peds

Question 1

How is the pediatric airway different from an adults?

Answer 1

• proportionally large tongue
• large, floppy, epiglottis
• Cricoid cartilage is the narrowest part of ped airway
• Kids are not little adults−Smaller airways=more resistance
  
  • Increased chest wall compliance
    
    • Less respiratory reserve
    • Can tire out quickly and suddenly

Question 2

What is croup?

Answer 2

• most common cauae of airway obstruction btween 6mo to 6yr
• common in winter and fall
• gradual onset
• fever, sore throat, nasal congestion
• stridor and barky cough
• steeple sign on lateral neck radiograph

Question 3

What is the treatment for croup?

Answer 3

• Largely supportive
• Hydration
• Exposure to cool air
• Cool mist
• Racemic epinephrine
• Dexamethasone
• Heliox?
• If intubation is necessary be cautious to avoid any trauma

−Use smaller ETT

Question 4

What is Epiglottitis?

Answer 4

• Life threatening infection of the larynx that results in sudden swelling of epiglottis
• Very rare
  
  • H. influenza B
• Rapid onset
• High fever
• Drooling with dysphagia
• Severe respiratory distress
• Patient prefers to sit upright in sniffing position
• Lateral radiograph shows “Thumb Sign”

Question 5

What is the treatment for epiglottitis

Answer 5

• oxygen
• intubation
  
  • may need needle cricothyroidotomy

Question 6

What is tonsillitis?

Answer 6

• Acute illness with fever and sore throat can lead to swelling of oropharyngeal tissues
• Leads to inflammation of tonsils and adenoids
• Streptococcal pharyngitis
• Severe or recurring cases may need surgical removal of tonsils and adenoids

Question 7

What is anaphylactic laryngospasm>

Answer 7

• Pediatric allergies are becoming more prevalent
• Severe side effect of anaphylaxis can be critical laryngospasm
• Treat with inhaled racemic, IM or IV epinephrine

Question 8

Foreign body aspiration

Answer 8

• leading cause of death in mobile infants, toddlers and young children
• signs
  
  • mild to severe respiratory distress
  • recurring pneumonia
  • unilateral wheezing
  • right sided aspiration more likely

Question 9

What is treatment for foreign body aspiration?

Answer 9

• Depends on severity of obstruction
• Support oxygenation as needed
• if the child is stable
  
  • XRAY and History to determine the size and location of the object
  • Controlled bronchoscopy in the OR to remove the object
• if the child is unstable
  
  • PALS algorithm for severe airway obstruction
  • Emergent flexible bronchoscopy to remove object may be necessary

Question 10

What is RSV?

Answer 10

• Highly contagious
• Most often affects infants less than one year of age
• Newborn to 6 month olds are at risk for most serious infections
• Infants with pre-existing conditions (BPD, CF, etc) are at higher risk
• Infection lasts 5-10 days and peaks at 5-7 days

Question 11

What is Bronchiolitis?

Answer 11

• Acute viral infection causing small airway obstruction and inflammation
• Respiratory distress
• Tachypnea
• Cough
• Wheezing
• Copious secretions
• Apnea (Newborns and very young infants)

Question 12

Cystic Fibrosis

Answer 12

• Lethal autosomal recessive disease caused by a dysfunctional gene on chromosome 7

Question 13

What does Cystic Fibrosis Transmembrane Regulator (CFTR) gene do and what happens when it dysfunctions?

Answer 13

• Normally helps control flow of ions and substrates across cell membranes lining the airways, intestines, vas deferens, biliary tree, sweat ducts, and pancreatic ducts
• CFTR dysfunction
• Chloride ion cannot be transported
  
  • Insufficient secretion of fluid and inadequate hydration
  • Leads to thickened secretions in all affected organ systems

Question 14

What are some treatments for CF and what are the symptoms?

Answer 14

• increased goblet cells - increased secretions and sputum
• secrections are dry and thick
• airway inflammation
• Treatments
  
  • VEST, Postural drainage and CPT, Acapella, Metaneb
• Meds
  
  • Bronchodilators
  • Mucoltics- Dornase alfa (Pulmozyme), 7% NaCl
  • Antibiotics- Tobi
• GI symptoms
  
  • pancreatic insufficiency
    
    • ducts can plug due to thickened pancreas secretions→ malabsorption of fat and protein

Question 15

What is Spinal muscular atrophy (SMA)?

Answer 15

• Autosomal recessive inherited disorder
• Progressive destruction of the motor neurons of spinal cord and brainstem

−Results in significant muscle weakness

•Three identified types of SMA

−Type 1

−Type 2

−Type 3

Question 16

What is Duchenne Muscular Dystrophy?

Answer 16

•Genetic disorder

−Mutation of the dystrophin gene an Important structural component of muscle tissue

•Affects cardiac, respiratory, gastrointestinal, endocrine, and nervous systems

−Male predominance (X Linked)

•Progressive, irreversible muscle weakness

• Signs and symptoms
  
  • childhood-onset
  • difficulty running, climbing stairs, and standing
  • may become wheelchair bound
  • no cure, most die by 20

Question 17

What happens when a child drowns and how do we treat them?

Answer 17

• child below surface of water → voluntary apnea→ become hypercarbic, hypoxemic and acidotic → involuntarily swallow water and inhale water into lungs → become unconscious, panic and eventually arrest
• provide supportive care, PALS algorithm
• attempt to correct acidosis
• warm slowly
• maybe difficult to ventilate
• ECMO

Question 18

What is ARDS

Answer 18

• Acute lung injury characterized by pulmonary edema die to disruption of AC membrane, hypoxemia, bilateral infiltrates, P/F ratio <200mmHg
  *

Question 19

What are the stages of ARDS?

Answer 19

•Exudative Stage

−Diffuse injury to AC membrane by inflammatory mediators

−Alveoli fill with fluid

−Surfactant inactivation

−Widespread atelectasis

−Lung compliance decreases

• Proliferative stage

−1-3 weeks after the initial injury

−Proliferation of Type 2 pneumocytes to replace the destroyed type 1 cells

Fibrotic Stage

−Severe ARDS cases

−Lung tissue is replaced by collagenous tissues

−Vascular remodeling

−Results in decreased surface area for gas exchange

−May need tracheostomy and home ventilation