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PAR2012 - Respiratory > Week 4 > Flashcards

Week 4 Flashcards

1
Q

what are the anatomical differences between adult and paed respiratory system?

A 
Anterior and superior larynx
larger tongue
Horizontal ribs
smaller airways
larger floppier epiglottis 
tonsils and adenoids
less fatigue-resistant muscle fibres
less developed
Diaphragmatic breathers
small mandible and neck
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2
Q

At what age does a childs rep system reach maturity?

A

approx 8 years old

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3
Q

precautions of child with resp conditions?

A

Children are obligate nose breathers
- nasal secretions or malformations can easily obstruct air flow

Predominately diaphragmatic breathing until 6-8 years… anything that interferes with this (pneumonia, abdo pain) can cause resp distress

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4
Q

what age does a baby in gestation start to generate pulmonary surfactant

A

24 weeks

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5
Q

what age does a baby in gestation generate adequate pulmonary surfactant

A

35 weeks

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6
Q

What is the O2 consumption of a child compared to adult?

A 
Infant = 6ml/kg/min
adult = 3ml/kg/min
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7
Q

Explain the difference in lung mechanics during inspiration and expiration between an adult and a premature infant

A

Adult:
Insp - diaphragm contracts down, chest wall expands out
Exp - Diaphragm relaxes up, chest wall moves inward

Prem Infant:
Insp - Diaphragm contracts down, chest wall moves inward
Esp - diaphragm relaxes up, chest wall moves outward

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8
Q

What is the tidal volume of a child?

A

5-7mls/kg

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9
Q

What is minute alveolar ventilation more dependent on in infants?

A

Increased RR rather than TV

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10
Q

If a radius is halved, how much does resistance increase by? (exam Q)

A

16x

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11
Q

What are some signs of respiratory distress in infants?

A
  • Nasal flaring
  • drooling
  • cyanosis despite 02, pallor
  • grunting/wheezing
  • irregular breathing/apnoea
  • inability to lie down
  • diaphoresis
  • stridor
  • flaring
  • head bobbing
  • decrease conscious state
  • lethargy
  • floppy
  • WOB +- accessory muscles
  • Tachyponea
  • Tachycardia initially, moving to bradycardia as late sign
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12
Q

What is the threshold for CPR in a paed?

A

Infant <60

Child <40

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13
Q

What are the components of the Paediatric Assessment triangle?

A

Appearance (TICLS)

  • tone
  • interactiveness
  • Consoliability
  • Look/gaze
  • Speech/Cry

Work of breathing

  • abnormal breathing sounds
  • abnormal positioning
  • retractions
  • nasal flaring

Circulation to the skin

  • Pallor
  • Mottling
  • Cyanosis
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14
Q

What are the normal values and age and weight of a newborn?

A 
HR = 110 - 170
BP = 60 SBP
AGE = 24 hours
Weight = 3.5 kg
RR = 25 - 60
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15
Q

What are the normal values and age and weight of a small infant?

A 
HR = 110 - 170
BP = 60 SBP
AGE = <3 months
Weight = 6 kg
RR = 25 - 60
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16
Q

What are the normal values and age and weight of a large infant?

A 
HR = 105 - 165
BP = 65 SBP
AGE = 3 - 12 months
Weight = 6kg - 3 months / 8kg - 6 months / 10kg - 12 months
RR = 25 - 55
17
Q

What are the normal values and age and weight of a small child?

A 
HR = 85 - 150
BP = 70 SBP
AGE = 1 - 4 years
Weight = age x 2 + 8
RR = 20 - 40
18
Q

What are the normal values and age and weight of a medium child?

A 
HR = 70 - 135
BP = 80 SBP
AGE = 5 - 11 years
Weight = age x 3.3
RR = 16 - 34
19
Q

What accessory muscles are used by infants in resp distress?

A 
intercostals
suprasternal
supraclavicular
substernal
subcostal
20
Q

What are the signs of hypoxia in infants?

A
  • pallor
  • bradycardia
  • hypotension
  • apnoea
  • lethargy
21
Q

What are the signs of hypoxia in children?

A
  • restlessness
  • cyanosis
  • tachycardia (brady as late sign)
  • tachypnoea
22
Q

What is Respiratory Syncytial Virus (RSV)?

A

presents similar to influenza and is the principal cause of bronchiolitis

  • disease spectrum ranging from Rhinitis and Otitis media to bronchiolitis and pneumonia

peaks at 2-5 months. everyone would have had it by 3

23
Q

what is the most common cause of lower respiratory tract infection (LRTI)?

A

RSV - respiratory syncytial virus

24
Q

What are the symptoms of the respiratory syncytial virus

A
  • high fever with ill appearance
  • thick nasal discharge
  • worsening cough or cough that produces yellow, green or grey mucus
  • signs of dehydration
  • trouble breathing
25
Q

How do you treat respiratory syncytial virus?

A

Oxygen

26
Q

What is Bronchiolitis

A

Acute inflammatory disease of the lower resp tract, resulting in obstruction of the small airways of children under 2.

It is short-lived and self-limiting lasting a few days

27
Q

What are the symptoms of bronchiolitis?

A
  • rapid resp
  • chest retractions
  • wheezing
  • mainly occurs in autumn and winter
  • history of runny nose
  • unwell for 1-2 days
  • gradual onset of irritating cough
  • resps are shallow due to trapped air
  • nasal flaring
  • febrile but not toxic (good differential)
  • may develop cyanosis, exhaustion and hypoxia
28
Q

What is the common age group for Bronchiolitis?

A

2-6 months

may be up to 2 years

29
Q

what are the signs and symptoms of dehydration?

A
  • dry mouth
  • dry lips
  • skin turgor - doesn’t ping back
  • hypotension
  • decreased urine output -> important question to ask
  • cracked tongue
  • increased thirst
30
Q

What is the management of bronchiolitis?

A
  • monitor
  • oxygen
  • salbutamol may help
  • artificial ventilation to eh infant who developed resp failure
  • transport
31
Q

What is Croup of Laryngotracheobronchitis?

A
  • viral infection - most common cause of stridor
  • swelling of tracheal mucosa
  • occurs between ages of 1-6 - peaks at 2
    more common in boys
  • Inspiratory stridor
32
Q

what are the stage sin the progression of croup?

A
  • Inflammation and oedema
  • Upper airway obstruction
  • Increased resistance to airflow
  • increased intrathoracic negative pressure
  • Collapse of upper airway
  • resp failure
33
Q

What are the clinical features of croup?

A
  • gradual onset preceded by URTI of >48 hours
  • Hoarseness
  • Biphasic stridor, mainly at night
  • Dry cough
  • Low grade fever
  • Child prefers to lie down but is restless
  • sternal retraction and accessory muscle use possible
  • dysphagia & drooling absent

PAR2012 - Respiratory (13 decks)

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