Respiratory Distress in Children

Question 1

Anticipation of CP arrest typically involves the pediatric assessment triangle (PAT); what is included in this?

Answer 1

1. Appearance [abnormal tone, interactiveness, consolability, abnormal look/gaze, abnormal speech/cry]
2. Breathing [sounds, position, retractions, flaring, apnea/gasping]
3. Circulation [pallor, mottling, cyanosis]

[These are all things that should be noted before even examining the child]

Question 2

In terms of the appearance of a child in respiratory distress, their overall demeanor may be restless, anxious, and compative, suggesting hypoxia.

What type of behavior my suggest hypoxia, hypercarbia, and/or respiratory fatigue, and is an ominous sign of impending respiratory failure?

Answer 2

Somnolence or lethargy

Question 3

The initial response to respiratory compromise is usually _______.

What happens as respiratory compromise progresses?

Answer 3

Tachypnea

[As respiratory compromise progresses, RR often decreases and pattern of respirations becomes irregular. The development of slower, irregular respiratory pattern in the setting respiratory distress is an OMINOUS sign and respiratory arrest will quickly develop if no intervention is made]

Question 4

In terms of heart rate, when in a state of respiratory compromise, you will initially see _______ to compensate. When ability to compensate is exceeded, you will see ________

Answer 4

Tachycardia; bradycardia

Question 5

What circulatory changes might be indicated by cyanosis?

Answer 5

Low oxygenation of blood

Significant blood loss

Inadequate perfusion (from whatever cause)

Question 6

Tension pneumothorax occurs when air from the lung leaks into the pleural cavity, causing a shift of the mediastinal structures to the _____ side, sometimes compressing the ____ and _____

Answer 6

Opposite; heart; opposite lung

Question 7

Hallmarks of tension pneumothorax

Answer 7

Severe respiratory distress

Ipsilateral chest hyperexpansion

Decreased or absent breath sounds on the side of the collapsed lung

Shift of mediastinal structures, sometimes the deviation of the trache is visible externally

Hyperresonance to percussion over the collapsed lung

Question 8

Acute cardiac tamponade is rare in kids (unless traumatic); it can be secondary to insidious buildup of fluid in the pericardial sac d/t infection or oncologic disease (i.e., leukemia) resulting in respiratory distress and hypotension. What is Beck’s triad associated with 1/3 of pts with cardiac tamponade?

Answer 8

Jugular venous distention

Muffled heart sounds

Hypotension

Question 9

________ and ______ are potential causes of respiratory distress in kids that more typically cause sore throat, difficulty swallowing, swelling, and local pain; may present with hoarse voice, and may become an ENT emergency

Answer 9

Retropharyngeal abscess; peritonsilar abscess

Question 10

Most common cause of infectious airway obstruction in kids ages 6-36 months

Answer 10

Croup (acute laryngotracheobronchitis)

Question 11

Croup is not a dx confined to children. It is most often viral (________ virus), less often allergic (spasmodic cough).

______ is most often a secondary bacterial infection to croup, in which kids are febrile and really sick.

If on auscultation you note _______, think croup

Answer 11

Parainfluenza

Tracheitis

Stridor

Question 12

X-ray finding with croup

Answer 12

Steeple sign

Question 13

_______ is another potential cause of respiratory distress in kids, characterized by inflammation, edema, bronchospasm, and/or mucus

Answer 13

Asthma

Question 14

Asthma may trigger respiratory distress d/t infection, exercise, environmental irritants, stress, GERD, etc., resulting in sudden worsening. Sudden changes can be due to _________ and/or ________

Answer 14

Alveolar disease; atelectasis

Question 15

Signs of anaphylaxis include facial edema and urticaria. How does anaphylaxis lead to respiratory distress?

Answer 15

Most commonly due to food or medications

Respiratory distress is often due to retropharyngeal/laryngeal edema as well as bronchospasm in lower airways

Question 16

If an allergy is reported during history-taking, what is the most important follow up question?

Answer 16

Always ask what happens when exposed to allergen

Question 17

Lifesaving, immediate intervention in the setting of anaphylaxis

Answer 17

Epinephrine (often given IM)

Question 18

Presentation of a FB in the trachea

Answer 18

Sudden, dramatic coughing

Stridor, drooling, choking often noted if upper airway is obstructed

Question 19

Presentation of aspirated FB into lower lung fields

Answer 19

Coughing, choking when FB is first ingested

Delayed symptoms — recurrent PNA, chronic cough

Question 20

Presentation of esophageal FB

Answer 20

Drooling, swallowing problems

[remember that an estimated 40% of FB ingestions by children are not witnessed]

Question 21

Choking hazard item found in most households that is especially dangerous d/t its ability to corrode the mucosa of the esophagus and potentially result in tracheoesophageal fistula

Answer 21

Button batteries

Question 22

Pediatric pt population in which initial respiratory compromise is most often due to chronic hypoventilation

Answer 22

Those with congenital or acquired neuromuscular disease [i.e., developmentally disabled, cerebral palsy, etc.]

Question 23

If a pediatric pt with hx of sickle cell disease presents with sudden onset respiratory distress, chest pain, fever, and new infiltrate on CXR, you should suspect _____ _____ _____

Answer 23

Acute chest syndrome

Question 24

In what pt population do you see acute chest syndrome and what are the presenting signs/symptoms?

Answer 24

Sickle cell patients

Present with sudden onset respiratory distress, chest pain, fever, and new infiltrate on CXR