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Peds - Spring 2016 > Respiratory Dysfunction (Part 1)- Unit 2 > Flashcards

Respiratory Dysfunction (Part 1)- Unit 2 Flashcards

1
Q

What is the leading cause of preventable death in pediatrics?

A

Respiratory Arrest (asthma and RSV can kill!)

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2
Q

Leading causes of out of hospital arrest - what are they?

A

Asthma, choking (9-10 months = pincer), pneumonia, poisoning, SIDS, submersion, trauma.

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3
Q

___% die in er, ___ die in PICU.

A

45% in ER, 10% in PICU

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4
Q

What are leading causes of in-hospital arrests?

A

Arrhythmia’s (respiratory related), drug toxicity, metabolic disorder, respiratory failure, sepsis

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5
Q

What are some airway differences in pediatrics?

A

smaller nasopharynx (easily occluded during infection), lymph tissue grows rapidly (atrophies after 12), small oral cavity and large tongue increase risk of obstruction, small nares (easily occluded), long/floppy epiglottis, larynx and glottis are higher in neck (increasing risk of aspiration), thyroid/cricoid/tracheal cartilages can collapse, less compensable to inflammation, mucus can cause a problem,etc.

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6
Q

Right mainstem bronchus in children has a steeper slope than in adults. T/F?

Bifurcation where?

A

True

In kids, bifurcation is at T3 level, it’s T6 for adults!

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7
Q

Adult airway - how big?

Kid airway? how big?

A 
adult = ~ 20mm
Kid = ~ 4 mm

so any inflammation for the kid can be bad

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8
Q

What’s involved in keeping the pH at 7.4?

A

HC03 (bicarbonate) buffer system

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9
Q

pH of blood changes - what do the lungs and kidneys do?

A

They respond and change

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10
Q

Normal levels -

pH - 
PO2 -
PCO2 - 
HCO3 - 
Base Excess -
A 
pH - 7.35-7.45
PO2 - 80-100
PCO2 - 35-45
HCO3 - 22-26
Base Excess - -2 to +2
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11
Q

if pH is less than 7.35, it’s ___

if pH is greater than 7.45, it’s ____.

A

less than = acidosis

Greater than = alkalosis.

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12
Q

ROME - what is it?

A

Respiratory opposite, metabolic equal. That means that if the pH goes down and so does the bicarb, it’s metabolic, etc.

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13
Q

Asthma - associated with respiratory ____.
Respiratory failure - associated with respiratory ____.
DKA - associated with metabolic ____.

A

Asthma - respiratory alkalosis.
Respiratory failure - respiratory acidosis.
DKA - metabolic acidosis.

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14
Q

What do we assess with respiratory disease?

A

Quality of respirations (rate, depth, ease, symmetry), auscultation, quality of heart rate (increased with respiratory distress), color and capillary refill, cough (dry, wet, brassy, croupy, productive), hydration status, behavioral changes.

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15
Q

Should we take shirts off kids to see if retractions are present?

A

YES

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16
Q

What are some signs of respiratory distress?

A

Tachypnea, tachycardia, grunting (extended expiration), stridor (upper airway), head bobbing, flaring, inability to lie down, agitation, retractions, accessory muscles, wheezing (lower airway), sweating, prolonged expiration, apnea, cyanosis

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17
Q

Infants only breathe through their mouths. T/F? Until what age?

A

FALSE - they can only breathe through their nose until 6 months.

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18
Q

What are retractions?

A

Chest wall becomes less compliant as child ages - so until then, we see retractions.

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19
Q

Suprasternal retraction - might mean….

substernal retractions + subcostal - might mean….

A

Suprasternal retraction - might mean….upper respiratory infection
substernal retractions + subcostal - might mean….lower respiratory infection.

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20
Q

What are some signs of impending respiratory failure?

A

Reduced air entry, severe work, cyanosis despite O2, irregular breathing/apnea, altered consciousness, diaphoresis, 1000 mile stare (anxious).

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21
Q

If the kid has no wheezing when they should, what does this mean?

A

They are probably in respiratory failure…no wheezing? probably no air exchange

22
Q

Why do children h ave more ear problems than adults?

A

Eustachian tubes are short, wide, and straight. They distend easier because of underdeveloped cartilage and they also have immature defense mechanisms.

23
Q

What is otitis media?

A

Inflammation of inner ear. It’s very common.

24
Q

What are some risk factors for otitis media?

A

In daycare, around smoke, allergies, pacifier, winter (germs), etc.

25
Q

Breast feeding - helps with otitis media. T/F?

A

True

26
Q

What’s otitis media with effusion?

A

Chronic - fluid in the middle ear without symptoms of acute infection, AFFECTS hearing. Use pneumatic otoscope when examining ears (senses movement of the ear)

27
Q

What causes otitis media ?

A

Viruses (typically RSV), bacteria (streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis)

28
Q

What are symptoms of acute otitis?

A

Earache (depends on age), pulling on ear, vomiting, diarrhea, crying, irritability, might be hitting ear if they are too young for words

29
Q

Chronic otitis - affects hearing?

A

YES

30
Q

How do we manage otitis media?

A

Antibiotics, pain management

31
Q

Otitis media antibiotics - when? what?

A

Amoxicillin - 1st time, or 1st time in a month.
Amoxicillin-clavulanate (augmentin)
Cefriaxone (ideally IV, or IM - it’s extremely painful, mix with lidocaine)

32
Q

AOM - under 6 months, always antibiotic.
Over 6 months with SEVERE symptoms (pain for 2 days, temp greater than 102.2)

T/F?

A

True

33
Q
A

FALSE - they are not safe.

34
Q

What’s a myringotomy?

A

Surgical incision into the eardrum to relieve pressure or drain fluid.

It’s for SEVERE pain

35
Q

What’s tympanostomy?

A

tubes! for 3 EF’s in 6 months or 4 in a year…helps with drainage and equalizes pressure.

36
Q

What is otitis exterana?

A

Swimmers ear (or really dry!) - infection of external ear, especially in extremely wet or dry conditions, with 5-14 year olds (fingers in ear)

37
Q

Older than 3 - pull the auricle __ and ___.

Younger than 3 - pull the auricle __ and ___

A

Older than 3 - up and out.

Younger - down and out.

38
Q

What is nasopharyngitis?

A

Cold!

39
Q

What are some cold symptoms for infants younger than 3 months old?

A

Lethargy, irritability, feeding poorly, fever (but may be absent)

40
Q

What are some cold symptoms for infants 3 months of age or older?

A

Fever, vomiting, diarrhea, sneezing, anorexia, irritability, restlessness

41
Q

Older children - what are the symptoms of a cold?

A

Dry, irritated nose and throat, chills/fever, generalized muscle aches, headache, malaise, anorexia, thin nasal discharge (which may later become thick and purulent), possible sneezing

42
Q

Cold and cough meds for kids - what should we do? use instead?

A

don’t give cold medicine to children under 2, use proper measuring device and use saline drops and bulb syringes

43
Q

Use steam humidifiers for kids. T/F?

A

FALSE - use cool mist.

44
Q

What is sinusitis?

A

Inflammation of paranasal sinuses - usually follows URI

45
Q

What are symptoms of sinusitis? What about for young ones?

A

cold that resolves but fever, facial pain, headache, postnasal drip, persistent cough - these return. Treated by antibiotics.
For really young ones, it might include bad breath, hacking up, etc.

46
Q

What is pharyngitis?

A

Inflammation of throat and tonsils, usually viruses (Group A Beta hemolytic strep)

47
Q

When does pharyngitis usually occur? (Ages)

A

4-7 years

48
Q

How do we diagnose pharyngitis? Treat?

A

Throat culture - antibiotic if strep.

49
Q

Untreated GABHS infections can lead to what?

A

Rheumatic fever and glomerulonephritis

50
Q

A child with acute streptococcal pharyngitis can return to school when?

A

After taking antibiotics for 24 hours.

Peds - Spring 2016 (29 decks)

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