Peds Thorax Flashcards
How does the AP diameter in peds compare to those of adults?
decreases through the first 3 years of life
How does the diaphragm attach in peds compared to adults?
Angle of insertion is horizontal in infants, leading to lower contraction efficiency
When does alveolar multiplication stop?
until thoracic growth is complete–around two years of age
Who has more alveoli after two yo: boys or girls?
Boys
When are the capillaries grown to the adult form?
2-3 yo
Why are children more susceptible to respiratory distress?
not enough growth
What is the first step of child’s peds exam?
ABCs (airways, breathing, circulation)
What is the RR at birth and less than 28 days old?**
40-60**
How do infants breathe?
Obligate nasal breather
What is the normal breathing pattern in infants?
Periodic breathing
What is apnea considered for children?
greater than 20 seconds
What is the only way to count the number of breaths for infants?
counts over a minute
What are the six pertinent symptoms that can change breathing?
- High Fever
- Not Eating
- Color change (red is okay, blue is bad)
- Nasal congestion
- Cough
- Sudden onset (FB?)
Coughing to the point of vomiting for children is indicative of what preventable disease?
Pertussis
What are the signs of respiratory distress in infants?
- Rate and effort
- Retractions
- Nasal flaring
- Head bobbing
- Grunting
Where are retractions seen in children? (3)
- Suprasternal
- Subcostal
- Intercostal
What are the five aspects of the cardiac exam for peds?
- Heart
- Lungs
- Liver
- Skin
- Pulses
What is acrocyanosis?
Normal cyanosis in the fingers/extremities
When is cyanosis worrisome in children?
Central cyanosis
What is the hyperoxitest? Result interpretation?
Check ABG, provide 100% PaO2.
Rise or pO2 > 100mmHg the cause is probably pulmonary. If no rise, cardiac
Where is the heart listened to in peds?
midclavicular line, 4th or 5th intercostal space (same as adult)
What are three conditions that can cause a heart shift?
- Pneumothorax
- Dextrocardia
- Diaphragmatic hernia
What is the normal newborn HR?
120-160 BPM
A fixed HR above 220 in children can be indicative of what?
Supraventricular tachycardia
Which sound is higher in pitch; S1 or S2?
S2
True or false: splitting of the heart sounds in common in infants
True
True or false: murmurs are common in the newborn in the first 1-3 days
True
What causes most murmurs in newborns?
Changes in vascular pressures during early transition after birth
What is a machinery murmur indicative of?
PDA
A bounding pulse in infants can indicative of what?
PDA
Diminished femoral pulses may be due to what?
Aortic coarctation
What is the order of the femoral artery, nerve, and vein, going medially to laterally?
VAN
What is a hypertensive BP in infants?
> 80/50
True or false: sinus arrhythmia is less common in peds than in adults?
False–more common
What are innocent murmurs? (3)
- Midsystolic
- 2-3/6 intensity
- Maximally heard at the mid left sternal border
When are murmurs common?
3-7 years of age
After what age as murmurs concerning?
After 7 yo
What happens when children lie supine (as far as murmurs go)?
Heard better
What happens when children sit/stand up or hold their breath (as far as murmurs go)?
Heard less
What happens to murmurs in instances of increased metabolic rate?
More pronounced
Which murmurs are always concerning? (4)
Diastolic
Loud
Central cyanosis
Abnorm pulses
What is a normal cap refill for children?
Under 2 seconds
Where should the extremity be when cap refill is assessed?
Above the heart
How does the diaphragm attach in peds compared to adults, and what is the consequence of this?
Diaphragm is more horizontal in infants, leading to decreased contraction efficiency
True or false: an enlarged liver may be an early sign of heart failure in peds
True
