Pediatric Respiratory/Noisy Breathing in Child Flashcards
When does surfactant and alveoli develop
usually around 30-38 weeks
5 phases of lung development
- embryonic
- pseudoglandular
- canalicular
- saccular
- alveolar
respiration rate change in children vs adults
RR is 4-60/min, tachypnea is considered >60 min (rather than 30 in adults).
“wasted” energy of muscles trying to increase VT& inefficiency of increasing RR– they are often on their bellies which compress their diaphragm and increase the resistance needed o overcome to breathe. additionally, there is a decreased total functional capacity= decreased risk of desaturating.
- due to chest wall shape changes– because of their chest wall and diapghram, they are already fully extended, requiring increased breath cause you cna’t increase volume.
the chest wall in infants have ___ compliance
increased compliance because they are cartilagenous.
babies are preferential __ breathers
nose breathers. look at nasal flare on physical exam
note; Natural tendency of isolated lung is to collapse. NT of chest wall is to flail out. FRC is the pressure balance that prevent either from happening. In infants, because chest Wallis more compliant, the curve moves tot he right. The FRC thus moves down. Then, there is an increased likely hood to desaturate and have atelectasis beacause FRC happens at a lower volume. For us, expiration is passive, but for babies, it’s not. They begin to close their glottis as they expire in order to maintain FRC. Overall decreased lung volume.
signs of peds airway factors
speaking, drooling, signs/sounds of upper airway obstruction
vital signs of peds
on PE; the chest wall shape:
B/c can’t increase VT (chest volume)
then…⇒ Become ___ quickly
B/c accessory muscles can’t move chest, then…⇒ __ __
B/c can’t increase VT (chest volume)
then…⇒ Become TACHYPENIC quickly
B/c accessory muscles can’t move chest, then…⇒ HEAD BOB
Chest Wall Compliance • B/c chest is so compliant, greater negative intrathoracic
pressure results in…
chest wall retraction (in-drawing)- suprasternal, supraclavicular, sternal, intercostal, subcostal
B/c of greater compliance, greater tendency
towards alveolar collapse (atelectasis), what PE findings would indicate atelectasis
Grunting
noisy breathing is often due to ___ ___ related to obstruction.
turbulent flow related to obstruction.
Types of noisy ped breathing
• Wheeze
___ noise, high-pitched, musical ___ airways (bronchi, bronchioles)
Stridor
More commonly an ___ noise, can be expiratory High or low pitched Larynx and trachea
• Stertor: ___ airway noise/congestion/rattle
Snoring
• Wheeze
EXPIRATORY noise, high-pitched, musical SMALL airways (bronchi, bronchioles)
Stridor
More commonly an INSPIRATORY noise, can be expiratory High or low pitched Larynx and trachea
• Stertor: UPPER airway noise/congestion/rattle
Snoring
broad ddx of wheeze in child
- inflammatory/edema of airway wall
- endobronchial
- structural
- extrinsic compression
inflammatory/edema causes of wheeze
- bronchiolitis
- asthma
- aspiration– chronic, acute
- endobronchitis: cystic fibrosis, primary ciliary dyskinesia
- pulmonary edema.
endobronchial causes of wheez
foreign body aspiration
granuloma
extrinsic compression causes of wheeze
vascular,mass
main causes of wheeze in a younger patient
-Younger: congenital anomaly, Cystic Fibrosis
Foreign Body
Acute onset wheeze, cough
Mean age __ years
___ wheeze
-most common on the ___ side
History of choking absent in 50% cases Maintain a high index of suspicion
Acute onset wheeze, cough
Mean age 2 years
FOCAL wheeze
-most common on the RIGHT side
History of choking absent in 50% cases Maintain a high index of suspicion
gas trapping– air still in right lung even during expiration
-obstruction
note;
extrathoracic causes of stridor
- vocal cord paralysis
- laryngomalacia
intrathoracic causes of stridor
vascular compression of trachea
possible cause of stridor?
this flow curve is consistent with intrathoracic lesion causing vascular compression of trachea and truncated expiratoyr loop of flow volume loops
possible cause of stridor?
this loop is consistent with extra-thoracic causes of strifor. could be vocal cord paralysis or laryngomalacia
possible cause of stridor?
fized obstruction, or both intra-and extra thoracic. could be subglottic stenosis
features of early/non-acute congenital or acquired lesions causing stridor
Laryngomalacia: possible extra-thoracic stridor cause:
- Approximately 70% stridor in infancy
- Typically presents at ___ weeks of age
- High-pitched, ___
- Worse ___, ___, crying
- Better ___, calm
- Rarely interferes with sleeping, feeding, growth
- Peaks ~3 months
- Spontaneous resolution by ___months
Laryngomalacia:
- Approximately 70% stridor in infancy
- Typically presents at 2 - 3 weeks of age
- High-pitched, inspiratory
- Worse supine, feeding, crying
- Better prone, calm
- Rarely interferes with sleeping, feeding, growth
- Peaks ~3 months
- *-Spontaneous resolution by 12 - 18 months**
most common Congenital Laryngeal Anomalies
laryngomalacia
redflags of stridor
Red flags:
Present at birth
Biphasic
Abnormal voice
Poor feeding / growth
- must do a Diagnostic laryngoscopy
common Congenital Tracheal Lesions
stemming from the abdominal vasculature. pulmonary trunk comes behind the trachea and constricts it instead of being in front of it
causes of acquired stridor
Acute onset stridor: Croup
- age
- cough type
- worse at __
- happens on the ___ months
- main bug:
- management:
6mo-6 years
- barky cough. coryza
- worse at night time
- happsn in the fall months
- most common bug is para influenzae
managemetn: nebulizied epinephrine, systemic steroids
Acute onset stridor: bacterial tracheitis
symptoms and managemnet. what bug causes it?
Staph aureus and group A strep main causes
management: NPO, analgesia, antbiotics
