Respiratory Distress in Children Flashcards
What are the 3 components of of the pediatric assessment triangle?
- appearance
- breathing
- circulation
What are the 3 components of cardiopulmonary arrest in children?
- respiratory (O2) ***
- cardiac (pump, perfusion, BP)
- circulatory volume (perfusion, BP)
What is the terminal results of progressive respiratory failure/shock in children?
cardiac arrest
-also called an asphyxial arrest
What does somnolence or lethargy suggest in a child?
severe hypoxia, hypercarbia and/or respiratory failure
What does the development of a slower, irregular respiratory pattern indicate?
it is an ominous sign**
- respiratory arrest will quickly develop if no intervention is made
What is stridor usually secondary to?
a narrowing of the larynx (laryngomalacia) or trachea (tracheomalacia), or a vascular ring
what is a squeaking noise made by air passing through narrowed tracheobronchial airways?
wheezing
what is a moist sound heard upon auscultation resulting from air passing through narrowed bronchi?
rales
what is a high pitched crowing sound, most prominent with inspiration?
stridor
what is an expiratory sound heard without a stethoscope, generated in an attempt to maintain airway patency?
grunting
What are the heart rate changes (general rule of thumb)?
when compromised, will initially see tachycardia to compensate
- when ability to compensate is exceeded, will see bradycardia
What is the clinical presentation of a severe/complete upper airway obstruction?
no audible speech, cry, or cough
What will you likely hear with a partial upper airway obstruction?
stridor with inspiration
What are the hallmarks of severe a tension pneumothorax?
severe respiratory distress
- ipsilateral chest hyper-expansion
- decreased/absent breath sounds on the side of the collapsed lung
- mediastinal shift
What is Beck’s Triad, and when does it present?
- JVD
- muffled cardiac sounds
- hypotension
Is seen with cardiac tamponade
What is the most common cause of airway obstruction in kids ages 6-36 months?
croup
- most often vial (parainfluenza virus), less often allergic (spasmodic croup)
What is the most common cause of pneumonia in kids?
Strep pneumo
- bacterial, more localized (lobar), generally higher fever, ill-appearance
NOTE: viral and atypical pneumonia (mycoplasma and chlamydia) tend to be diffuse interstitial/peribronchial, but can be lobar at times
what causes bronchiolitis in kids?
- RSV
- children less than 2 years old
- URI symptoms -> progressive cough -> wheezing/atelectasis
What are the most common causes of anyphylaxis in children?
food or medications
- always ask what happens when exposed to the allergen
- Tx: Epi oxygen, steroids
When would you see acute chest syndrome?
patient with sickle cell disease
- sudden onset respiratory distress and chest pain
- new infiltrate on CXR
- fever
What are the signs and symptoms of asthma?
- cough
- wheezing
- chest tightness
- prolonged exhalation
- SOA
What is the most common triggers of asthma?
Non specific triggers?
- exposure to allergens
- exercise, URI, sinusitis, allergic rhinitis, aspiration, GER, air pollution, NSAIDs, occupational, obesity
What are curschmann spirals?
characteristic finding in sputum or broncho-alveolar lavage specimens
- extrusion of mucus plus from sub-epithelial mucous gland ducts or bronchioles
What are Charcot-Leyden crystals?
also found in sputum or broncho-alveolar lavage specimens
- composed of an eosinophil protein called galectin-10
What differentiates asthma from COPD?
symptoms under age 35, waking at night with breathlessness or wheeze, FEV and FEV/FVC ratio return to normal with drug therapy
What does the asthma volume curve look like compared to the vocal cord dysfunction curve?
- asthma (obstructive) looks like a scooped out chair
- VCD has a truncated inspiratory loop that is flat/shallow at the bottom
What is the rescue medication for asthma?
SABA (b2 agonist) albuterol
NOTE: ICS is NEVER a rescue medication!
What are the most common long-term asthma medications?
inhaled corticosteroids
- fluticasone, beclomethasone, budesonide
leukotriene modifiers
- montekulast, zafirlukast
- zileuton
What are the signs that respiratory arrest are imminent in the following:
- respiratory rate
- body position
- accessory muscle use
- wheeze
- pulse
>30 minute unable to recline paradoxical thoracoabdominal movement absent bradycardia
