Respiratory Flashcards
Where does the most resistance to airflow occur? Also where inhaled gas is warmed and humidified.
upper airway
Where does gas exchange occur?
lower airway
The pediatric airway is harder to intubate because they have a ___ tongue, ____ vocal cords, ____ epiglottis, and ___ larynx.
large, angled, floppy, funneled
The narrowest part of the pediatric airway if the?
cricoid cartilage
We do not overextend an infant’s airway due to its large?
occiput
Up to what age are infants obligate nose breathers?
6 months of age
Because infants are obligate nose breathers, they are at increased risk for difficulty breathing when _____ airway disease occurs.
upper
Anatomically, infants have a harder time compensating with lower airway disease due to their poorly developed _____ _____, ____ shaped chest, and e____ airway.
chest muscles, barrel, edematous
Prior to asystole or cardiac arrest, children begin with?
respiratory conditions or respiratory arrest
upper airway illness will lead to an increase in sn____ and no____ breathing.
snoring, noisy
Macroglossia, laryngomalacia, and an extrathoracic foreign body can lead to what respiratory problem?
inspiratory stridor
laryngitis, vocal cord paralysis, and papillomatosis may lead to what respiratory problem’s?
hoarse voice or stridor
Children with congenital syndrome Pierre-Robinson syndrome are harder to intubate due to their ____ chin and ___ tongue.
small, large
The obstruction of 1 or 2 nostrils is called?
choanal atresia
Children with asthma or a foreign body may present with an __ or ___ cough.
acute or chronic
Dehydration will lead to an elevation in __/__ and __
H/H and WBC
What type of chest x-ray is indicated to assess for effusions or pulmonary fluid level?
lateral decubitus
What test is used to assess for solid lung etiologies such as tumors?
pulmonary MRI
What diagnostic test is used to evaluate lung disease in the presence of asthma?
PFTs ( pulmonary function test)
Laryngotracheobronchitis also known as croup, is most common in kids less than ___ YOA, and often seen in what months?
6, October- march
What is the most common croup pathogen?
parainfluenza 1 & 2
Croup s/s are worse at ____, due to upper airway e____
night, edema
croup s/s include s____, a ____ cough, and h____
stridor, a barky cough, and hoarseness
Croup often begins ___ hours after a ____
48 hours after a URI
If croups s/s are severe, obtain a ____ ___ film x-ray.
lateral neck
The characteristic croup x-ray finding is known as the ____ sign.
steeple
Croup management includes ____. The dosing is ___mg/kg IV/IM x1
dexamethasone, 0.6 mg/kg
If a child with croup s/s does not improve with dexamethasone, obtain an __/__ neck ___ to r/o the presence of a foreign body.
a/p neck x-ray
Tracheitis is often bacterial in nature. The most common tracheitis pathogens include s____ and s___ ____
Staph and strep pneumonia
Key tracheitis characteristics include a ____ fever > ____ with ___ look
high fever, > 103 with a toxic look
What condition presents with high fever, toxic appearance, stridor, respiratory distress?
tracheitis
- May look like croup, doesn’t respond to racemic epi
What type of X-ray do you obtain for tracheitis?
lateral x-ray
Tracheitis x-ray findings include the ____ sign.
thumb
tracheitis management includes
C______ + na____ or ox____
Or
C_______ + c_______ if penecillin resistance exists
Or
V______ +- c_______ of patient toxic appearing with multi organ involvement
Ceftriaxone + naficillin/oxacillin
Ceftriaxone + clindamycin
Vancomycin + clindamycin
foreign body airway obstruction occurs in what age groups?
infants and toddlers
The most important history piece in a child with foreign body airway obstruction is that there is no?
illness prior to s/s development
Foreign body airway obstruction is an acute event of c___, c___, ____ breathing, and CHRONIC _____.
choking, coughing, difficulty breathing, and chronic stridor
When working up a child with a foreign body aspiration, what assesses for differences in lung sizes while the child is holding their breath?
An i_____ film
an inspiratory film
What diagnostic test, identifies where the foreign object is?
A Fl______ evaluation
a fluroscopic evaluation
What is the gold standard treatment for a foreign body aspiration?
a bronchoscopy in OR
Ensure to keep children with a foreign body aspiration ____ due to their high risk for complete ____. When agitation, foreign objects tend to?
calm, obstruction.
move further down the airway.
If the foreign object cannot be removed with bronchoscopy, prepare the child for a?
tracheotomy
What is the most common tracheal congenital anomaly?
tracheomalacia
Over time, tracheomalacia may?
improve on its own.
tracheomalacia is more common in premies and infants with a history of previous _____ as well as those with a history of pulmonary i____ or le____
intubation, lesions or injuries
tracheomalacia is associated with?
f____ problems
feeding problems
s/s of tracheomalacia include ___ and ___ which worsen with ____ or _____
stridor and cough. feeding or agitation
Due to a history of feeding difficulties, children with tracheomalacia may present as?
FTT
tracheomalacia is diagnosed with a fl______ br_____ during ______ respiration
flexible bronchoscopy, during spontaneous respiration
What radiology exam assesses for the presence of a vascular ring?
CT scan
What radiologic exam evaluates pulmonary anatomy?
fl______
fluoroscopy
what diagnostic test r/o laryngomalacia?
a laryngoscopy
Tracheomalacia management includes?
observation
Tracheomalacia typically resolves by what age
18 M.O.A
Severe cases of tracheomalacia may be treated with a T____+ ____
tracheostomy and CPAP
In severe cases of tracheomalacia, an aortopexy may be used to help decrease?
a____ c____
airway compression
What is acute severe epiglottis inflammation?
epiglottitis
epiglottitis is considered an airway _____
emergency
In epiglottitis, there is a sudden onset of breathing ____ without _____.
obstruction without fever
The most common organism of epiglottitis in children who aren’t vaccinated is?
Haemophilus influenza
The most common organism of epiglottitis in children who are vaccinated is?
1)
2)
1) strep
2) staph
What age group is most affected by epiglottitis?
1-5 YOA
The diagnostic test for epiglottitis is a?
lateral neck xray
What x-ray finding is characteristic of epiglottitis?
thumbprint sign
When evaluating a child with epiglottitis, a laryngoscopy will show a ___, ____, ___ epiglottis
beefy, red, swollen
Epiglottitis management includes keeping the child?
calm
- do not examine throat
- intubate, if intubation fails immediate tracheotomy
Treatment for a child with epiglottitis includes
R_____ and
D______
Rocephin
Dexamethasone
Warm humidified oxygen
Treatment for a child with epiglottitis resistant to MRSA and Penicillin includes r_______ + _____.
Rocephin + Vanco
What type of airway abscess is more common in older kids and teens
a peritonsillar abscess
A peritonsillar abscess typically begins as a L____ C____ that turns into a D___ N___ A___
Local cellulitis that turns into a deep neck abscess
Peritonsillar abscesses are typically polymicrobial. The most common 3 organisms in order of occurrence are?
strep, staph, H. flu
Peritonsillar abscess s/s include c/o of a ___ ____, decrease in ____ ____, ear ___, and a ____ voice (hot potato)
sore throat, oral intake, pain, muffled
Peritonsillar abscess outpatient treatment includes?
Augmentin
If a peritonsillar abscess does not improve with antibiotics treatment, consult with ENT who will?
lanse abscess
What is the most common reason for a TNA?
obstructive sleep apnea
The following clinical manifestations are characteristic of what?
snoring, obesity, daytime hyperactivity, and sleeping at school.
obstructive sleep apnea
Obstructive sleep apnea complications include ___ ___ and ___ ____
pulmonary hypertension and cor pulmonale
pulmonary hypertension can be diagnosed with an?
ECHO
What is the diagnostic exam for obstructive sleep apnea?
a polysomnography and/or sleep study
To rule out the presence of complications associated with OSA, obtain both an?
EKG and ECHO
True or False. After a TNA, obese kids may still have s/s?
true
After TNA, obese children may need extra respiratory support s/p surgery with a?
CPAP or BiPAP
What is the curative treatment for patients with severe obstructive sleep apnea?
a tracheotomy
What is the most common chronic illness in childhood?
asthma
Asthma is characterized by airway _____ leading to broncho ____
inflammation, constriction
Children that present with nighttime coughing, sob, hypoxia, unable to speak, and retractions unresponsive to treatment are in?
status asthmaticus
What type of asthma occurs less than or equal to 2 days/week
intermittent asthma
What type of asthma occurs > 2 days/week but not daily
mild asthma
In what type of asthma do s/s once occur daily?
moderate asthma
What type of asthma has s/s that occur several times daily?
severe asthma
In asthma and ETT may cause further ____ making it difficult to _____
bronchoconstriction, ventilate
The gold standard diagnostic test for asthma is a?
chest x-ray
