Respiratory Upper and Lower Flashcards
Main causes of death in children worldwide
Main causes of respiratory and circulatory failure leading to cardiac arrest in kids?
What are the three E’s of assessing a child breathing
Effort of breathing
-Looking for intercostal, subcostal and suprasternal recession
-Looking for accessory muscle use
-Determining the rate of breathing
-Listening for inspiratory and expiratory noises such as wheezing and stridor
-Fatigue
-Cerebral depression
-Neuromuscular disease
Efficacy of breathing
-Observing chest expansion
-Listening for air entry
-Performing pulse oximetry
Effects of respiratory inadequacy on other organ systems that may be present
- Heart rate. Initially hypoxia will cause a tachycardia however if it is severe and prolonged the heart rate will fall: this is a pre-terminal event.
- Skin colour. Hypoxia will cause vasoconstriction and skin pallor. Cyanosis is a late sign.
- Mental status. Initially hypoxia will cause agitation and distress. As it progresses the child will become more drowsy and finally unconscious. Hypercarbia will cause drowsiness as well.
Normal heart rates in kids
Normal blood pressures in kids
rapid assessment of conscious level in kids?
AVPU
A Alert
V responding to Voice
P responding to Pain OR
U Unresponsive
Type of rash?
Urticaria - allergy
Type of rash am i?
Non blanching purpuric rash Eg meningococcal sepsis
In the rapid assessment of the seriously ill child How do you assess?
A+B
-Effort of breathing
-RR + rhythm
-Stridor/wheeze
-Auscultate
-Skin colour
C
-HR
-Pulse volume
-CRT
-BP
-Skin temp
D
-AVPU
-Posture
-Pupils
E
-Fever
-Rashes
- Trauma
Why are children more susceptible to severe respiratory illness
- Immunity - lack of immunity to organisms adults have acquired immunity to
- Both upper and lower airways are narrower in children and are more easily obstructed.
- The thoracic cage of young children is more compliant leading to recession with respiratory obstruction and less support for the maintenance of lung volume
- There are fewer alveoli present in early childhood.
- The respiratory muscles of young children are relatively inefficient leading to muscle fatigue and apnoea.
Lack of immunity in a small airways that have less alveoli with small muscles and a soft chest wall
The initial resuscitation of a child with breathing difficulties always involves:
opening the airway,
giving oxygen and
providing ventilatory support if necessary.
Features of acute severe asthma and Life-threatening asthma in kids
First steps for management of asthma? If they don’t respond to this?
Assess ABC and give high flow oxygen via face mask
Administer salbutamol via spacer or via nebuliser
Administer oral prednisolone or IV hydrocortisone.
Continue inhaled salbutamol up to continuous nebulised
Consider inhaled ipratroprium
Commence intravenous therapy – this may be one or more of:
-Magnesium Sulphate
-Salbutamol
-Aminophylline
Paeds asthma doses of
Salbutamol neb
Ipatroprium neb
Prednisolone
Hydrocortisone
Salbutamol IV
Magnesium IV
Amiophiline IV
Salbutamol neb - 2.5-5mg continuous if needed
Ipatroprium neb - 125-500mcg every 20mins
Prednisolone - 1mg/kg (max 40mg) for 3 days
Hydrocortisone - 4mg/kg every 6 hours (max 200mgQDS)
Salbutamol IV - 1-5mcg/kg/hr
Magnesium IV - 50mg/kg = 0.2mmol/kg = (0.1ml of 50%) over 20 mins
Amiophiline IV - 10mg/kg over 1 hour
Signs of severe bronchiolitis
Anaphylaxis management in kids 1st
Adrenaline 10mcg/kg (0.01 mls/kg of 1/1,000) IM
Rule of 4s in blood gasses
ph 7.4
PCO2 40
HCO3 24
How does PCO2 reflect as pH
Every increase of 10 in pCO2 - pH decreases by 0.1
Every decrease of 10 in pCO2 - pH increases by 0.1
If a PCO2 is 60 what would you expect the pH to be
20 high = decrease in pH by 0.2
= pH of 7.2
For every chronic increase of pCO2 of 10 what will HCO3 do? Decrease pCO2 by 10
Increase pCO2 by 10 - Increase HCO3 by 3-4
Decrease pCO2 by 10 - Decrease HCO3 of 2-3
Why does bicarbonate decrease in acidosis
The bicarbonate is low as it has combined with hydrogen ions produced by the poor peripheral perfusion.
In respiratory acidosis how do you get a rise in your bicarb
Renal retention of HC03- and the high C02 from poor ventilation
Why do you get low K+ in vomiting
The low K+ is a consequence of the renal retention of H+ as compensation, and loss of potassium
[H+ ions are exchanged for K+ ions in the kidney in an attempt to correct the alkalosis.]
Barking cough, harsh stridor and hoarsness of voice are usually preceded by fever and coryza for 1-3 days?
Usual causes?
Croup - laryngotracheobronchitis
parainfluenza, respiratory syncytial virus or adenovirus
Management of mild croup? Severe? how do the doses of meds change?
Mild/mod
Dex 0.15mg/kg
Severe
Dex 0.6mg/kg (max 12mg)
Adrenaline nebulised - 5mls 1:1000
Unwell child. Rx?
Intubation
IV antibiotics
What is Laryngomalacia? Tracheomalacia? Relevance?
Laryngomalacia is a congenital abnormality of the larynx, specifically the supraglottic structures, with collapse on inspiration causing stridor in infancy.
Tracheomalacia refers to a similar collapse of a compliant trachea.
Viral upper respiratory infections may affect children with these conditions more severely and worsen airway obstruction.
Choking child algorithm?
First thing you check?
*Heimlich is not recommended as may damage abdominal organs
How are chest thrusts done in choking child ?
Back blows?
Like compressions in BLS (but slower rate - approx 1/second)
Heel of palm and strike firmly using gravity
An 18 month old toddler presents to the emergency dept with severe stridor, increased work of breathing (RR - 40, intercostal recession) and an oxygen saturation of 89%. There is a 48 hr history of an URTI with a “croupy” cough. Correct management includes?
Adrenaline 5 mls of 1/1,1000 (5 mg) via nebuliser is an urgent priority in management
Dexamethasone 0.6 mg/kg
Minimise distress to the child, as this can worsen upper airway obstruction
A toddler swallowed a pen top and is brought into the ED by her parents. She is gasping with a weak cough and appears cyanosed. The most correct immediate management is?
5 back blows then 5 chest thrusts and reassess
Acute bronchiolitis management
Aim Sats 92%
Glucose
Monitor for apnea
Anaphylaxis algorithm
Dose of drugs?
Fluids?
Often easy analgesic in an infant other than nasal fentanyl
Oral sucrose
