Difficult breathing in children as lecture to 5th year medical students

3. 
 Definition.
 Causes:
 Types:
 Approach.
 Diagnosis.
 DD.
 Treatment.
 Prognosis.
Objectives:

4. 
It has many definitions but simply it is
when child is dyspnic.
So what is dyspnea???
It is shortness of breath (dyspnea) is the
subjective sensation of difficult, laboured,
uncomfortable breathing.
Breathlessness is another term for dyspnea.
It is usually associated with tachypnea.
Definition:

5. 
Tachypnea is increased respiratory rate.
Upto WHO standards RR is normal when :
Not more than 60 c/m in children less than 2
months old.
Not more than 50 c/m between 2 and 12 mnths
old.
Not more than 40 c/m between 1 and 4 yrs old.
Not more than 30 c/m between 5 and 12 yrs old.
Respiratory rate:

6. 
They could be either:
respiratory
or
cardiac
or
others
Causes and types:

7. Laryngomalacia.
Tracheomalacia.
foreign body.
Epiglottitis.
 pneumonia.
Asthma.
Bronchiolitis.
Retropharyngeal abscess.
GERD.
Respiratory causes:

8. 
 inadequate delivery to lungs (hypoxemia):
R heart failure (cyanotic CHD).
 inadequate delivery to body (pulmonary
edema):
L heart failure (a cyanotic CHD).
 Anemia.
 Vascular rings and slings.
Cardiac causes:

9. 
Central hypoventilation:
brain edema or CNS infection.
Drugs:
diazepam.
Respiratory muscle paralysis:
ascending polyneuropathy.
Others:

10. 
History.
Clinical examination.
Investigations.
Imaging.
Approach and diagnosis:

11. 
Onset: acute or chronic.
Fever: infectious.
Associated symptoms: cyanosis.
Noisy breathing: croup.
Family history: CHD or CF or asthma.
Drug history: anticonvulsants.
Surgery: cardiac.
History:

12. Vital signs: tachypnea or tachycardia.
Color: cyanosis or pallor.
Dysmorphic features: down syndrome.
Signs of RD: working alae nasii and
retractions.
Signs of HF: tachycardia and cyanosis.
Growth parameters: failure to gain weight.
Chest: rhonchi or basal rales.
General: edema or clubbing or hepatomegaly.
Clinical examination:

13.  CBC: leukocytosis or low hgb level.
 CRP and ESR: nonspecific inflammatory reactants.
 ABG: hypoxia.
 Blood for c/s: pneumonia.
 PCR:
 Viral serology:
 IGE level: non specific and specific.
 Skin brick test: asthma triggers.
 Sweat test: CF.
Investigations:

14. 
CXR: consolidation.
ECHO: CHD.
Gatrograffin study: tracheoesophygeal
fistula.
CT and MRI angio: vascular rings.
Direct laryngoscopy and bronchoscopy: FB.
24 ph monitoring: GERD.
Imaging studies:

15. Rt side lobar pneumonia

16. Huge cardiomegaly

17. Steeple sign in croup

18. 
 Supportive: o2 and fluids.
 Specific:
1. antibiotics:
2. Bronchodilators.
3. Steroids.
4. Bronchoscopy: rigid one for FB.
5. Surgery: CHD.
Treatment:

19. 
It does range from excellent to poor
depending on the cause.
Bronchiolitis has excellent prognosis as
well as asthma.
And complex CHD has poor prognosis.
Prognosis: