Respiratory Distress in Children (Newman)

Question 1

Cardiopulmonary arrest in children components

Answer 1

respiratory
cardiac
circulatory volume

Question 2

why do kids have cardiac arrest?

Answer 2

its usually due to progressive respiratory failure and/or shock

Question 3

common causes of pediatric cardiopulmonary arrest

Answer 3

respiratory failure
cardiac failure
endocrinopathy
trauma
infection
renal failure

Question 4

is sudden, non traumatic cardiac arrest common in kids?

Answer 4

no

usually due to known risk such as operative CHD

or

unknown risk–Long QT, IHSS, cardiomyopathy

Question 5

pediatric assessment triangle

Answer 5

appearance
breathing
circulation

Question 6

appearance at the door assessment

Answer 6

abnormal tone

decrease interaction

decrease consolability

abnormal look/gaze

abnormal speech/cry

Question 7

work of breathing, at the door assessment

Answer 7

abnormal sounds

abnormal position

retractions

flaring

apnea/gasping

Question 8

circulation to skin, at the door assessment

Answer 8

pallor

mottling

cyanosis

Question 9

restlessness, anxiety, and combativeness suggests

Answer 9

hypoxia

Question 10

hoarse of muffled cry can be indicative of

Answer 10

partial airway obstruction

Question 11

weak or no cry

Answer 11

is really bad

Question 12

development of slower, irregular respiratory pattern in the setting of respiratory distress

Answer 12

is a very ominous sign and respiratory arrest can develop quickly

Question 13

Stridor

Answer 13

high pitched crowing sound, mainly heard with inspiration

secondary to narrowing of the larynx (croup) or trachea

Question 14

wheezing

Answer 14

squeaking noise made by air passing through narrowed tracheobronchial airways

obstruction via bronchoconstriction or inflammation

Question 15

rales

Answer 15

moist sounds heard upon auscultation resulting from air passing through narrowed bronchi

due to airway inflammation or thick mucus

Question 16

grunting

Answer 16

expiratory sound hear without stethoscope generated in an attempt to maintain airway patency

breathing out against partially closed glottis

desire for decreased chest wall excursion with pleural pain and intra-abdominal pain

Question 17

pale, mottled, cool, or ashen skin are concerning why?

Answer 17

they may indicate hypoxemia and shock

Question 18

cool environment effect on capillary refill

Answer 18

can prolong it

Question 19

when a patient is compromised

Answer 19

we initially see tachycardia but then when compensation is exceeded we will see bradycardia

Question 20

respiratory distress in kids results in

Answer 20

hypoxemia and hypercarbia

Question 21

disability of ABCDE

Answer 21

conscious?

semi-conscious?

recognizing parents?

making eye contact?

Question 22

Exposure of ABCDE

Answer 22

hpothermia
hyperthermia
chemical agent
nasty things

Question 23

severe upper airway obstructions

Answer 23

no audible speech/cry/cough

due to

foreign body aspiration
angiodema from anaphylaxis
epiglottitis

Question 24

if partial upper airway obstruction you will hear

Answer 24

stridor on inspiration

due to

foreign body aspiration

infection(croup)

injury

Question 25

beck's triad for tamponade

Answer 25

JVD muffled cardiac sounds hypotension

Question 26

pulmonary embolism in kids

Answer 26

uncommon ``` due to central lines hyper coaguable state (factor V leiden) congenital heart disease trauma nephrotic syndrome SLE ```

Question 27

Retropharyngeal and peritonsillar abscesses

Answer 27

more typically cause sore throat, difficulty swallowing, and local pain + swelling hoarse voice is common (hot potato voice ENT emergency

Question 28

croup

Answer 28

acute laryngotracheobronchitis most common cause of infectious airway obstruction in kids 6-36 months is not confined to kids STRIDOR

Question 29

croup viral cause

Answer 29

parainfluenza less often allergic (spasmodic croup)

Question 30

tracheitis most often

Answer 30

secondary bacterial infection to croup (kids are febrile, really sick)

Question 31

epiglottitis

Answer 31

H flu type B vaccine has largely eliminated kids would be very sick would go to OR for exam and possible intubation

Question 32

bronchiolitis

Answer 32

RSV, influenza, parainfluenza, adenovirus, others children less than 2 URI symptoms with progressive cough and wheezing/atelectasis

Question 33

Pneumonia

Answer 33

bacterial-more localized (lobar) in kids Strep Pneumo viral and atypical tend to be diffuse interstitial/peribronchial on x-ray but sometimes viral and atypical can be lobar

Question 34

atypical pneumonias

Answer 34

mycoplasma and chlamydia | diffuse interstitial/peribronchial viral is also diffuse

Question 35

asthma is characterized by

Answer 35

wheeze with prolongued expiratory phase

Question 36

anaphylaxis

Answer 36

usually due to food or medication retropharyngeal/laryngeal edema can be life threatening bronchospasm in lower airway common

Question 37

anaphylaxis is often associated with

Answer 37

facial edema and urticaria

Question 38

how treat anaphylaxis

Answer 38

epi O2 steroids

Question 39

assessment of anaphylaxis

Answer 39

airway breath circulation consciousness

Question 40

foreign body in trachea

Answer 40

sudden dramatic coughing stridor with drooling and choking

Question 41

lower foreign bodies

Answer 41

coughing choking when foreign body is first ingested delayed symptoms: recurrent pneumonia and chronic cough

Question 42

foreign bodies esophageal

Answer 42

drooling, swallowing problems

Question 43

in kids how what amount of foreign bodies are not witnessed

Answer 43

40%

Question 44

muscular dystrophy is a disease process of

Answer 44

chest wall

Question 45

acquired cardiovascular conditions that cause respiratory distress

Answer 45

arrythmia myocarditis inflammation of pericardium causing splinting with inspiration (grunting)

Question 46

GI tract issues leading to respiratory distress

Answer 46

GERD | intra-abdominal process with secondary inflammation or abdominal distention

Question 47

congenital or acquired CNS disease leading to respiratory distress

Answer 47

neuromuscular (initial compromise due to chronic hypoventilation) infectious trauma medication effect

Question 48

noncardiogenic pulmonary edema leading to respiratory distress

Answer 48

chemical pneumonia submersion/drowning secondary to airway obstruction medication toxicity

Question 49

systemic disease leading to respiratory distress

Answer 49

thyroid disease (hyper and hypo) metabolic disease

Question 50

hematologic cause of respiratory distress

Answer 50

decreased O2 delivery secondary to anemia and abnormal hemoglobin

Question 51

'acute on chronic conditions' leading to respiratory distress

Answer 51

kids with chronic upper airway obstruction asthma caused pneumothorax CF with secondary pneumonia/bronchitis sickle cell disease -> acute chest syndrome neuromuscular disease -> aspiration

Question 52

acute chest syndrome

Answer 52

caused by sickle cell sudden onset respiratory distress and chest pain new infiltrate on CXR fever