Respiratory Distress Flashcards
What are the three components of the pediatric assessment triangle?
appearance
breathing
circulation
What are the 3 components of cardiopulmonary arrest in children?
respiratory
cardiac
circulatory volume
What is the overall demeanor for children in respiratory distress?
restlessness, anxiety and combativeness suggest hypoxia. Somnolence or lethargy suggests severe hypoxia, hypercarbia or respiratory fatigue
What is the tone of children in respiratory distress?
poor tone, lethargic and listlenessness
What is the interaction of children in respiratory distress?
not interacting with other children and won’t play with toys
Are children in respiratory distress consolable?
no
What does the gaze of a child in respiratory distress look like?
unfocused, eyes rolling around
Describe the speech/cry of children in respiratory distress
hoarse or muffled/ weak or absent
What is the ominous breathing sign in a child with respiratory distress?
initial tachypnea followed by decrease in RR and irregular patterns of respiration
What are some physical findings for breathing in a child with respiratory distress?
nasal flares intercostal/subcostal/sternal retractions rocking respiration stridor diffuse wheeze grunting accessory muscle involvement decreased breath sounds tripoding
Describe stridor
high pitched crowing sound, prominent in inspiration. secondary to narrowing of the larynx
describe wheezing
speaking noise made by air passing through narrowed tracheobronchial airways (obstruction, bronchoconstriction, inflammation)
describe rales
moist sounds heard upon auscultation resulting from air passing through narrowed bronchi (airway inflammation and mucus)
describe grunting
expiratory sound heard without a stethoscope generated in an attempt to maintain airway patency.
breathing out against a partially closed golittis.
How do we assess circulatory status in children?
skin exam (decreased perfusion would present as cooling of the skin peripherally. pale, mottled, cool or ashen skin are concerning)
capillary refill (less than 2 seconds)
What is the general rule of thumb for heart rate changes in compromised patients?
initially we see tachycardia to compensate. but when the ability to compensate is exceeded, we see bradycardia.
What causes a tension pneumothorax?
air from lung leaking into the pleural cavity
What are the hallmarks of a tension pneumothorax? (5)
- severe respiratory distress
- ipsilateral chest hyperexpansion
- decreased or absent breath sounds on the side of the collapsed lung
- shift of mediastinal structures, deviation of trachea
- hyperresonance to percussion over collapsed lung
What is a cardiac tamponade?
blood, serious fluid or air fill the pericardial sack with life threatening compromise of venous return and cardiac stroke volume
What two things result from a cardiac tamponade?
respiratory distress and hypotension
What is Becks triad?
3 signs of acute cardiac tamponade: JVD, muffled cardiac sounds, hypotension
What is a retropharyngeal abscess?
What is a peritonsillar abscess?
a collection of pus behind the pharynx
a collection of pus around the tonsils
What are the signs and symptoms of retropharyngeal and peritonsillar abscesses?
difficulty swallowing, local pain, swelling, hoarse voice, hot potato voice
What is the most common cause of infectious airway obstruction in children ages 6-36?
croup
most common cause of croup?
parainfluenza
What breath sound do you hear with croup?
stridor
What is epiglottitis caused by?
H influenza type B
What is bronchiolitis caused by?
RSV, influenza, parainfluenza, adenovirus
What is the epidemiology and clinical presentation of children with bronchiolitis?
children less than 2 years old
characterized by URI symptoms, progressive cough, wheezing/atelectasis
What is the most common cause of pneumonia in children?
streptococcus pneumoniae
What is the difference in presentation of bacterial vs viral pneumonia?
bacterial is more localized(lobar), high grade fever and ill appearing
viral and atypical pneumonia are diffuse interstitial, with peribronchial processes on x-ray (viral and atypical can sometimes by lobar)
What is anaphylaxis most commonly due to?
food or medications
How can anaphylaxis be life threatening?
retropharyngeal/laryngeal edema can close the airway
What are the three most important agents used in treatment of anaphylaxis?
epinephrine, oxygen and steroids
What is the presentation of a foreign body aspiration in the trachea?
sudden, dramatic coughing. Stridor, drooling and choking are noted if upper airway is obstructed
What is the presentation of a lower foreign body aspiration?
coughing, choking, recurrent pneumonia and chronic cough.
What congenital or acquired CNS diseases can cause respiratory distress in kids?
neuromuscular (muscular dystrophy)
infectious
trauma
medication effect
