Pediatric Respiratory Care Flashcards
What are 3 things are important to know about pediatric brain development?
Brain cells not fully developed until about age 5
Motor development is from head to trunk
Developing brain more sensitive to poisions, infections and injury
What is an important to know about the bones of the rib cage in pediatric patients?
Rib cage is more elastic and flexible due to higher amounts of cartilage than bone.
Has more cartilage than bone (fractures less common than pulmonary contusions)
About what age are lung fully developed?
about age 8
What can be said about the lung anatomy with regards to airway generations?
2 things
16 - 17 generations
Relatively small number of broncholes
this produces smaller number of cross sections and makes them more susceptible to broncholitis and RSV.
What can be said of the differences in airway diameter in the presence of edema between a pediatric patient and an adult?
Airway diameters pediatric patients can be 1/2 that of an adult.
in the presence of an edema, a pediatric airway can narrow the airway by 50% while in the adult, it only narrows by 10%.
When performing auscultaions on a pediatric patient, what additional area do you check?
Trachea
What test is used to diagnose CF?
sweat chloride test
What are the normal vital signs for term infant?
RR 30 – 50
HR 84 – 145
BP 70/44
What are the normal vital signs for 10 year old?
RR 16 – 21
HR 60 – 120
BP 120/77
What are the normal vital signs for a 6 year old?
RR 19 -24
HR 65 – 130
BP 111/70
What can are signs of hypercapnia in pediatric patients?
increased ICP and lethargy
Normal kids are hyper and active.
What are respiratory patterns/sounds for pediatric patients?
Retractions
Sighs
grunting
nasal flairing
What is an oxygen deliver device tolerated by infants?
include liter flow and Fi02 capability
oxygen hood
10-15 lpm
Fi02 .80-.90
Alternatively: nasal cannula
What 3 things can be said about the oxygen tent?
Can deliver greater than .50 FiO2 at high flows
Not reliably stable concentrations
Limits access to patient
What is the formula used to chose at pediatric ET tube size?
(age + 16)/4 = et tube size then round up.
How do you measure depth of insertion of an ET tube?
et tube inner diameter x 3 = depth
what position should the head be in during intubation?
neutral with a towel placed under it
What are signs and symptoms of epiglotitis?
2-6 yrs old
Bacterial (Haemophillus influenzae, type B)
Acute onset
Complaint of sore throat
High fever
Muffled voice
Perfers sitting upright with chin forward
Retractions, Drooling, Appears acutely ill
CXR show thumb sign
What do you see in a CXR of epiglotitis?
enlarged epiglotis
Thickened aryepiglottic folds
How do you treat epiglotitis?
Establishment of stable, artificial airway is first priority!
ETT under general anesthesia
Use 1 size smaller than predicted due to edema
In place 12-48 hours to allow inflammation to decrease
Extubate when fever diminished and 20 cwp leak around ETT
Antibiotic Therapy
2 day course of ceftriaxone
5 day course of chloramphenicol
What are the signs of symptoms of LTB or croup?
3 months – 3 years
Gradual onset usually during “cold season”
Often preceded by low grade fever, malaise, rhinorrhea and hoarse voice
Barky, seal-like cough
Nasal flaring, nasal congestion, retractions
Stridor that worsens as child gets agitated
What is LTB?
Laryngotracheobronchitits
What 2 things can you see in CXR for patients with croup?
Steeple sign
narrowing of the subglottic area
What are the treatment options for Croup/LTB?
Treatment is largely supportive care Cool mist Oxygen as indicated by SpO2 Racemic Epinephrine - Vasoconstriction of upper airway 2.2% solution O.5 – 1.0 ml diluted in 3.0 ml normal saline Deliver by face mask Steroid Therapy Single dose dexamethasone 0.6 mg/kg Oral Dexamethasone at 0.6 mg/kg
What diseases is related to Acute bronchiolitis?
RSV
How can you diagnose RSV?
sputum samples
immunofluorescence of respiratory secretions
Who have the greater risk for bronchiolitis?
Have history of prematurity Have chronic lung disease– CF, BPD Have history of congenital heart defects Live in crowded environments Attend day care facilities Are exposed to second hand smoke
What are the signs and symptoms of acute bronchiolits?
for infants less than 1 year and those older that 2 years of age.
Less than 1 year
Cold (coryza)
Cough, respiratory distress
Wheezing, tachypnea
Older than 2 years of age
Profound nasal congestion, productive cough
Diffuse rales (velco)
Wheezing
What are the treatment options for Acute Bronchiolitis?
Mostly supportive care with careful monitoring
Watch for dehydration
Low O2 concentration- .30 - .40 by hood or tent.
Bronchodilators? (Controversial)
Antiviral Medications
Ribavirin via SPAG generator
What is in an indicator of RSV or Bronchiolitis on a CXR?
bilateral lower lobe alveolar infiltrates
Who have a greater risk on developing acute bronchiolitis in PEDS?
Have history of prematurity Have chronic lung disease– CF, BPD Have history of congenital heart defects Live in crowded environments Attend day care facilities Are exposed to second hand smoke
When is RSV season?
DEC - MAR
