T3-Blueprint: Respiratory Flashcards
Respiratory: What is the focus for pediatrics-airway or cardio?
Airway
When do children have alveoli?
Not till age 8 or 9
What type of airways do children have?
Short, more narrow airways from trachea to bronchioles
4 mm (child) vs 20 mm (adult)
Describe the trachea of children.
Trachea is shorter, angle of the right bronchus at bifurcation is more acute
Child or adult:
Small nasopharynx
Child
Child or adult:
Lymph tissue grows rapidly
Child
Lymph tissue grows rapidly till age 12, then atrophies
Child or adult:
Smaller nares
Child
Child or adult:
Smaller oral cavity
Child
Child or adult:
Large tongue
Child
*risk for obstruction since they have a large tongue but small oral cavity
What kind of epiglottis does the child have?
Long, floppy epiglottis which is vulnerable to swelling
What is higher in the neck for a child..what does this mean?
Larynx and glottis is higher in the neck–risk of aspiration
What cartilage is immature in the child and can collapse?
Thyroid, cricoid, tracheal cartilage
Do children have few or lots of functional muscles in airway
Few
Children have ____ amounts of soft tissues and loosely anchored mucus–risk of edema and obstruction
Large
Respiratory: What is the focus for adults-airway or cardio?
Cardio
T/F: Chest wall is inflexible in infants and children
FALSE–it is flexible–their chest muscles are immature and ribs are cartilaginous—this is why you see their retractions so well
Location of retractions for mild distress?
Intercostal (between ribs)
Location of retractions for worsening distress?
Substernal & subcostal
*below the sternum and ribs
Locations of retractions for severe distress?
Supraclavicular
Suprasternal
*Use of accessory muscles: sternocleidomastoid and trapezius
What is laryngotracheobronchitis (LTB)? And what age?
Aka croup; Moderate to severe airway obstruction caused by inflammation of larynx, trachea, and large bronchi
Ages 1-3
What is the classic sign of laryngotracheobronchitis (LTB)/Croup?
Inspiratory stridor
How does LTB begin?
With simple URI for 1-2 days and infection descends
Since LBT causes problems to larynx, trachea, and large bronchi…what symptoms will occur first: laryngeal, tracheal, bronchial? Describe.
Laryngeal
-Stridor, brassy, barking, or seal like cough
LBT: Laryngeal symptoms occur first..Then what?
Inflammation of the trachea and bronchi
-Resp obstruction (secretions, swelling of mucosa, muscle spasms)
What are some other s/s of LBT?
Hoarseness Mild fever Restlessness Nasal flaring Retractions Hypoxia Respiratory fatigue
What is treatment for mild croup?
Can manage at home if no strider at rest
Oral fluids encouraged if RR is under 60
Cool mist humidifier, steam from shower, go outside in cool night air
Fever control: Acetaminophen
What is treatment for severe croup?
If stridor is constant–GO TO HOSPITAL
Oxygen is needed
Nebulized racemic epi or nebulized corticosteroids
Pulse ox needed
Severe croup: What is nebulized racemic epinephrine?
Alpha adrenergic causing vasodilation of mucosa
General term applied to a complex of symptoms characterized by a barking cough (swelling of larynx)
Croup
Mild or severe croup: croup cough, hoarseness, no stridor at rest
Mild
Mild or severe croup: continuous stridor, retractions, use of accessory muscles
Severe
A potentially life threatening condition that occurs when the epiglottis swells, blocking the flow of air into your lungs
Epiglottitis
What is the epiglottis?
A small cartilage lid that covers your windpipe
What are 3 ways to get epiglottis?
Bacterial (comes from H flu if not immunized)
Staph
Strep
Is inflammation of the epiglottis a medical emergency?
YES
What is the hallmark sign for Epiglottitis?
Drooling
Epiglottitis: Describe the S/S?
*Hallmark: Drooling
Others:
- Very sore throat
- Refuse to swallorw
- *Prefers UPRIGHT TRIPOD POSITION with chin out and mouth open
- Muffled voice
- Reluctant to cry/speak
- Retractions
- Anxiety, fever
- *Epiglottis is SWOLLEN AND CHERRY RED
How is epiglottitis diagnosed?
“Thumb sign” in lateral X-ray verse the normal little finger shape of the trachea
*must take lateral X-ray of neck
Epiglottitis: Is intubation necessary?
May be depending on how closed the airway is due to inflammation
Epiglottitis: What antibiotic?
Methyprednisolone
Epiglottitis: Why would we give IV steroids?
To help with inflammation
Is epiglottis seen much still today?
No seen as much because of the Hib vaccine
Sudden onset of symptoms of obstruction of airway of varying degrees due to inhalation of object
Foreign body aspiration
If a FB is taken in through nose, where can it move to?
Into lower structures
FB aspiration is common in what ages?
Toddlers, 1-3
What do the symptoms of FB inhalation depend on?
- Size of object
- Where object lands in resp. tree
- If it was witnessed or unwitnessed
FB: If it was unwitnessed, what may be the first indication that event has occurred?
Infection
FB: If there is partial obstruction and the patient is moving air what do we do?
Go to ED
FB: Partial obstruction signs?
Coughing and wheezing but continues to move air with decreased breath sounds or absence of breath sounds in lung segment
FB: What are signs of total obstruction?
Cyanosis
Cant speak
Collapse
*can cause death!!
FB: What do we do for total obstruction for a child under 1 year?
Back blows, chest thrusts
FB: What do we do for total obstruction for an older child?
Abdominal child
What are choking hazard foods?
- Hot dog
- Nuts
- Grapes
- Veggie pieces (carrots, peas, beans, corn)
- Popcorn
- PB
- Gum
- Hard candy
- Small parts of balloons
- Coins
- Beads
- Buttons
- Pins
What are management for FB?
Xray: object is visible on chest xray
Surgery: Laryngoscopy and bronchoscopy
Signs of a foreign body in the nose:
- What kind of discharge?
- What kind of obstruction?
Unilateral nasal discharge that is foul smelling
Local obstruction with sneezing and mild discomfort
Foreign body in the nose: Discomfort may ____ in time, especially as objects may grow bigger as it absorbs moisture. Local _____
Increase in time
Local mucosal swelling
Foreign body in the nose: Can infection occur?
Yes, followed by foul breath and purulent or bloody discharge from one nostril
What is a lower respiratory tract (RSV) problem?
Bronchiolitis
What are the initial signs and symptoms of bronchiolitis?
URI with fever, sneezing, rhinorrhea, coughing, and anorexia
What are the signs after a few days of having bronchiolitis?
- Rapid respirations and retractions
- CHOKING COUGH
- FROTHY MUCOUS
- Nasal flaring
- Rales, rhonchi
- Prolonged expiratory wheeze
- Decreased intake in infants
What are some treatments for bronchiolitis?
- Home rest
- Chest x ray
- RSV culture
- Possible hospitalization
What are meds for bronchiolitis?
Bronchodilators
Corticosteroids
Humidified O2
Bronchiolitis (LRT-RSV) is very common. When is the higher incidence?
95% of kids have by age 3; winter and early spring usually
What is an upper respiratory infection?
Strep pharyngitis
Strep pharyngitis: majority or bacterial or viral?
Viral
Strep pharyngitis: What do we do if it is bacterial or suspect it to be bacterial?
Throat culture
S/S of strep pharyngitis?
- Sudden onset of sore throat/fever
- Headache
- Abdominal pain
- Vomiting
- Poss rash
- Lyphadenopathy (neck)
- Neck pain
Poss rash is a s/s of strep pharyngitis. What is this?
Fine, sandpaper like rash
What is the treatment for pharyngitis?
Oral penicillin G for 10 days
Oral penicillin G is given for treatment of strep pharyngitis. What is given to penicillin sensitive patients?
Erythromycin
Strep pharyngitis: What can we put on the neck? What can help soothe the throat?
Neck: warm or cool compress
Mouth: Gargle with warm saline
Tonsillitis have a ___ throat and difficulty ____
Sore throat and difficulty swallowing
*have a fever
Tonsillitis patients have a history of what?
Otitis media and hearing difficulities
Tonsillitis: Nose or mouth breathers?
Mouth breathing and snoring; have mouth odor
Tonsillitis: What kind of qualities are heard in the voice
Nasal
Tonsillitis: What kind of inflammation?
Tonsil inflammation with redness and edema
*small patches of yellowish pus also may become visible
What is a tonsillectomy?
Removal of the palatine tonsiles
Tonsillectomy is removal of the palatine tonsils. Where are these palatine tonsils located?
Both sides of oropharynx
What is an adenoidectomy?
Removal of the pharyngeal tonsils
What is another name for pharyngeal tonsils?
Adenoids
What is the normal color for TM?
Translucent
Slightly pink of grey
When we shine the light in an ear of a patient with a normal TM, what should we see?
Well defined light reflex, and the cone shaped reflection (points away from face)
Inflammation of middle ear without reference to etiology or pathogenesis
Otitis media
Infection of the structures of the middle ear with rapid clinical symptoms of infection
Acute otitis media
S/S of acute otitis media?
- Pain and irritable
- Fever and rhinorrhea
- Decreased appetite
- Ruptured TM (will be non transparent grayish color)
Treatment for acute otitis media?
Antibiotics for at least 10 days
How do we look in ear of a child less than 3?
Pull pinna down and back
T/F: Many acute otitis media infections can clear up spontaneously in a few days
True
What if a child has recurrent otitis media?
- Tympanostomy tube placement
2. Adenidetomy
What does a tympanovstomy tube placement do for a child with recurrent otitis media?
They are pressure equalizer tubes and spontaneously fall out in ~6 months
Otits media problems are mostly related to eustachian tube malfunction. How are these tubes in children?
Short and more horizontal
Otitis media: What age is this common in?
First 24 months of life and again during school (5-6)
*infrequently after age 7
What months and homes are otitis media cases common in?
- Winter months
- Homes with second hand smoke
What other illnesses/disorders increase risk of otitis media?
Down Syndrome
Cleft lip/palate
Lower or higher risk of otitis media in those who are breastfed?
Lower
Collection of fluid in the middle ear but not infection
Otitis media effusion
“Swimmers ear”–infection of outer ear canal.
Otitis externa
*inflammation of skin of ear canal
FB: How do we remove soft objects (paper, insects)?
With foreceps
FB: How do we remove small, hard objects (like pebbles)?
Suction tip
Hook
Irrigation
FB: When is irrigation contraindicated?
If subject is a vegetative matter (beans, pasta) because it will swell with fluid
