Resp Case 1

Question 1

Common cause of wheezing in kids

Answer 1

viral infections

Question 2

what time of day is ore suggestive of asthma?

Answer 2

Coughing thats worse in middle of the nigh (midnight at 3AM)

Question 3

What are some risk for developing asthma?

Answer 3

• RSV infection prior to 6 months

- Family history of atopy: allergic rhinits, eczema

Question 4

What are some examples of common triggers for astha?

Answer 4

• virus
• allergies
• exercise
• cold air
• cigs

Question 5

what are some common finding on a CXR in a kid with asthma or reactive airway disease (RAD)

Answer 5

• atelectasis
• hyperinflation of both lungs
• perihiblar thickening

Question 6

compare capillary refill in an asthmatic kid vs healthy

Answer 6

• cap refil right at 2 sec is concerning, chiild isn’t heading in right direction
• > 2 sec MUCH more concerning
• healthy kids cap refill nearly instantly

Question 7

what is the best way to obtain blood gasses in a peds pts?

Answer 7

• Capillary blood gas fairly common in kids (quicker and less distressing than arterial gas which are more accurate
• can’t use PaO2 from them
• useful only for pH and Co2

Question 8

where should a peds pt with asthma exacerbation be admitted?

Answer 8

PICU - due to risk of decompensation

Question 9

Options for maintenance IVF in kids

Answer 9

1/2 NS in >1 yo OR 1/4 NS in <1 yo

• NS is reserved for bolusing
• In peds usually K is added to IVF

Question 10

when is it appropriate to intubate an asthmatic pts and prior treatments

Answer 10

Make every attempt to maintain respiratory status before intubating. Add: terbutaline drip, Mg, Theophylline, subc epi, heliox, or BiPAP IN ORDER TO NOT INTUBATE.

• Time to intubate is where between irritable and obtunded

Question 11

why do you not want to intubate asthmatics?

Answer 11

they can’t exhale, so if you force in air they get fuller and fuller and risk pneumothorax or acute right heart collapse and die

Question 12

which population of asmathics has highest mortality?

Answer 12

• adolescents because theyre too cool to carry around rescue inhalers

Question 13

signs of respiratory distress in a respiratory pt

Answer 13

• inspiratory and expiratory wheezing
• nasal flaring and tachypnea
• subcostal, intercostal and suprasternal retractions
• stridor
• sniffing or tripod position
• decreased air movement

Question 14

what would indicate concern for CF in a respiratory distress pt and how would you test for it?

Answer 14

• poor height and wt
• clubbing
• foul smelling stools
• recurrent pneumonia
• edema
• failure to thrive

Test with sweat chloride test

Question 15

sudden stridor in a child makes you think of what?

Answer 15

• foreign body aspiration