Lecture 3 - Cardiorespiratory Physio in Paeds

Question 1

name a few anatomical differences between the respiratory system of a child

Answer 1

nose breathers
trachea shorter and smaller - 1/3rd of the size of adults
large tongue, tonsils

Question 2

Name a few physiological differences between the respiratory system of a child

Answer 2

lungs are less compliant
CC>FRC - work harder to initiate new breath
preferentially ventilate the non-dependent regions
mm fatigue quickly
higher resting metabolic rate

Question 3

What is Tachypnea?

Answer 3

> 60 breaths per min

Question 4

What is Tachycardia/Bradycardia

Answer 4

Tachycardia = >200bpm 
Bradycardia = <80bpm

Question 5

Give the normal Breaths per minute for Newborn, <2 yrs, 2-6, >6yrs

Answer 5

30-50
20-40
20-40
15-30

Question 6

Give the Hr range for Newborn, <2 yrs, 2-6, >6yrs

Answer 6

140
130
80
75

Question 7

What are some signs of respiratory distress in a child/infant

BCSA - SCAB

BEFG - Big friendly Giant Eh

Answer 7

breathing pattern - in drawn on inspiration - children and infants
cyanosis/pallor - children and infants
sweating - children and infants
reduced activity/inability to feed/cry - children and infants
head bobbing - weak neck mm - infants
neck extension - infants
nasal flaring - infants
grunting - infants

Question 8

How do you position to improve ventilation in a child

Answer 8

affected lung up
Prone position - stabilizes chest wall
abdominal wall forced up, doming the diaphragm and improving the length tension relationship

Question 9

What are some techniques to improve ventilation

Answer 9

breathing games - flowers - inspiration is automatic so need to train expiration
blow bubbles - at 2 yrs
mobilize

Question 10

True or false: you can perform head down tilt under 5 yrs

Answer 10

False

Question 11

ACT: percs, vibs, shakes

Answer 11

3-5 mins per position, adjust hands

Question 12

PEP: when can you start bubble pep

Answer 12

start as soon as you know they wont drink the water

start pep at 4 years via facemask

Question 13

When can a child cough on command

Answer 13

after 18 months , cant expectorate until 6 years

Question 14

When do you time your suctioning

Answer 14

just before feed or 1 hour after

Question 15

name 6 acute respiratory disorders

AVIPPP

Answer 15

• Asthma - positiong in LFP –> percs, cough
• Viral infections - ACT
• Pneumonia - ACT
• Inhaled foreign body
• Post surgery - improve gas, DB exercises (bubble games), stimulate cough, mobilize
• Patients in iCU - listen to nurse

Question 16

In a chronic lung disorder, when do you perform ACT

Answer 16

abnormal cough 
altered rheology of mucus
altered MCC
structural defects - bronchiectasis
difficulty clearing secretions because of chest infection