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CPR Exam 3 > Respiratory Distress in Children > Flashcards

Respiratory Distress in Children Flashcards

1
Q

Cardiopulmonary MRGENCIES are the absence of _________, ________ or both.

A

effective ventillation, circulation or both.

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2
Q

What are the 3 components of cardiopulmonary arrest in children?

A
  1. Respiratory (O2)
  2. Cardiac (pump, perfusion, BP)
  3. Circulatory volume (perfusion, BP)
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3
Q

How is cardiac arrest different in infants/children vs adults?

A

In infants and children, cardiac arrest is the end result of progressive respiratory failure/shock (asphyxial arrest), NOT a primary cardiac cause.

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4
Q

What is the progression of Asphyxia?

A
  • Variable period of systemic hypoxemia, hypercapnea and acidosis => bradycardia & hypotension => cardiac arrest.
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5
Q

In pediatric patients, without intervention

______ arrests => ______ arrests => _______ arrests.

A

respiratory =>

cardiac =>

cardiopulmonary

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6
Q

Sudden, unanticipated non-traumatic cardiac arrests are _______ in children.

A

uncommon

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7
Q

While uncommon, sudden, unanticipated non-traumatic cardiac arrest can occur in what population of children?

A
  • Children with a known risk (pre and post-operative CHD)
  • Children with unknown risk (long QT, IHSS, cardiomyopathy)
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8
Q

What are the 3 components of the pediatric assessment triangle (PAT) which is used for the first, from the door, general assessment?

A

ABC

1. Appearance

2. Breathing

3. Circulation

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9
Q

APPEARANCE:

Restless, anxious, combative child suggests what?

A

Hypoxic

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10
Q

APPEARANCE

A somnolence or lethargic* child suggests what?

A
  • Severe hypoxia
  • Severe hypercarbia
  • Respiratory fatigue

Lethargic in children means on the verge of CP arrest.

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11
Q

APPEARANCE

What type of tone is reassuring vs not reassuring?

A
  • Reassuring: vigorous movement and good tone
  • Not reassuring: lethargy, listlessness and poor tone
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12
Q

APPEARANCE

What type of interaction is reasuring vs. not reassuring?

A
  • Reassuring: somewhat playful and interacts other
  • Not reassuring: does not interact with others, will not play with toys, not even acknowledging they are there.
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13
Q

APPEARANCE

When consoling a child, what indicates if they are really sick?

A

If no one can comfort or distract the child

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14
Q

APPEARANCE

  • What type of gaze is reassuring in pediatric patients?
  • Ill/hypoxic patients
  • Decreased levels of consciousness?
A
  • You want the child to focus on parents/others in the room and be aware of people/things that are happening.

- Ill/hypoxic: eyes roll around

- Loss of consciousness: unfocused gaze

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15
Q

APPEARANCE

What types of cries are good, indicate a partial airway obstruction, bad?

A
  • Good: loud and strong

- Partial airway obstruction: hoarse or muffled

- Bad: weak or no cry

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16
Q

The development of which breathing pattern in child w/ respiratory distress is an ominous sign?

A

Slower, irregular respiratory pattern

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17
Q

In a pediatric patient, the intitial response to respiratory compromise is ________. As it progresses, RR _________ and the patterns of respirations become ________.

A
  • Tachycardia
  • RR decreases
  • Irregular
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18
Q

What is stridor and what causes it?

A
  • Stridor: high pitched, cowing sound that is most prominent when the patient breathes in.
  • -Narrowing of larynx (croup or laryngomalacia) or trachea (tracheomalacia/vascular ring)
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19
Q
  • Croup occurs due to ________ and is relieved with ______.
  • Tracheomalacia occurs most often in _________.
A
  • Croup
    • Parainfluenza virus
    • Cold
  • Tracheomalacia
    • Inspiration and expiration
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20
Q

_____ is a sqeaking noise made by air passing through [narrrow tracheobronchial airways].

D/t?

A

Wheezing

-Obstruction (bronchoconstriction and inflammation)

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21
Q

____ is a moist sound that is heard on ausculatation d/t air passing through narrowed bronchi.

D/t?

A

Rales

  • Airway inflammation & thick mucus
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22
Q

_____ is a expiratory sound heard without a stethoscope, made in an attempt to maintain airway patency (breath out against partially closed glottis)

What is desired and what are 2 signs of it?

A
  • Grunting
  • Decreased chest wall excursion
  • Pleural pain and intra-abdominal pain.
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23
Q

_______ is useful for assessing perfusion (circulation).

A

Skin exam

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24
Q

Decreased perfusion is indicative of what?

A

Body increases peripheral vascular resistance to maintain BP (hypervolemia)

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25
Q

Cooling of the skin begins _______ and goes _______ when CO decreases.

A

Peripherally

Proximally

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26
Q

What skin findings may indicate hypoxemia or shock?

A
  1. Pale
  2. Mottled
  3. Cool
  4. Ashy
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27
Q

Abnormal capillary refills are ____ seconds and can indicate?

A

>2 seconds

Cool environment

Volume depletion or hypotension

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28
Q

When there is respiratory compromise, how does the HR change?

A
  • When compromised, will initially see tachycardia to compensate
  • When ability to compensate is exceeded, will see bradycardia (bad sign)
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29
Q

What are the 3 cauess of cyanosis?

A

1. Low O2 in blood

2. Significant blood loss

3. Inadequate pefusion

30
Q

In children, respiratory distress occurs in ____________________, resulting in what?

A

Breathing does not match bodies metabolic demand for O2.

Hypoxemia or hypercarbia

31
Q

ABCDE

A

D (disability); consciousness, recognize parents, make eye contact

E (exposure); hypothermia/hyperthermia, chemicals

32
Q

There 2 immediately lifethreatening conditions

  • If severe upper airway obstruction, the patient will display
  • If partial upper airways obstruction, the patient will display
A

- severe upper airway obstruction: no audible speech/cry/cough

- partial upper airways obstruction: stridor with inspiration

33
Q

What is the differences in causes of severe upper airway obstruction & partial upper airway obstruction?

A

Severe upper airway obstruction: FB aspiration, angioedema from anaphlyaxis, epiglottitis

Partial upper airways obstruction: FB aspiration, infection (croup, bacterial tracheitis), injury (thermal or chemical burn)

34
Q

IMMEDIATELY LIFE THREATNING CONDITIONS

What is a tension pneumothorax?

A

Air from lungs leaks into pleural cavity, causing contralateral mediastinal shift, which will compress the <3 and good lung.

35
Q

What are the hallmarks and PE findings of tension pneumothorax?

A
  1. Severe respiratory distress
  2. Ipsilateral chest hyperexpansion
  3. Decreased or absent breath sounds on the side of the collapsed lung
  4. Mediastinal shift, deviation of trachea AWAY
  5. HYPER-resonance to percussion over the collapsed lung
36
Q

IMMEDIATELY LIFE THREATNING CONDITIONS

What is Beck’s triad of cardiac tamponade?

A
  1. - JVD
  2. - Muffled heart sounds
  3. - Hypotension

Patients will also get respiratory distress.

37
Q

IMMEDIATELY LIFE THREATNING CONDITIONS

PE is how common?

Occurs in..

A

Very uncommon

Central line, hypercoag states, CHD, trauma, nephrotic syndrome, SLE

38
Q

Respiratory tract infections can also cause respiratory distress.

Often present with ______ and develop ____.

A

Fever and ill in appearance

Gradually, unless upper airway structures are directly involved.

39
Q

Which cause of a sore throat, hard time swallowing, hoarse voice (hot potato voice), local pain/swelling in a child is an ENT emergency?

A

Retropharyngeal and peritonsillar abscess

40
Q

What is the most common cause of infectious airways obstruction in kids age 6-36 months?

A

Croup (acute laryngotracheobronchitis)

41
Q

Croup in a child is most often due to what etiology, but in some cases may also be due to what?

A
  • Most often viral (parainfluenza virus)
  • Less often allergic (spasmodic croup)
42
Q

When you hear stridor in a child you should think about what underlying cause?

A

Croup

43
Q

Which secondary bacterial infection most often arise from croup?

A

Tracheitis (kids are febrile, really sick)

44
Q

Respiratory distress can also be caused by epiglottitis, which is caused by what?

A

H. Influenza type B

45
Q

Today, what how prominant is epiglottitis?

A

Vaccine has eliminated HIB meningitis and HIB epiglottitis.

46
Q

Prior to vaccines, patients with Epiglottitis would …

A
  1. Be really sick.

2 Go to the OR for exam, with possible intubation.

47
Q

On CXR, what is a sign of epiglottits?

A

Thumb print sign.

48
Q

Respiratory distress can also be caused by bronchiolitis, which is caused by what?

A
  1. RSV
  2. Influenza
  3. Parainfluenza
  4. Adenovirus
49
Q

Bronchiolitis is most common in children _______ and characterized by what symptoms?

A
  • less than 2 YO
  • URI symptoms (snot), progressive cough and wheezing/atlectasis.
50
Q

Respiratory distress in children can also be due to pneumonia. What is the most common pneumonia in kids?

A

Strep. pneumoniae

51
Q

How do bacterial vs viral/atypical (chylamidia/mycoplasma) pneumonia present differently?

A
  • Bacterial: more localized (lobar), high fever and appear ill.
  • Viral: diffuse (but can ALSO be lobar) intersitital/peribronchial process on XRAY.
52
Q

What are the triggers of asthma?

A
  1. Infection
  2. XRCISE
  3. Environmental irritants
  4. Stress
  5. GERD
53
Q

Asthma patients will have what 2 symptoms?

They can experience sudden worsening due to _____________.

A
  • Wheezing and prolonged expiratory phase
  • Alveolar disease and/or atelectasis.
54
Q

What makes it hard to breathe in an asthmatic person?

A
  • Muscles of the bronchial tubes tighten and thicken
  • Air passages become inflammed and filled with mucus, making it hard to move air.
55
Q

Anaphlayxis is most commonly due to ___________.

What process occurs, that can make it life-threatening?

A

Food or meds

Retropharyngeal/laryngeal edema

56
Q

Symptoms of anaphalyxis are often ______ and associated with ____________.

What can occur in the lower airways?

A

Sudden

Facial edema and uticaria

Bronchospasms

57
Q

What is a treatement to anaphalyxis?

A
  1. Epinephrine
  2. O2
  3. Steroids
58
Q

Differentiate aspiration of a foreign body into the trachea vs. lower foreign bodies in terms of signs/sx’s

A
  • Trachea –> sudden, dramatic, cough; stridor, drooling, choking
  • Lower foreign bodies –> coughing/choking when FB is first ingested –> delayed sx’s (i.e., recurrent pneumonia, chronic cough)
59
Q

Ingestion of foreign bodies will most often go where?

A

R main stem

60
Q

Ingestion of foreign body into the esophagus will cause what symptoms?

A

Drooling

Swallowing

61
Q

_____ of foreign body ingestions in children are NOT witnessed.

A

40%

62
Q

Which household item is a choking hazard and also may lead to corosion of the esophageal mucosa?

A

Button batteries

63
Q

Aspiration of a foreign body into the right main bronchus leads to what effect during inspiration/expiration?

A
  • “Ball valve” effect
  • Air can flow into lung around the object on inspiration, but cannot flow out during expiration
64
Q

Congenital or acquired CNS disease can cause respiratory distress in children. How?

A
    1. Neuromuscular (chronic hypoventilation is the most common cause of initial respiratory distress)
  • 2. Infection
  • 3. Trauma
  • 4. Meds
65
Q

_________ is the most common cause of initial respiratory distress.

A

chronic hypoventilation

66
Q

Children with developmental delays have __________ due to CNS problems, causing them to have MUCH LESS reserves.

What happens if they get pneumonia?

A
  • - Decreased respiratory effort
    • Do not have the ability to breathe deeply and cough, thus, they decompensate much quicker.
67
Q

Noncardiogenic pulmonary edema can cause respiratory distress via what 4 ways?

A
    1. Chemical pneumonia
    1. Submersion/drowning
    1. Secondary to airway obstruction
    1. Medication toxicity
68
Q

What systemic diseases can cause respiratory distress?

A

thryoid (hyper/hypo)

69
Q

What disease is seen in a child with sickle cell disease presenting with sudden onset respiratory distress, chest pain, fever, and a new infiltrate in CXR?

A

Acute Chest Syndrome

70
Q

Asthma can lead to what chronic condition?

A

Spontaneous pneumothorax.

CPR Exam 3 (10 decks)

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