Resp Distress

Question 1

Signs of RD

Answer 1

Nasal/alar flaring is an attempt to decrease resistance to airflow

•Grunting is a sound heard during expiration as air passes through a partially closed glottis. This is an automatic reaction to respiratory insufficiency, providing the lungs with increased expiratory pressures in order to optimise gaseous exchange by splinting airways open.

Question 2

Signs of RD

Answer 2

Head bobbing may occur in infants, indicating use of the accessory muscles of respiration.

•Abnormal positioning includes a refusal to lie down and the child assuming the “tripod” or “sniffing” position to instinctively open the airways and use the accessory muscles of ventilation most effectively. Respiratory opisthotonus (extensor posturing of the neck) should not be corrected.

Question 3

Signs of RD

Answer 3

Recessions or retractions are an indrawing of the thoracic soft tissues during inspiration due to the very compliant chest wall. They may be subcostal, intercostal, supracostal, supra- or substernal

Question 4

RD

Answer 4

Expiratory wheeze / prolonged expiration may indicate an inhaled foreign body
•Stridor audible sound on inspiration
-Indication of upper airway obstruction
Medical emergency

Question 5

Alarm bells

Answer 5

falling respiratory rate or gasping;

• poor chest excursion and air entry;
• cyanosis or hypoxia (low SaO2);
• arterial blood gases indicating hypoxaemia and/or hypercapnoea with acidosis;
• tachycardia followed by bradycardia;
• altered level of consciousness and hypotonia.

Question 6

RD

Answer 6

Tachypnoea is one of the first signs of respiratory distress. Infants and young children first increase the rate rather than the depth of breathing. This must be recognised early as rapidly breathing children will eventually tire leading to respiratory arrest.