Pediatric Respiratory Care

Question 1

What are 3 things are important to know about pediatric brain development?

Answer 1

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

Question 2

What is an important to know about the bones of the rib cage in pediatric patients?

Answer 2

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)

Question 3

About what age are lung fully developed?

Answer 3

about age 8

Question 4

What can be said about the lung anatomy with regards to airway generations?
2 things

Answer 4

16 - 17 generations

Relatively small number of broncholes
this produces smaller number of cross sections and makes them more susceptible to broncholitis and RSV.

Question 5

What can be said of the differences in airway diameter in the presence of edema between a pediatric patient and an adult?

Answer 5

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%.

Question 6

When performing auscultaions on a pediatric patient, what additional area do you check?

Answer 6

Trachea

Question 7

What test is used to diagnose CF?

Answer 7

sweat chloride test

Question 8

What are the normal vital signs for term infant?

Answer 8

RR 30 – 50
HR 84 – 145
BP 70/44

Question 9

What are the normal vital signs for 10 year old?

Answer 9

RR 16 – 21
HR 60 – 120
BP 120/77

Question 10

What are the normal vital signs for a 6 year old?

Answer 10

RR 19 -24
HR 65 – 130
BP 111/70

Question 11

What can are signs of hypercapnia in pediatric patients?

Answer 11

increased ICP and lethargy

Normal kids are hyper and active.

Question 12

What are respiratory patterns/sounds for pediatric patients?

Answer 12

Retractions
Sighs
grunting
nasal flairing

Question 13

What is an oxygen deliver device tolerated by infants?

include liter flow and Fi02 capability

Answer 13

oxygen hood
10-15 lpm
Fi02 .80-.90

Alternatively: nasal cannula

Question 14

What 3 things can be said about the oxygen tent?

Answer 14

Can deliver greater than .50 FiO2 at high flows
Not reliably stable concentrations
Limits access to patient

Question 15

What is the formula used to chose at pediatric ET tube size?

Answer 15

(age + 16)/4 = et tube size then round up.

Question 16

How do you measure depth of insertion of an ET tube?

Answer 16

et tube inner diameter x 3 = depth

Question 17

what position should the head be in during intubation?

Answer 17

neutral with a towel placed under it

Question 18

What are signs and symptoms of epiglotitis?

Answer 18

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

Question 19

What do you see in a CXR of epiglotitis?

Answer 19

enlarged epiglotis

Thickened aryepiglottic folds

Question 20

How do you treat epiglotitis?

Answer 20

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

Question 21

What are the signs of symptoms of LTB or croup?

Answer 21

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

Question 22

What is LTB?

Answer 22

Laryngotracheobronchitits

Question 23

What 2 things can you see in CXR for patients with croup?

Answer 23

Steeple sign

narrowing of the subglottic area

Question 24

What are the treatment options for Croup/LTB?

Answer 24

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

Question 25

What diseases is related to Acute bronchiolitis?

Answer 25

RSV

Question 26

How can you diagnose RSV?

Answer 26

sputum samples

immunofluorescence of respiratory secretions

Question 27

Who have the greater risk for bronchiolitis?

Answer 27

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

Question 28

What are the signs and symptoms of acute bronchiolits?

for infants less than 1 year and those older that 2 years of age.

Answer 28

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

Question 29

What are the treatment options for Acute Bronchiolitis?

Answer 29

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

Question 30

What is in an indicator of RSV or Bronchiolitis on a CXR?

Answer 30

bilateral lower lobe alveolar infiltrates

Question 31

Who have a greater risk on developing acute bronchiolitis in PEDS?

Answer 31

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

Question 32

When is RSV season?

Answer 32

DEC - MAR