peds resp Flashcards
why would infant be cyanotic
amniotic fluid in lung
cong. heart disease
why would infant be cyanotic
amniotic fluid in lung
cong. heart disease
cong. heart vs respiratory cyanosis: how to tell the difference
listen for murmurs
-single S2: worrisome
baby PMI
right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)
- ensure not situs inversus
- ensure no tension pneumothorax (R: right hyper expands, shift left of PMI, vis versa)
baby PMI
right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)
cong. heart vs respiratory cyanosis: how to tell the difference
listen for murmurs
-single S2: worrisome
palpate this before listening to lungs/heart
PMI
baby PMI
right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)
check pre-ductal (PDA) pulse ox
right arm: if lower no mixing??
postductal : leg or left arm
cardiac pre vs. post O2
pH: 7.44
CO2: 20
O2: 50
pH: 7.44
CO2: 20
O2: 54
not much change! problem with ductus, still not getting O2
lung problem: CO2 levels and hyperoxia test
retained CO2 (elevated)
dec. O2
hyperoxia test PaO2>150 mmHg
retracting, gasping, grunting, crackles, rhonchi, rales
heart problem: CO2 levels and hyperoxia test
normal or dec. CO2
dec. O2
PaO2 50-150 mmHg
quiet tachypnea
norm.
resp pre vs post O2
pH: 7.2
CO2: 70
O2: 50
pH: 7.2
CO2: 66
O2: 160
cardiac pre vs. post O2
pH: 7.44
CO2: 20
O2: 50
pH: 7.44
CO2: 20
O2: 54
oxyhood
can be given instead of mask/intubation
*if CO2 is not a problem
transient tachypnea of the newborn
typ. term baby
mult. deliveries, C sec
respiratory problem
some retained fluid
check CBC
ddx for trans. tachypnea of newborn (“blue baby”)
meconium in utero: thick pea soup–>meconium aspirates: would intubate (ET tube, meconium aspirator) may need to bag them
-fluid in lungs–>chemical pneumonitis (bile acid)–>tachypnea
“meconium staining”
rare for premies, mostly term: think inf. w/ listeria if premie
chorioamnioitis orgs
group B. Strep, E. coli, listeria
meconium does not have
bacteria?
pneumothorax
seen on CXR: free air, pushes heart to opposite side
may occur from meconium aspiration
mom had fever while baby in utero, baby has foul smell
chorioamnionitis
can dev. into pneumonia
baby comes out w. flu, tachypnic
chorioamnioitis orgs
group B. Strep, E. coli, listeria
premature risk w/ O2 deficiency
surfactant deficiency 37 wks inc. work of breathing grunting inc. resp. rate
phys. signs of resp. distress
Nasal flaring: causes marked reduction in nasal resistance…can reduce lung resistance, and decrease work of breathing
Retractions: disturbance in lung and chest wall mechanics: intercostal, subcostal and suprasternal muscles
Cyanosis: clinically apparent when at least 5gm/100ml of hgb becomes unsaturated
cardiac baby would NOT grunt
common pulm. causes
Retained Fetal Lung Liquid Syndrome (RFLLS or also known as Transient Tachypnea of newborn or TTN)* Respiratory Distress Syndrome Meconium Aspiration Syndrome Pneumonia Air leak* most likely for premie
non-pulm causes RD
Cardiac: ie: cyanotic congenital heart disease
Infection : sepsis
Metabolic Disorders: ie Hypoglycemia, inborn errors of metabolism
CNS disorders: ie: meningitis, seizure, obstructed hydrocephalus
Other: ie Anemia, polycythemia, asphyxia
“panting like a dog”
not retractions
CXR for surf. deficiency
air bronchograms wet lungs "ground glass" higher surface tension (with 100% O2, O2 would inc., CO2 would still be elevated)
can give babies CPaP?
yes, can also intubate but use oxyhood if not as bad
what lung cells respond to surfactant
type 2 alveolar cells
can give exogenous surfactant?
Yes, down trachea via intubation, tip them around, let ventilator blow into lungs, get better quickly
complication of surfactant
pulmonary hemorrhage, calculate amount need to be given
Sweat chloride test
The most discriminatory test for CF and is the gold standard
-IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene
(But child with single gene may not have CF)
what lung cells respond to surfactant
type 2 alveolar cells
meconium ileus
poor weight gain
**(buzzword for CF)
elevated IRT
IRT: immunoreactive trypsinogen
meas. fraction of pancreatic enzymes normally rel. in low conc.
if elevated, suspect pancr. dysfunc, CF
Sweat chloride test
The most discriminatory test for CF and is the gold standard
-IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene, i.e. + for carrier (But child with single gene may not have CF)
>60 is dx
40-60 intdeterminant (>30)
-newborns don’t sweat much
CF can result in…
chronic sinopulmonary disease and pancreatic insufficiency Chronic cough Decreased appetite/failure to thrive Weight loss Dyspnea Increased sputum production Rectal prolapse pseudomonas infection
CF inheritance
autosomal recessive
chromosome 7
CF affects
- Peribronchial cuffing
- Tram lines (bronchial line shadows)
- Recurrent infiltrates
- Fibrosis
- Pulmonary blebs and bullae
CF also affects
vas deferens
nasal polyps
In managing a child with CF, which of the following is the most appropriate choice?
a. Pulmonary therapies including bronchodilators and mucolytics
b. Macrolides for suspected bacterial infections
c. Pancreatic enzymes only for those with pancreatitis
d. Avoidance of live vaccines
all except d.
will put on macrolides later, pseudomonas is a big dog
CF complications
Recurrent pneumonia Recurrent sinusitis Hemoptysis Pneumothorax Respiratory failure Nasal polyps
Which of the following is the LEAST likely to be a complication of CF?
a. Hemoptysis b. Pneumothorax c. Pancreatic cancer d. Male infertility e. Cirrhosis
pancreatic ca
Which of the following is usually clinically diagnostic of CF in neonate?
meconium ileus (1/5)
macrolide tx
give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread
CF tx
Oxygen Empiric antibiotic therapy Bronchodilators Support of ventilation Support nutrition with pancreatic enzymes/GI Treat complications: Pneumothorax Hemoptysis Diabetes (usually as teens)
what dx studies for CF?
lymphocytes on CBC (70%), elevated WBC
CF colonization
S aureus, nontypeable H influenzae, gram-negative bacilli
P aeruginosa becomes predominant organism by 10 years of age.
Antibiotic therapy continued for 2 to 3 weeks and may be given on an inpatient service combined with home IV therapy
macrolide tx
give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread
how to prevent pertussis
infant DTaP
adult TdaP
pregnant: TdaP + flu shot–>passive imm. to baby
more wheezing bac or viral?
viral
most common cause of bronchiolitis
RSV
collect via saline tube on ice
other causes of bronchiolitis
hMPV, adenovirus, influenza, hit kids
peribronchial cuffing
“donut” rings around bronchi
other CXR findings bronchiolitis
air expansion, air in subQ tissuses (crackly), hyperinflation
bronchiolitis
don’t need steroids, albuterol; but can try
sev. may need to be intubated(premies, CV probe)
RSV ppx
Palivizumab (MoAb IM)
criteria: typ. premies on O2
$$
bronchiolitis: complications
Apnea (most common in premature infants and young term infants) Pneumonia Atelectasis Dehydration Respiratory failure Bacterial superinfection Air leaks
Ribavirin
don’t use much
give in a hood
ppx and supp. care is better
placenta previa or abruption can result in
fetal anema or hypovolemia–>resp. distress
poorly controlled DM can result in fetal
hypoglycemia, polycythemia, rel. surfactant deficiency
polyhydramimnios can cause
tracheoesophageal fistula
oligohydramnios can be a sign of
hypoplastic lungs
triple screen
a-fetoprotein, hCG, estradiol
during prey, lung epi is mostly
secretory membrane; chloride pump cause influx of Cl and H2O from interstitial into alv space
just before delivery, fluid begins to clear
alv. space about 2-3 days before labor onset, pulm. epi becomes an absorbing membrane
fetal RR
60 implies resp. distress)
prior to delivery, if notice lecithin:sphingomeylin ratio is
implies fetal lung is immature
-give mom steroids (betamethason >2 days before)
acute onset
fever
CP
grunting
BACTERIAL
most common: S. pneumo
-localized lobar pneumonia
pneumonia diagnostics
CXR
CBC: high WBCs, left shift
pneumonia: bac or viral?
viral more common, bac higher mortality/morbidity
leading cause of bac CAP
- S. pneumo
- S. aureus
- GAS
pneumonia vs. effusion
pneumo: rhonchi, wheezes, rales
eff: not as much, dec. breath sounds, egonphony
Mycoplasma pneumonia
(teens)
“walking pneumonia”
tx: macrolide
neg. Gs
