Respiratory Emergencies

Question 1

Clinical Identification of Respiratory Distress

Answer 1

Tachypnea

Abnormal positioning

Indrawing: subcostal, intercostal, supraclavicular, suprasternal (tracheal tug)

Nasal flaring

Sounds: stridor, wheeze, grunting

Question 2

compare and contrast ABCDEs between respirtory distress and respiratory failure

Answer 2

Question 3

DDx for Acute Stridor

Answer 3

Croup → COVID can cause croup!

Epiglottitis

Bacterial tracheitis

Foreign body

Other: retropharyngeal abscess, peritonsillar abscess, anaphylaxis, ingestion of corrosives, airway trauma

Question 4

what are the stats of aspiration sites for foreign body aspiration

Answer 4

1/4 upper airway, 1/2 right bronchi, 1/4 left bronchi

Question 5

what CXR findings might indicate a lower airway foreign body aspiration

Answer 5

Lower airway foreign body aspiration– may see air trapping or atelectasis on CXR → try to do inspiratory/expiratory views

Question 6

how does clinical presentation change depending on if upper airway vs lower airway is obstructed

Answer 6

upper airway: if partial –> stridor, hoarseness. if complete, death.

lower airway: wheeze, crackles.

Question 7

management for partial upper airway obstruction

Answer 7

Management of Partial Upper Airway Obstruction: monitored bed, keep calm (in position of comfort, defer IV), provide O2 as needed , ENT consult for emergent bronchoscopy.

Question 8

management of complete upper airway obstruction

Answer 8

Management of Complete Upper Airway Obstruction: BLS!

<1 year: 5 back slaps, 5 chest thrusts, chest mouth, repeat

If >1 year: abdominal thrusts, check mouth, repeat

If unresponsive: CPR: start with chest compressions, look into mouth before delivering breath

After stabilize→ Advanced Life Saving strategies (ALS)

Laryngoscopy and removal with magill forceps

Intubate with ETT to push FB down into a bronchus

Needle cricothyrotomy or surgical tracheostomy

Question 9

outline the etiology, symptoms, and management of croup

Answer 9

Etiology: parainfluenza, COVID, happens in younger children 6moths to 3 years

Symptoms: barky cough, hoarse voice +/- stridor

Management: cold air, dexamethasone, epi neb/MDI for severe biphasic stridor (severe indrawing, agitation)

Question 10

DDX of Acute Wheeze

Answer 10

Bronchiolitis

Asthma

Other: FB aspiration, GERD, TEF, pneumonia, cystic fibrosis, mediastinal mass, vascular ring, CHF, anaphylaxis, toxin (organophosphates)

Question 11

etiology, investigations and management of bronchiolitis

Answer 11

Etiology: Viral LRTI→ mostly RSV, COVID, affects 0-24 month old infants

• 33% get bronchiolitis
• 3% get admitted to hospital for bronchitis

Wheezing = LOWER AIRWAY

Investigations: usually only need clinical diagnosis (H+P)

Management: O2, hydration, possible epi neb

Question 12

when to suspect asthma>bronchiolitis

Answer 12

Recurrent wheeze episodes

Atopic personal or family history

Environmental or allergic precipitant

Over 2 years old

Not bronchiolitis season (November to January) → make sure to do a SAMPLI History!

Question 13

for initial treatment of an asthma exacerbation, you use salbutamol and oral dexamethasone for all severeities. what other meds to you add if moderate? if severe?

Answer 13

Epi: lifetime prevalence of asthma in Canadian children: 11-16%

Management: dependent on severity, which can be assessed using the pediatric respiratory assessment measure

Initial Treatment: salbutamol (for all severities), ipratropium if mod-severe, oral dex for all, Mag sulphate for severe-resp failure, and also consider IV ventolin for impending resp failure.

Question 14

outlien the PRAM score to determine asthma clinical severity

Answer 14

1. suprasternal indrawing

scalene retraction

3. wheezing
4. ait entry
5. oxygen saturation on room air

Question 15