peds Flashcards
How is the pediatric airway different from an adults?
- 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
- Increased chest wall compliance
What is croup?
- 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
What is the treatment for croup?
- 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
What is Epiglottitis?
- 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”
What is the treatment for epiglottitis
- oxygen
- intubation
- may need needle cricothyroidotomy
What is tonsillitis?
- 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
What is anaphylactic laryngospasm>
- Pediatric allergies are becoming more prevalent
- Severe side effect of anaphylaxis can be critical laryngospasm
- Treat with inhaled racemic, IM or IV epinephrine
Foreign body aspiration
- 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
What is treatment for foreign body aspiration?
- 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
What is RSV?
- 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
What is Bronchiolitis?
- Acute viral infection causing small airway obstruction and inflammation
- Respiratory distress
- Tachypnea
- Cough
- Wheezing
- Copious secretions
- Apnea (Newborns and very young infants)
Cystic Fibrosis
- Lethal autosomal recessive disease caused by a dysfunctional gene on chromosome 7
What does Cystic Fibrosis Transmembrane Regulator (CFTR) gene do and what happens when it dysfunctions?
- 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
What are some treatments for CF and what are the symptoms?
- 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
- pancreatic insufficiency
What is Spinal muscular atrophy (SMA)?
- 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
What is Duchenne Muscular Dystrophy?
•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
What happens when a child drowns and how do we treat them?
- 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
What is ARDS
- Acute lung injury characterized by pulmonary edema die to disruption of AC membrane, hypoxemia, bilateral infiltrates, P/F ratio <200mmHg
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What are the stages of ARDS?
•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
