obstruction due to edema, mucus, and cellular debris. Respiratory syncytial virus (RSV) is the most common cause, but other viruses such as influenza and parainfluenza may cause bronchiolitis as well.
cxr bronchoiolitis
Chest radiographs may show hyperinflation, increased interstitial markings, peribronchial cuffing, and scattered atelectasis from bronchial obstruction.
pneumonia is due to
inflammation of the lung parenchyma.
most common cause of pneumonia in kids is
virual -adeno, rsv, parainflu, influ
viral vs bacterial pneumonia on cxr
Findings of viral pneumonia on chest x-ray are variable and may show diffuse or patchy interstitial infiltrates, hyperinflation and small pleural effusions.
Chest x-rays in bacterial pneumonia typically show air-space disease with lobar or segmental consolidation and air bronchograms.
lab findings pna
viral pneumonia, peripheral white blood cell counts tend to be normal or only slightly elevated. Viral antigen testing of respiratory secretions may be helpful in making the diagnosis but is usually not necessary.
In bacterial pneumonia, peripheral white blood cell counts are usually elevated and have a neutrophilic predominance.
X-ray saying hyperinflation of L lung not right
FB in L lung
causes of asymm wheeze
FB»> or mucus plug from bronchiolitis or ashtam
film findings in R sided FB obstruction
PA film (with the child in a sitting position): Right hemidiaphragm is flattened, suggesting unilateral hyperexpansion on the right. Right decubitus: With child on her right side, the mediastinal structures remain in the midline, rather than shifting towards the right lung due to gravity, further demonstrating the fixed hyperinflation of the right lung. Left decubitus: With child on her left side, the mediastinal structures shift towards the left lung as expected.
xr findings in partial vs complete FB obstruction
parital = ball vale effect, hyperinflation of affected side
complete - atelecatasis or volume loss and elev of hemidiaphragm or mediastinal shift toward affected side
what determines local tissue reaction to aspirated fb
compassion of the fb - fatty things cause more pneuonitis, batteries etc erode
what concern is there after a fb aspiration (not the immediate life or death choking but after that)
pneumonai
bordatella vs bartonella
cough vs cats!!
conjunctival hemorrhages and pneumothoraces from the increased intrathoracic and intracranial pressures from Valsalva
seen in forceful whooping cough
azithromycin, clarithromycin, and erythromycin
tx choices for whooping cough - given in P phase will not alter course but lowers transmissibility
epiglttiss presntation
appear toxic and sit in the “sniffing position” (sitting, leaning forward, neck hyperextended, chin protruding). A “thumb sign
