PEDS mod 5 Flashcards
What are the 4 diagnostic criteria for ARDS?
Hypoxemia profound Acute onset dyspnea Bilateral pulmonary infiltrates Absence of left atrial hypertension
What is a late finding of bilateral pulmonary infiltrates?
Pulmonary fibrosis
In ARDS, what will be high vs what will be low in respect to the pulmonary artery pressure and the left atrial pressure?
The pulmonary artery pressure will be high but the left atrial pressure will be low.
What should the pulmonary artery pressure be in order to be classified as elevated?
Mean PAP >20 mmHg
Pulmonary HTN should be thought to be associated with what?
Underlying cardiac or lung disease* like bronchopulmonary dysplasia, idiopathic or familial.
What are two common respiratory causes of ARDS?
Infections and CF
What are some common cardiac causes of ARDS?
Congenital, infections, tamponade
What are some GI causes of ARDS?
Aspiration, abd pain, abd distention.
What are some other non respiratory, non cardiac, non GI causes of ARDS?
Metabolic, hematologic, toxins/drugs, head trauma.
Pulmonary action does not match body’s needs for gas exchange.
ARDS
What are the 4 mechanisms of ARDS?
No oxygen in No CO2 out Mechanical problem Control problem
What is the main symptom of ARDS?
Increased work of breathing or dyspnea.
What is a hallmark of obstruction in the upper airway? Could also be from swollen airway seen in croup.
Stridor
This sound will be from an obstruction in the lower airway.
Wheeze
This sound is fine and can be from fluid, or atelectasis (dry).
Crackles/Rales
Lower airway obstruction sound common in pneumonia.
Grunting (@20 min mod 5)
This sound is a rough snoring sound from the large airways.
Rhonchi
What would you suspect if lung sounds were absent?
Fluid, air around, collapsed lung, Lung tissue dz.
abnormal tone, decreased interactiveness, poor color, abnormal stare, weak cry.
Appearance
Abnormal airway sounds, a position of comfort that maximizes airway opening, and use of accessory muscles. Tripoding.
Breathing
Pallor or cyanosis, decreased perfusion, poor capillary refill or cool skin
Circulation
What pulse ox saturation is needing oxygen?
Less than equal to 94%
Transient and remains unexplained after an appropriate medical evaluation If you find an explanation it’s no longer this.
BRUE
What are some of the characteristics of a BRUE?
< 1 yr 20-30 sec Cyanosis or pallor Absent, decreased or Irregular breathing Hyper or hypotonia Alt level of responsiveness
What are some risk factors of BRUE?
Feeding difficulties Recent URI < 2 mo old Hx of prior episodes +/- premature birth/low birth weight, maternal smoking
FU 2 PPM
What are the warning signs of BRUE?
Toxic appearance Lethargy Unexplained recurrent vomiting Respiratory distress Sustained cyanosis or LOC, CPR Bruising Hx or prior events Sibling Abuse or maltreatment Dysmorphic features.
LTS VCR ABD
What does the AAP guidelines recommend for low risk?/
No need for routine testing and recommends against eval for systemic infection. For low risk they recommend parent education, CPR, and reassurance. High risk: r/o underlying conditions/ admit.
The most common cause of respiratory distress in premature infants is?
Hyaline membrane disease.
Deficiency of surfactant Surfactant also leaks into airspaces
Hyaline membrane disease
• decreases surface tension during expiration • allows alveoli stay partially expanded • PPX given to neonates <27wks • Tx for infants with hyaline membrane dz
Surfactant
Lack of surfactant =
poor lung compliance and atelectasis
What is a big red flag of neonatal respiratory distress/Hyaline membrane dz?
If there is greater than 16 breaths per min. Absent breath sounds due to faulty alveoli Ground-glass appearance and or bronchogram. Ground-glass will be on atelactasis.
What is the treatment of Neonatal Respir Distress/Hyaline membrane dz?
O2, nasal CPAP, early intubation, surfactant, umbilical artery and vein line placement,
What will lessen the chance for Neonatal Respir Distress/Hyaline membrane dz if the mom takes what > 24 hours prior to a pre-term birth?
Maternal steroids. Have better neonatal outcomes and lower chances of hyaline membrane disease.
Most common lethal inherited disease in caucasians?
CF
CF affects what organ systems mostly?
Lungs and GI
What is the pathophysiology of CF?
Disruption of salt and water balance. Mucus becomes thick and sticky.
If a patient has nasal polyps and cough what should you think?
CF
When is CF usually diagnosed?
6-8 mo old
Why does CF cause greasy malodorous stools?
The impact on the pancreas causing malabsorption.
Neonates with intestinal blockage is suspicious for?
CF
Undescended testicles Clubbing fingers (older kids)
CF
What are the normal ranges of the sweat chloride test?
30-60 Positive is greater than 60mmol/L
What other additional criteria do you need if the sweat chloride test is positive?
Either COPD Dx, Exocrine pancreatic insufficiency (via fecal test) or + fam hx of CF CFTR genetic test is easier than doing the sweat test and the additional criteria.
is the abnormal distortion and dilation of the bronchial tree.
Bronchiectasis
Loss of elasticity and will have tram tracks on CXR
Bronchiectasis
S/Sx are daily chronic cough with mucopurulen sputum over months to years.
Bronchiectasis
What is the standard dx for bronchiectasis?
CT scan
Are Brochiectasis airway obstruction reversible with bronchodilators?
No, the only helpful treatments are antibiotics and chest therapy.
defined as a single entity of oxygen requirement either at 28 postnatal days or 36 weeks postmenstrual age
Bronchopulmonary dysplasia
NICHD criteria also proposed that the requirement of supplemental oxygen be confirmed by using a physiologic test after a room air challenge test. What is a positive test?
If they drop below 90% on RA within 1 hour.
What is the most significant sequelea of ARDS
Bronchopulmonary dysplasia
Most cases of Bronchopulmonary dysplasia will have a birth weight below what?
1250 g
What is the main symptoms of bronchopulmonary dysplasia?
Tachypnea
What is the Tx of bronchopulmonary dysplasia?
Surfactant
In Bronchopulmonary dysplasia, muscles of arterioles can thicken leading to what?
Pulmonary hypertension.
This is usually a diagnosis of exclusion. It is a restrictive group of disorders. This is a parynchama problem as opposed to mucus or swollen airways.
Interstitial lung disease (diffuse lung disease)
Presents as unexplained respiratory failure in newborns, tachypnea, crackles, “velcro rales” hypoxemia, This is a chronic lung disease out of proportion to the degree of prematurity.
Interstitial lung disease (diffuse lung disease)
How do you Dx Interstitial lung disease (diffuse lung disease)?
Dignosis of exclusion
What is the treatment for Interstitial lung disease (diffuse lung disease)?
supportive, lung lavage, lung transplant.
