Respiratory Distress in Children Flashcards
Cardiopulmonary MRGENCIES are the absence of _________, ________ or both.
effective ventillation, circulation or both.
What are the 3 components of cardiopulmonary arrest in children?
- Respiratory (O2)
- Cardiac (pump, perfusion, BP)
- Circulatory volume (perfusion, BP)
How is cardiac arrest different in infants/children vs adults?
In infants and children, cardiac arrest is the end result of progressive respiratory failure/shock (asphyxial arrest), NOT a primary cardiac cause.
What is the progression of Asphyxia?
- Variable period of systemic hypoxemia, hypercapnea and acidosis => bradycardia & hypotension => cardiac arrest.
In pediatric patients, without intervention
______ arrests => ______ arrests => _______ arrests.
respiratory =>
cardiac =>
cardiopulmonary
Sudden, unanticipated non-traumatic cardiac arrests are _______ in children.
uncommon
While uncommon, sudden, unanticipated non-traumatic cardiac arrest can occur in what population of children?
- Children with a known risk (pre and post-operative CHD)
- Children with unknown risk (long QT, IHSS, cardiomyopathy)
What are the 3 components of the pediatric assessment triangle (PAT) which is used for the first, from the door, general assessment?
ABC
1. Appearance
2. Breathing
3. Circulation
APPEARANCE:
Restless, anxious, combative child suggests what?
Hypoxic
APPEARANCE
A somnolence or lethargic* child suggests what?
- Severe hypoxia
- Severe hypercarbia
- Respiratory fatigue
Lethargic in children means on the verge of CP arrest.
APPEARANCE
What type of tone is reassuring vs not reassuring?
- Reassuring: vigorous movement and good tone
- Not reassuring: lethargy, listlessness and poor tone
APPEARANCE
What type of interaction is reasuring vs. not reassuring?
- Reassuring: somewhat playful and interacts other
- Not reassuring: does not interact with others, will not play with toys, not even acknowledging they are there.
APPEARANCE
When consoling a child, what indicates if they are really sick?
If no one can comfort or distract the child
APPEARANCE
- What type of gaze is reassuring in pediatric patients?
- Ill/hypoxic patients
- Decreased levels of consciousness?
- 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
APPEARANCE
What types of cries are good, indicate a partial airway obstruction, bad?
- Good: loud and strong
- Partial airway obstruction: hoarse or muffled
- Bad: weak or no cry
The development of which breathing pattern in child w/ respiratory distress is an ominous sign?
Slower, irregular respiratory pattern
In a pediatric patient, the intitial response to respiratory compromise is ________. As it progresses, RR _________ and the patterns of respirations become ________.
- Tachycardia
- RR decreases
- Irregular
What is stridor and what causes it?
- 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)
- Croup occurs due to ________ and is relieved with ______.
- Tracheomalacia occurs most often in _________.
-
Croup
- Parainfluenza virus
- Cold
-
Tracheomalacia
- Inspiration and expiration
_____ is a sqeaking noise made by air passing through [narrrow tracheobronchial airways].
D/t?
Wheezing
-Obstruction (bronchoconstriction and inflammation)
____ is a moist sound that is heard on ausculatation d/t air passing through narrowed bronchi.
D/t?
Rales
- Airway inflammation & thick mucus
_____ 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?
- Grunting
- Decreased chest wall excursion
- Pleural pain and intra-abdominal pain.
_______ is useful for assessing perfusion (circulation).
Skin exam
Decreased perfusion is indicative of what?
Body increases peripheral vascular resistance to maintain BP (hypervolemia)
Cooling of the skin begins _______ and goes _______ when CO decreases.
Peripherally
Proximally
What skin findings may indicate hypoxemia or shock?
- Pale
- Mottled
- Cool
- Ashy
Abnormal capillary refills are ____ seconds and can indicate?
>2 seconds
Cool environment
Volume depletion or hypotension
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)
What are the 3 cauess of cyanosis?
1. Low O2 in blood
2. Significant blood loss
3. Inadequate pefusion
In children, respiratory distress occurs in ____________________, resulting in what?
Breathing does not match bodies metabolic demand for O2.
Hypoxemia or hypercarbia
ABCDE
D (disability); consciousness, recognize parents, make eye contact
E (exposure); hypothermia/hyperthermia, chemicals
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
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)
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.
What are the hallmarks and PE findings of tension pneumothorax?
- Severe respiratory distress
- Ipsilateral chest hyperexpansion
- Decreased or absent breath sounds on the side of the collapsed lung
- Mediastinal shift, deviation of trachea AWAY
- HYPER-resonance to percussion over the collapsed lung
IMMEDIATELY LIFE THREATNING CONDITIONS
What is Beck’s triad of cardiac tamponade?
- - JVD
- - Muffled heart sounds
- - Hypotension
Patients will also get respiratory distress.
IMMEDIATELY LIFE THREATNING CONDITIONS
PE is how common?
Occurs in..
Very uncommon
Central line, hypercoag states, CHD, trauma, nephrotic syndrome, SLE
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.
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
What is the most common cause of infectious airways obstruction in kids age 6-36 months?
Croup (acute laryngotracheobronchitis)
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)
When you hear stridor in a child you should think about what underlying cause?
Croup
Which secondary bacterial infection most often arise from croup?
Tracheitis (kids are febrile, really sick)
Respiratory distress can also be caused by epiglottitis, which is caused by what?
H. Influenza type B
Today, what how prominant is epiglottitis?
Vaccine has eliminated HIB meningitis and HIB epiglottitis.
Prior to vaccines, patients with Epiglottitis would …
- Be really sick.
2 Go to the OR for exam, with possible intubation.
On CXR, what is a sign of epiglottits?
Thumb print sign.
Respiratory distress can also be caused by bronchiolitis, which is caused by what?
- RSV
- Influenza
- Parainfluenza
- Adenovirus
Bronchiolitis is most common in children _______ and characterized by what symptoms?
- less than 2 YO
- URI symptoms (snot), progressive cough and wheezing/atlectasis.
Respiratory distress in children can also be due to pneumonia. What is the most common pneumonia in kids?
Strep. pneumoniae
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.
What are the triggers of asthma?
- Infection
- XRCISE
- Environmental irritants
- Stress
- GERD
Asthma patients will have what 2 symptoms?
They can experience sudden worsening due to _____________.
- Wheezing and prolonged expiratory phase
- Alveolar disease and/or atelectasis.
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.
Anaphlayxis is most commonly due to ___________.
What process occurs, that can make it life-threatening?
Food or meds
Retropharyngeal/laryngeal edema
Symptoms of anaphalyxis are often ______ and associated with ____________.
What can occur in the lower airways?
Sudden
Facial edema and uticaria
Bronchospasms
What is a treatement to anaphalyxis?
- Epinephrine
- O2
- Steroids
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)
Ingestion of foreign bodies will most often go where?
R main stem
Ingestion of foreign body into the esophagus will cause what symptoms?
Drooling
Swallowing
_____ of foreign body ingestions in children are NOT witnessed.
40%
Which household item is a choking hazard and also may lead to corosion of the esophageal mucosa?
Button batteries
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

Congenital or acquired CNS disease can cause respiratory distress in children. How?
- Neuromuscular (chronic hypoventilation is the most common cause of initial respiratory distress)
- 2. Infection
- 3. Trauma
- 4. Meds
_________ is the most common cause of initial respiratory distress.
chronic hypoventilation
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.
Noncardiogenic pulmonary edema can cause respiratory distress via what 4 ways?
- Chemical pneumonia
- Submersion/drowning
- Secondary to airway obstruction
- Medication toxicity
What systemic diseases can cause respiratory distress?
thryoid (hyper/hypo)
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
Asthma can lead to what chronic condition?
Spontaneous pneumothorax.