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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
**Cooling of the skin** begins _______ and goes _______ when CO decreases.
**Peripherally** **Proximally**
26
What **skin findings** may indicate **hypoxemia** or **shock**?
1. **Pale** 2. **Mottled** 3. **Cool** 4. **Ashy**
27
**Abnormal capillary refills** are ____ seconds and can indicate?
**\>2 seconds** **Cool environment** **Volume depletion or hypotension**
28
When there is **respiratory compromise,** how does the HR change?
- When compromised, will initially see **tachycardia** to compensate - When ability to compensate is exceeded, will see **bradycardia** (bad sign)
29
What are the 3 cauess of **cyanosis**?
**1. Low O2 in blood** **2. Significant blood loss** **3. Inadequate pefusion**
30
In children, **respiratory distress** occurs in \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, resulting in what?
**Breathing does not match bodies metabolic demand for O2.** **Hypoxemia** or **hypercarbia**
31
ABC**DE**
**D (disability);** consciousness, recognize parents, make eye contact **E (exposure);** hypothermia/hyperthermia, chemicals
32
_There 2 **immediately lifethreatening conditions**_ - If **severe upper airway obstruction**, the patient will display - If **partial upper airways obstruction**, the patient will display
**- severe upper airway obstruction:** no audible speech/cry/cough **- partial upper airways obstruction:** stridor with inspiration
33
What is the differences in causes of severe upper airway obstruction & partial upper airway obstruction?
**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
**_IMMEDIATELY LIFE THREATNING CONDITIONS_** What is a tension pneumothorax?
**Air** from **lungs** leaks into **pleural cavity,** causing **contralateral mediastinal shift,** which will **compress** the **\<3** and **good lung**.
35
What are the hallmarks and PE findings of **tension pneumothorax?**
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
**_IMMEDIATELY LIFE THREATNING CONDITIONS_** What is Beck's triad of **cardiac tamponade**?
1. **- JVD** 2. **- Muffled heart sounds** 3. **- Hypotension** Patients will also get _respiratory distress._
37
**_IMMEDIATELY LIFE THREATNING CONDITIONS_** PE is how common? Occurs in..
**Very uncommon** **Central line, hypercoag states, CHD, trauma, nephrotic syndrome, SLE**
38
**Respiratory tract infections** can also cause respiratory distress. Often present with ______ and develop \_\_\_\_.
**Fever** and **ill** in appearance **Gradually**, unless upper airway structures are directly involved.
39
Which cause of a **sore throat**, **hard time swallowing**, **hoarse voice (hot potato voice)**, **local pain/swelling** in a child is an *ENT emergency?*
**Retropharyngeal** and **peritonsillar abscess**
40
What is the most common cause of **infectious** **airways obstruction** in kids age **6-36 months**?
**Croup (acute laryngotracheobronchitis)**
41
Croup in a child is most often due to what etiology, but in some cases may also be due to what?
- Most often **viral (parainfluenza virus)** - Less often **allergic** **(spasmodic croup)**
42
When you hear **stridor** in a child you should think about what underlying cause?
**Croup**
43
Which **secondary bacterial infection** most often arise from **croup**?
**Tracheitis** (kids are **febrile**, **really sick)**
44
Respiratory distress can also be caused by **epiglottitis**, which is caused by what?
**H. Influenza type B**
45
Today, what how prominant is **epiglottitis**?
**Vaccine** has eliminated **HIB meningitis** and **HIB epiglottitis.**
46
Prior to vaccines, patients with Epiglottitis would ...
1. **Be really sick.** 2 Go to the **OR** for exam, with possible **intubation**.
47
On CXR, what is a sign of epiglottits?
**Thumb print sign.**
48
Respiratory distress can also be caused by **bronchiolitis**, which is caused by what?
1. **RSV** 2. **Influenza** 3. **Parainfluenza** 4. **Adenovirus**
49
**Bronchiolitis** is most common in children _______ and characterized by what symptoms?
- **less than 2 YO** - **URI symptoms (snot)**, **progressive cough** and **wheezing/atlectasis**.
50
**Respiratory distress** in children can also be due to **pneumonia**. What is the most common pneumonia in kids?
**Strep. pneumoniae**
51
How do **bacterial** vs **viral/atypical (chylamidia/mycoplasma)** **pneumonia** present differently?
* **Bacterial**: more localized (lobar), high fever and appear ill. * **Viral**: diffuse (but can ALSO be lobar) intersitital/peribronchial process on XRAY.
52
What are the **triggers** of **asthma**?
1. Infection 2. XRCISE 3. Environmental irritants 4. Stress 5. GERD
53
**Asthma patients** will have what 2 symptoms? They can experience **sudden worsening** due to \_\_\_\_\_\_\_\_\_\_\_\_\_.
- **Wheezing** and **prolonged expiratory phase** - **Alveolar disease** and/or **atelectasis**.
54
What makes it hard to breathe in an asthmatic person?
* **Muscles** of the bronchial tubes **tighten** and **thicken** * **Air passages** become **inflammed** and **filled with mucus**, making it hard to move air.
55
**Anaphlayxis** is most commonly due to \_\_\_\_\_\_\_\_\_\_\_. What process occurs, that can make it life-threatening?
**Food** or **meds** ## Footnote **Retropharyngeal/laryngeal edema**
56
Symptoms of **anaphalyxis** are often ______ and associated with \_\_\_\_\_\_\_\_\_\_\_\_. What can occur in the lower airways?
**Sudden** **Facial edema** and **uticaria** **Bronchospasms**
57
What is a treatement to **anaphalyxis**?
1. **Epinephrine** 2. **O2** 3. **Steroids**
58
Differentiate aspiration of a foreign body into the **trachea** vs. **lower foreign bodies** in terms of signs/sx's
- **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
Ingestion of foreign bodies will most often go where?
**R main stem**
60
Ingestion of foreign body into the **esophagus** will cause what symptoms?
**Drooling** **Swallowing**
61
\_\_\_\_\_ of foreign body ingestions in children are **NOT** witnessed.
**40%**
62
Which household item is a choking hazard and also may lead to **corosion of the esophageal mucosa**?
**Button batteries**
63
Aspiration of a foreign body into the **right main bronchus** leads to what effect during inspiration/expiration?
- "**Ball valve" effect** - Air can flow into lung around the object on inspiration, but cannot flow out during expiration
64
Congenital or acquired CNS disease can cause respiratory distress in children. How?
* 1. **Neuromuscular** (chronic hypoventilation is the most common cause of initial respiratory distress) * **2. Infection** * **3. Trauma** * **4. Meds**
65
\_\_\_\_\_\_\_\_\_ is the most common cause of initial respiratory distress.
**chronic hypoventilation**
66
Children with developmental delays have __________ due to CNS problems, causing them to have **MUCH LESS reserves.** What happens if they get pneumonia?
* **- Decreased respiratory effort** * - Do **not** have the ability to **breathe deeply** and cough, thus, they decompensate much quicker.
67
**Noncardiogenic pulmonary edema** can cause respiratory distress via what 4 ways?
* 1. Chemical pneumonia * 2. Submersion/drowning * 3. Secondary to airway obstruction * 4. Medication toxicity
68
What systemic diseases can cause respiratory distress?
**thryoid (hyper/hypo)**
69
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?**
**Acute Chest Syndrome**
70
**Asthma** can lead to what chronic condition?
**Spontaneous pneumothorax.**

CPR Exam 3 (10 decks)

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