Pediatric Respiratory Flashcards
What is respiratory distress
Increased work of breathing to maintain oxygenation and/or ventilation.
-Compensated state in which increased work of breathing results in adequate pulmonary gas exchange
What are the three classifications of respiratory distress
-mild
-moderate
-severe
What are the hallmarks of respiratory distress
-Retractions
-Abdominal breathing
-Nasal flaring
-Grunting
What is respiratory failure
Patient can no longer compensate for underlying pathologic or anatomical problem by increased work of breathing
-Hypoxia and/or carbon dioxide retention may occur
Signs of respiratory failure
Decreased or absent retractions due to chest wall retractions due to chest wall fatigue
Altered mental status due to inadequate oxygenation and ventilation of the brain
Abnormally low RR
Respiratory Arrest
Pt not breathing spontaneously
BVM immediately
Resuscitation is often successful
How to assess work of breathing
Patients position of comfort
Presence or absence or retractions
Grunting or flaring
How to assess the airway
Listen for stridor
Check for obstructions
How to assess breathing
Determine the RR
Listen to the lungs for adequacy of air entry and abnormal breath sounds
Check SPO2
Management of foreign body aspiration or obstruction
-position of comfort
-providing supplemental O2
-Avoid agitation
-Transport
Severe airway obstruction management
Five back slaps and five chest thrusts
If the child is still apneic after the obstruction is removed
Assess for a pulse and preform CPR if needed
What is the dose for IM epi
0.01mg/kg of 1:1000 up to a max dose of 0.5mg
Treatment for anaphylaxis
-IM epi
-supplemental O2
-fluid resuscitation for shock
-Diphenhydramine (1mg/kg)
-Bronchodilators for wheezing
Croup (laryngotracheabronchitis)
Viral infection of the upper airway
Most common cause of upper airway emergencies in children under five
Transmitted through respiratory secretions
What is the hallmark sign of croup
Stridor
What does the sample history for croup usually reveal?
-several days of cold symptoms and low-grade fever, followed by barky cough, stridor, and trouble breathing
PAT of a child with croup
-Audible stridor
-Barky cough
-increased WOB
-Normal skin colour
Treatment of croup
Position of comfort
When is the use of nebulized epinephrine indicated
Stridor at rest
Moderate to severe respiratory distress
Poor air exchange
Hypoxia
Altered appearance
Dose for racemic epinephrine (2.25%)
0.5ml in 3ml of saline
Epiglottitis
Life-threatening inflammation of the supraglottic structures, usually due to bacterial infection
Why is epiglottitis rare now
The vaccine against Haemophilus influenzae type B
Epiglottitis PAT
-Child will look sick and anxious
-sniffing position
-drooling due to inability to swallow
Increased work of breathing
Pallor or cyanosis
Signs of epiglottitis
Stridor upon auscultation of the neck
Muffled voice
Decreased or absent breath sounds
Hypoxia
Sudden onset of high fever or sore throat in preschool or school-age children
Epiglottitis management
-do not look in the mouth
-do not put in an IV
-be prepared with a BVM and an ET tube one or two sizes smaller than normal
Bacterial Tracheitis
Invasive exudative bacterial infection of the soft tissues of the trachea
Typically presents with cough, stridor and respiratory distress of varying degree with a history of preceding viral infection
Toddlers are at an increased risk of complications due to their relatively narrow airway diameter and may present in extremis
Pts are often febrile and prefer the sniffing position
Bacterial tracheitis treatment
POC
Do not look in the mouth
Do not insert IV
Try to keep pt calm and quiet
Have a BVM and ET tube one to two sizes smaller than required ready
What is an upper airway emergency
Restriction of airflow into the lungs
What is a lower airway obstruction
Respiratory emergencies that involve restriction of air flow out of the lungs
What are the three components of asthma that lead to poor gas exchange
-Bronchospasm
-Mucus production
-Airway inflammation
Why does asthma cause hypoxia
Ventilation - perfusion mismatch
Blood flowing to parts of the lung is poorly oxygenated
What are some triggers for an asthma attack
-Upper respiratory infections
-Environmental allergies
-exposure to cold
-changes in weather
-second hand smoke
Clinical signs of asthma
-wheezing
-frequent cough
Respiratory distress
Mild to moderate respiratory caused by asthma (presentation)
-child will be awake and alert, sometimes preferring a seated posture
Increased work of breathing may be evident by retractions and nasal flaring, circulation will be normal
Signs of severe respiratory distress and impending respiratory failure
-Decreasing
-Tripod position
-Deep retractions
-Cyanosis
Primary assessment findings for asthma
-inability to speak in full sentences
-increased RR
Prolonged expiration phase
Wheezes noted on auscultation
Expiratory wheezes may be audible in moderate to mild attacks
Inspiratory and Expiratory wheezes in severe cases
Dose of salbutamol
2.5mg of salbutamol premixed with 3ml of normal saline
4 puffs MDI
Treatment for asthma
Salbutamol
Atrovent (ACP)
Supplemental O2
Epi 1:1000 (SEVERE CASES ONLY)
Bronchiolitis
Inflammation or swelling of the small airways (bronchioles) in the lower resp tract
Common in winter
Usually occurs in children under 2
Highly contagious
Symptoms of bronchiolitis
Similar to asthma
Retractions
Tachypnea
Diffuse wheezing
Diffuse crackles
Mild hypoxia
Severe bronchiolitis signs
-sleepy or obtunded
-severe retractions
-diminished breath sounds
-moderate to severe hypoxia (SpO2 less than 90)
Management of bronchiolitis
Position of comfort
Supplemental oxygen
Signs of pneumonia
-Nasal flaring
-tachypnea
-crackles
-chest pain
-hypothermia /fever
Pertussis - Whooping cough
Highly contagious, potentially deadly
Caused by bacteria
Presents as a common cold
Whooping cough
The distinctive whoop sound heard during the Inspiratory phase
-the cough can be so severe that it can cause post cough vomiting, conjunctival hemorrhage, and cyanotic
BVM rate for children
12 to 20bpm
One breath every 3 to 5 secs
Only squeeze the bag until chest rise is seen
