Lecture 6: Respiratory Distress in Children Flashcards
What are the 3 components of cardiopulmonary arrest in children?
- Respiratory (O2)
- Cardiac (pump, perfusion, BP)
- Circulatory volume (perfusion, BP)
What are the 3 components of the pediatric assessmen triangle which is used for the first, from the door, general assessment?
- Appearance
- Breathing
- Circulation
What does a somnolent or lethargic appearance in child with respiratory distress suggest?
SEVERE hypoxia, hypercapnia, and/or respiratory fatigue
What does a restless, anxious, and combative child in respiratory distress suggest?
Hypoxia
The development of which breathing pattern in child w/ respiratory distress is an ominous sign?
Slower, irregular respiratory pattern
Which cause of a sore throat, dysphagia and local pain/swelling in a child is an ENT emergency?
Retropharyngeal and peritonsillar abscess
What is the most common cause of infectious airways obstruction in kids age 6-36 months?
Croup (acute laryngotracheobronchitis)
Croup in a child is most often due to what etiology, but in some cases may also be due to what?
- Most often viral (parainfluenza virus)
- Less often allergic (spasmodic croup)
When you hear stridor in a child you should think about what underlying cause?
Croup
Which secondary bacterial infection most often arise from croup?
Tracheitis (kids are febrile, really sick)
What are 5 known triggers of asthma?
- Infection
- Exercise
- Enviornmental irritants
- Stress
- GERD
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?
- When compromised, will initially see tachycardia to compensate
- When ability to compensate is exceeded, will see bradycardia (bad sign)
What are the hallmarks and PE findings of tension pneumothorax?
- 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
What is Beck’s triad of cardiac tamponade?
- Jugular venous distention
- Muffled heart sounds
- Hypotension
What is the drug of choice as an immediate intervention for anaphylaxis?
Epinephrine I.M.
Differentiate aspiration of a foreign body into the trachea vs. lower foreign bodies in terms of signs/sx’s
- 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
Which household item is a choking hazard and also may lead to corosion of the esophageal mucosa?
Button batteries
Aspiration of a foreign body into the right main bronchus leads to what effect during inspiration/expiration?
- “Ball valve” effect
- Air can flow into lung around the object on inspiration, but cannot flow out during expiration
In child with neuromuscular disease the initial respiratory compromise is most often due to what?
Chronic hypoventilation
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?
Acute Chest Syndrome
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?
Vocal Cord Dysfunciton
Truncated inspiratory loop (basically looks like a triangle with a flat base)
Intermittent asthma symptoms (<2’s) puts the patient in which level of the AAP?
when classifying asthma patients, what two categories must be examined?
The green zone!
Severity of symptoms and risk (determines if intermittent or persistent)
When asthma sx become >2’s, what needs to happen?
Generally, what is the mainstays of treating an acute asthma exacerbation?
They need their regimen updated with another agent
Albuterol, Steroids and O2
What is the most notorious cause of Broncholitis?
RSV
Most common cause of PNA in infants/children?
S. Pneumoniae, Obviously
Meconium ileus is often associated with Hirschprung’s but can also be due to what?
Cystic Fibrosis
Which ethnic group has the highest rate of CF?
Ashkenazi Jew
What pathogens are common in CF patients as infants/children?
How about as 20-30s?
S. Aureus and H. INfluenzae
Pseudomonas
CF patients have a hard time digesting what compounds?
ADEK vitamins
Newborns are screened for CF after birth. What does a positive screen required?
A confirmatory test
Remember, early detection=early intervention
