Respiratory Distress in Children (Newman) Flashcards
Three components of cardiopulmonary arrest in children
1) respiratory (O2)
2) cardiac (pump, perfusion, BP)
3) circulatory volume (perfusion, BP)
What is the primary cause of most pediatric arrests?
progressive respiratory failure or shock (asphyxial arrest)
Progression of asphyxia
begins with systemic hypoxemia, hypercapnia, and acidosis. Progresses to bradycardia, hypotension and then cardiac arrest
The pediatric assessment triangle for cardiopulmonary arrest is..
1) appearance
2) breathing
3) circulation
Appearance of a child in respiratory distress that suggests hypoxia
restlessness, anxiety, combativeness
appearance of a child in respiratory distress that suggests severe hypoxia, hypercarbia, and/or respiratory fatigue
somnolence or lethargy
Reassuring tone of a child in respiratory distress
vigorous movement and good tone
Not reassuring tone of a child in respiratory distress
lethargy, listlessness, poor tone
Not reassuring interaction in a child in respiratory distress
not interacting with others, wont’ play with toys (not acknowledging they are there)
Is a child distractable or consolable if they are very ill?
no
Look/gaze of a child in respiratory distress (very hypoxic)
eyes rolling around. Unfocused gaze (decreased LOC)
What type of speech/cry is indicative of partial airway obstruction?
hoarse or muffled cry
Speech/cry of a child in severe respiratory distress
weak cry or no cry
Progression of breathing in a child with severe respiratory distress
Initial tachypnea. Then development of slower, irregular respiratory pattern (ominous sign)
describe stridor
high pitched crowing sound, most prominent with inspiration. Secondary to narrowing of larynx or trachea
describe wheezing
squeaking noise made by air passing through narrowed tracheobronchial airways
- bronchoconstriction
- inflammation
describe rales
moist sounds heard upon auscultation resulting from air passing through narrowed bronchi
- airway inflammation
- thick mucus
describe grunting
expiratory sound heard without a stethoscope, generated in an attempt to maintain airway patency
- breathing out against a partially closed glottis
Normal capillary refill
< 2 seconds
skin findings indicative of hypoxemia or shock
pale, mottled, cool, or ashen skin
heart rate changes with respiratory distress
- initially see tachycardia
- when ability to compensate is exceeded, see bradycardia
When is cyanosis seen?
- low oxygenation of blood
- significant blood loss
- inadequate perfusion
Hallmarks of tension pneumothorax (5)
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
Beck’s triad (for cardiac tamponade)
1) JVD
2) muffled cardiac sounds
3) hypotension
Causes of cardiac tamponade in kids
trauma, lupus, infection, leukemia
Describe retropharyngeal and peritonsillar abscess
- typically cause sore throat, difficulty swallowing and local pain/swelling
- hoarse voice (hot potato) voice is common
- uvula deviation
- ENT emergency
What is the most common cause of infectious airway obstruction in kids ages 6-36 months?
croup (acute laryngotracheobronchitis)
Describe croup (5)
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
What usually causes epiglottitis?
Haemophilus influenza B
Clinical course epiglottitis
- kids SICK
- go to OR for exam and possible intubation
What causes bronchiolitis?
- RSV
- influenza
- parainfluenza
- adenovirus
Who is bronchiolitis seen in?
children less than 2 y/o
Clinical Sx bronchiolitis
- URI Sx
- copious secretions
- progressive cough
- wheezing/atelectasis
most common cause of pneumonia in kids?
streptococcus pneumoniae
Bacterial pneumonia presentation
- lobar/more localized
- generally higher fever
- ill-appearance
Viral and atypical pneumonia presentation on X-ray
tend to be diffuse interstitial/peribronchial
Characteristics of asthma
inflammation, edema, bronchospasm, mucus
lung sounds asthma
wheeze, prolonged expiratory phase
X-ray of chest with asthma attack
peri-hilar thickening of bronchioles, flattening of diaphragm
What is asked if allergy is reported?
what happens when exposed to allergen
Treatment of anaphylaxis (3 things)
epinephrine, oxygen, steroids
Where are foreign bodies lodged after they pass through the trachea?
Right mainstem bronchi
Symptoms of foreign body in trachea
- sudden, dramatic coughing
- stridor, drooling, choking are often noted if upper airway is obstructed
Symptoms of foreign body in lower respiratory tree
- coughing, choking when first ingested
- delayed symptoms: recurrent PNA, chronic cough
Symptoms of esophageal foreign body
drooling, swallowing problems
Notable household items that are choking hazards
- button batteries (erode through trachea)
- coins
- magnets
Acute respiratory manifestations of sickle cell disease
Acute chest syndrome:
- sudden onset respiratory distress and chest pain
- new infiltrate on CXR
- fever
Progression of respiratory distress with congenital or acquired CNS disease
- with neuromuscular issues, initial respiratory compromise is most often due to chronic hypoventilation
- patients will often decompensate much quicker
What is Winter’s Formula?
PCO2 = 1.5[HCO3] +8 +/-2
What is winter’s formula used for?
metabolic acidosis
