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03. Cardiopulm Renal > Respiratory Distress in Children (Newman) > Flashcards

Respiratory Distress in Children (Newman) Flashcards

1
Q

Three components of cardiopulmonary arrest in children

A

1) respiratory (O2)
2) cardiac (pump, perfusion, BP)
3) circulatory volume (perfusion, BP)

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2
Q

What is the primary cause of most pediatric arrests?

A

progressive respiratory failure or shock (asphyxial arrest)

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3
Q

Progression of asphyxia

A

begins with systemic hypoxemia, hypercapnia, and acidosis. Progresses to bradycardia, hypotension and then cardiac arrest

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4
Q

The pediatric assessment triangle for cardiopulmonary arrest is..

A

1) appearance
2) breathing
3) circulation

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5
Q

Appearance of a child in respiratory distress that suggests hypoxia

A

restlessness, anxiety, combativeness

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6
Q

appearance of a child in respiratory distress that suggests severe hypoxia, hypercarbia, and/or respiratory fatigue

A

somnolence or lethargy

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7
Q

Reassuring tone of a child in respiratory distress

A

vigorous movement and good tone

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8
Q

Not reassuring tone of a child in respiratory distress

A

lethargy, listlessness, poor tone

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9
Q

Not reassuring interaction in a child in respiratory distress

A

not interacting with others, wont’ play with toys (not acknowledging they are there)

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10
Q

Is a child distractable or consolable if they are very ill?

A

no

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11
Q

Look/gaze of a child in respiratory distress (very hypoxic)

A

eyes rolling around. Unfocused gaze (decreased LOC)

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12
Q

What type of speech/cry is indicative of partial airway obstruction?

A

hoarse or muffled cry

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13
Q

Speech/cry of a child in severe respiratory distress

A

weak cry or no cry

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14
Q

Progression of breathing in a child with severe respiratory distress

A

Initial tachypnea. Then development of slower, irregular respiratory pattern (ominous sign)

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15
Q

describe stridor

A

high pitched crowing sound, most prominent with inspiration. Secondary to narrowing of larynx or trachea

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16
Q

describe wheezing

A

squeaking noise made by air passing through narrowed tracheobronchial airways

  • bronchoconstriction
  • inflammation
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17
Q

describe rales

A

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

  • airway inflammation
  • thick mucus
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18
Q

describe grunting

A

expiratory sound heard without a stethoscope, generated in an attempt to maintain airway patency
- breathing out against a partially closed glottis

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19
Q

Normal capillary refill

A

< 2 seconds

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20
Q

skin findings indicative of hypoxemia or shock

A

pale, mottled, cool, or ashen skin

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21
Q

heart rate changes with respiratory distress

A
  • initially see tachycardia

- when ability to compensate is exceeded, see bradycardia

22
Q

When is cyanosis seen?

A
  • low oxygenation of blood
  • significant blood loss
  • inadequate perfusion
23
Q

Hallmarks of tension pneumothorax (5)

A

1) severe respiratory distress
2) ipsilateral chest hyperexpansion
3) decreased or absent breath sounds on side of collapsed lung
4) shift of mediastinal structures (tracheal deviation)
5) hyper-resonance to percussion over the collapsed lung

24
Q

Beck’s triad (for cardiac tamponade)

A

1) JVD
2) muffled cardiac sounds
3) hypotension

25
Q

Causes of cardiac tamponade in kids

A

trauma, lupus, infection, leukemia

26
Q

Describe retropharyngeal and peritonsillar abscess

A
  • typically cause sore throat, difficulty swallowing and local pain/swelling
  • hoarse voice (hot potato) voice is common
  • uvula deviation
  • ENT emergency
27
Q

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

A

croup (acute laryngotracheobronchitis)

28
Q

Describe croup (5)

A

1) not confined to children
2) usually caused by parainfluenza virus
3) tracheitis is often a secondary bacterial infection 4) STRIDOR on auscultation
5) steeple sign on X-ray

29
Q

What usually causes epiglottitis?

A

Haemophilus influenza B

30
Q

Clinical course epiglottitis

A
  • kids SICK

- go to OR for exam and possible intubation

31
Q

What causes bronchiolitis?

A
  • RSV
  • influenza
  • parainfluenza
  • adenovirus
32
Q

Who is bronchiolitis seen in?

A

children less than 2 y/o

33
Q

Clinical Sx bronchiolitis

A
  • URI Sx
  • copious secretions
  • progressive cough
  • wheezing/atelectasis
34
Q

most common cause of pneumonia in kids?

A

streptococcus pneumoniae

35
Q

Bacterial pneumonia presentation

A
  • lobar/more localized
  • generally higher fever
  • ill-appearance
36
Q

Viral and atypical pneumonia presentation on X-ray

A

tend to be diffuse interstitial/peribronchial

37
Q

Characteristics of asthma

A

inflammation, edema, bronchospasm, mucus

38
Q

lung sounds asthma

A

wheeze, prolonged expiratory phase

39
Q

X-ray of chest with asthma attack

A

peri-hilar thickening of bronchioles, flattening of diaphragm

40
Q

What is asked if allergy is reported?

A

what happens when exposed to allergen

41
Q

Treatment of anaphylaxis (3 things)

A

epinephrine, oxygen, steroids

42
Q

Where are foreign bodies lodged after they pass through the trachea?

A

Right mainstem bronchi

43
Q

Symptoms of foreign body in trachea

A
  • sudden, dramatic coughing

- stridor, drooling, choking are often noted if upper airway is obstructed

44
Q

Symptoms of foreign body in lower respiratory tree

A
  • coughing, choking when first ingested

- delayed symptoms: recurrent PNA, chronic cough

45
Q

Symptoms of esophageal foreign body

A

drooling, swallowing problems

46
Q

Notable household items that are choking hazards

A
  • button batteries (erode through trachea)
  • coins
  • magnets
47
Q

Acute respiratory manifestations of sickle cell disease

A

Acute chest syndrome:

  • sudden onset respiratory distress and chest pain
  • new infiltrate on CXR
  • fever
48
Q

Progression of respiratory distress with congenital or acquired CNS disease

A
  • with neuromuscular issues, initial respiratory compromise is most often due to chronic hypoventilation
  • patients will often decompensate much quicker
49
Q

What is Winter’s Formula?

A

PCO2 = 1.5[HCO3] +8 +/-2

50
Q

What is winter’s formula used for?

A

metabolic acidosis

03. Cardiopulm Renal (6 decks)

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