Z Respiratory Distress in Children Flashcards
What are the 3 components of the Cardiopulmonary Arrest in children?
Respiratory (oxygen)
Cardiac (pump, perfusion, BP)
Circulatory volume (perfusion, BP)
Cardiac arrest in children is usually due to what?
What is it often NOT a result of?
Progressive respiratory failure or shock (asphyxia arrest)
Rarely a result of primary cardiac etiology.
What is the progression of asphyxia in kids?
Asphyxia begins with hypoxemia, hypercapnia and acidosis, which leads to bradycardia and hypotension and culminates in cardiac arrest.
Sudden, unanticipated, non-traumatic cardiac arrests are uncommon in kids, but under what circumstances can they develop? (2)
In children with known risks (CHD) or in children with unknown risks (long QT, IHSS, CM).
What appearance is associated with hypoxia?
Restlessness
Anxiety
Combativeness
If a child cannot be consoled and their eyes roll around, what does it indicate?
Significant illness or hypoxia
Loud cry =
Hoarse/muffled cry =
Weak cry =
Loud cry = good
Hoarse/muffled cry = airway obstruction
Weak/no cry = bad
What is the initial response to respiratory compromise in children?
What does it lead to?
Tachycardia
Leads to decreased RR and an irregular pattern of respirations.
What is an ominous sign in children who are respiratory compromised?
The development of a slower, irregular respiratory pattern in the setting of respiratory distress.
What are the 3 components of the Pediatric Assessment Triangle (PAT)?
Appearance
Circulation to skin
Work of breathing
What is stridor?
What causes it?
High pitched crowing sound, more prominent in inspiration.
Occurs secondary to narrowing of larynx (croup, laryngomalacia) or trachea (tracheomalacia, vascular ring).
Grunting occurs in an effort to do what?
What are 2 reasons for a child to grunt?
It is an expiratory sound heard without a steth and is generated in an attempt to maintain airway patency.
- Breathing out against a partially closed glottis.
- A desire for decreased chest wall excursion (pleural pain, intra-abdominal pain).
Pale, mottled, cool or ashen skin are concerning for what? (2)
Hypoxemia and shock
What is the best way to check circulatory status in kids?
Cap refill
General rule of thumb in HR changes when circulation is compromised:
When the ability to compensate has been exceeded:
When compromised, HR will initially see tachycardia to compensate.
When the ability to compensate is exceeded, bradycardia will occur.
3 reasons for cyanosis
Oxygenation of blood may be low
Significant blood loss
Poor perfusion
Severe upper airway obstruction can occur by (full vs. partial) (3):
What will be heard when there is obstruction (full vs. partial)?
Full obstruction: foreign body aspiration, angioedema from anaphylaxis, epiglottitis.
Partial obstruction: foreign body aspiration, infection (croup), injury (thermal or chemical burn).
Full: nothing
Partial: stridor
Tension PTX occurs when:
Hallmarks include (5)…
Air from lung leaks into the pleural cavity and leads to a shift of mediastinal structures to the opposite side and compresses heart and good lung.
Severe respiratory distress IL chest hyper-expansion Dec./absent breath sounds Mediastinal shift Hyper-resonance to percussion over collapsed lung
Cardiac tamponade is life threatening due to…
What is the most common cause (secondary)? (2)
What classic triad is associated with cardiac tamponade?
Compromise of venous return and cardiac stroke vol.
Secondary to fluid build up from a previous infection OR malignancy (leukemia, etc.)
Beck’s triad: JVD, muffled heart sounds, hypotension (1/3 of pts.)
Is PE in kids common?
What can cause it?
Uncommon in kids.
Central lines/devices Hyper-coagulability Congenital heart disease Trauma Nephrotic syndrome SLE
Respiratory tract infections
How quickly do they develop?
How do the patients appear?
They develop more gradually, unless upper airway structures are highly involved.
Febrile and ill-appearing
Retropharyngeal and peritonsillar abscesses
What do they usually cause instead?
Who should be notified?
Sore throat, trouble swallowing and local pain, swelling.
ENT
Croup (acute laryngotracheobronchitis) is the most common cause of…
What are the 2 etiologies?
What occurs as a secondary bacterial infection to croup?
Infectious airway obstruction in ages 6-36 mo.
Viral (parainfluenza virus), less often allergic (spasmodic croup).
Tracheitis is the secondary bacterial infection to croup (kids are febrile and very sick)
Most common cause of Epiglottitis is:
Its vaccine has nearly eliminated what 2 infections?
What should be done?
H. flu type B
HIB meningitis and HIB epiiglottitis
OR for exam and possible intubation
Bronchiolitis is most commonly caused by which 4 viruses?
How old are the children?
What SX characterize bronchiolitis? (3)
RSV, influenza, parainfluenza, adenovirus.
Less than 2 y/o.
URI symptoms, progressive cough and wheezing/atelectasis.
Most common Pneumonia in children is:
Strep. pneumoniae
How do bacterial pneumonias vs. viral/atypical pneumonias appear on CXR?
Bacterial tend to be lobar
Viral/atypical tend to be more diffuse/interstitial/peribronchial, but can be lobar at times
Sudden changes in Asthma can be due to… (2)
Alveolar disease and/or atelectasis
Anaphylaxis causes _________ which can be life-threatening.
Common SX include (3):
What is given as Tx? (3)
Retropharyngeal/laryngeal edema
Facial edema, urticaria and bronchospasm
Epi, oxygen and steroids
SX of foreign body aspiration in trachea:
Lower foreign body aspirations:
Esophageal:
Stridor, drooling, choking
Coughing, choking, with delayed SX of pneumonia and chronic cough
Drooling, swallowing problems
Causes of non-cardiogenic pulmonary edema include (4)
Chemical pneumonia
Submersion/drowning
Secondary to airway obstruction
Medication toxicity
What 2 systemic diseases can cause respiratory distress in children?
Thyroid disease
Metabolic disease
What hematologic abnormality can cause respiratory distress in kids?
Decreased oxygen delivery secondary to anemia, abnormal Hb
Sickle cell disease can lead to:
SX (3)
Acute chest syndrome
Sudden onset of respiratory distress and chest pain
New infiltrate on CXR
Fever
