CP in Paeds

Question 1

Signs of respiratory distress - RR

Answer 1

Tachypnoea > 60
Newborn - 30 to 50
< 2 yrs - 20 to 40
2-6 yrs - 20 to 40
> 6 yrs - 15 to 30

Question 2

Signs of respiratory distress - HR

Answer 2

Tachy >200
Brady <80

Newborn - 140
< 2 yrs - 130
2-6 yrs - 80
> 6 yrs - 75

Question 3

Signs of breathing distress in INFANTS+CHILDREN

Answer 3

BTPASR

B SPART

1. Breathing pattern of recession
   - chest wall pulled inwards due to high intrathoracic negative pressure; intercostal, subcostal, substernal
2. Tracheal tug
   - downward tug on trachel in suprasternal notch on inspiration
3. Pallor/grey/motteled/dusky
   - infants are slow to cyanose so instead look for pallor/greyness
4. Accessory mm use
5. Sweating - but skin isnt warm; clammy
6. Reduced activity/floppy/inability to cry
   - this is a sign that the baby is using all their ability to breathe
7. Agitation/confusion - hypoxia or high CO2

Question 4

Signs of respiratory distress in INFANTS

Answer 4

To remember - think about what happens in the face (nasal and grunting) and in the head (bobbing and extension)

1. Nasal flaring - increase nostril diameter to reduce airway resistance
2. Expiratory grunt - to facilitate PEEP to increase FRC
3. Head bobbing
   - lifts its head up to straighten out the upper airway - but the muscles holding the head up are weak so the head falls down - the infant takes a rest and does it again - ie. head bobboing
4. Extension - baby extends head to reduce airway resistance

Question 5

Normal BP in kids?

Answer 5

Newborn - 50-70/25-45
< 2 yrs - 87-105/53-66
2-6 yrs - 95-105/53-66
> 6 yrs - 97-112/57-71

Question 6

What are some questions you might ask during paeds respiratory assessment?

Answer 6

Stability last few hours - more floppy or stopped crying?
Feeds - tolerating? last feed?
Tolerance of handlnig? - if low tolerance then getting sick

Question 7

How to use positioning in children?

Answer 7

1. Place affected lung uppermost to improve ventilation but monitor as they may desat
2. Prone position can help oxygenation - pushes abdo contents up and stabilises chest wall

Question 8

HOw to improve ventilation in children?

Answer 8

1. Breathing games (after 1 yr) - use game where they’re blowing out a lot - will automatially take deep breath in
2. Blowing bubbles (~2 yrs) - esp good for abdo surgery
   * need these games since deep breath on command probably not possible until 3 or 4
3. Mobilise!

Question 9

How to use airway clearance techniques in children?

Answer 9

1. Postural drainage
   - no HDT if hx of reflux, under 1 yr, or premmie
2. Percs
   - support the head so it doesnt bounce around
   - 3-5 mins/position
   - adjust hand position to chest size/shape
3. Vibes
   - hard to do bc of high RR
4. PEP
   - can start @ 4 - but only masters them at 8
   - mask only not mouth piece!
   - can use bubble PEP - make sure they dont dirnk the water! (2 yrs)
5. Huff
   - 2 yrs
   - hold tissue in front of them and have them move the tissue with the huff
6. Coughing/secretion
   - kids can cough on command until 1.5 yrs
   - tracheal rub can be used to stimulate cough

Question 10

When should suction be used in relation to feeds?

Answer 10

NP or OP suction - just before or 1 hr after feed

Turn off NG/PEG feed 30 mins before suction

Bolus feeds - suction just before the next feed

Question 11

What suction pressures should be used?

Answer 11

Premmie or upto 5kg - 10kpa
Infants upto 1 yr - 15 kpa

Otherwise use normal 20 kpa

Question 12

Can physio help with acute disorders in the child?

Answer 12

Asthma- ACT don’t help
Viral infection - ACT doesn’t help/can make worse
Pneumonia - ACT doesn’t help
Inhaled foreign body - DON’T DO ACT! CAN DISLODGE!

Post Op - pain meds, use technique to improve gas movement, can use DBEx, mobilise, stimulate cough