This document provides an overview of pediatric respiratory emergencies. It begins with an introduction to the approach and assessment of a child presenting with breathing difficulties. It then covers the grading of respiratory distress, features of respiratory failure, and the pathophysiology of increased airway resistance and edema. The document further discusses the pathophysiologic approach to various clinical conditions causing respiratory distress. It provides guidance on the initial assessment and immediate care of the child, including airway management, oxygen delivery, circulation support, and diagnostic evaluation. Specific conditions addressed include upper airway obstruction, pneumonia, and wheezing.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
This was done as a student presentation using photographs & content from various web sites & textbooks on the assumption of fair usage for studying & is for NON-COMMERCIAL purposes.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
pediatric assessment in emergency rooms , how to pass the PALS exam , part 1 search for the other 3 parts, for any comment send to sayedahmed 1900@ g mail .com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Evaluation of antidepressant activity of clitoris ternatea in animals
Approach to respiratory distress in children
1. “ Pediatric respiratory emergencies”
(Nelson, O.P. Ghai,)
Presented By:
Dr. Wasim Akram
Moderator
Dr. R. S. Sethi (MD, DCH)
Professor & Ex. HOD
Dr. Om Shankar Chaurasiya (MD)
Assistant Professor & Head
Dr. G. S. Chaudhary (MD)
Lecturer
Dr. Aradhana Kankane (MD)
Lecturer
DEPARTMENT OF PAEDIATRICS
M. L. B. Medical College, Jhansi
Dr. Anuj Shamsher Sethi (MD)
Lecturer
Dr. Sapna Gupta (MD)
Lecturer
&
All Resident
2. Approach to a child with breathing
difficulty
– Synonymous with dyspnea,
– Respiratory distress
3. Definition
– Clinical state characterized by increased rate & increased
respiratory efforts
OR
– It refers to any type of subjective difficulty in breathing.
4. Features of respiratory distress
– Tachypnea
– Dyspnoea
– Nasal flaring
– Chest wall retraction
– Added sounds
– Head bobbing
– CVS &CNS manifestation
5. Grading of acute respiratory
distress
Mild
– Tachypnea
– Dyspnea or shortness of breath
Moderate
– Tachypnea
– Minimal chest wall retaractions
– Flaring of alae nasi
Severe
– Marked tachynea (> 70 breaths/min)
– Apneic episodes/bradypnea/irregular breathing
– Lower chest wall retractions
– Head bobbing (use of sternocleidomastoid muscles)
– Cyanosis
6. Features of Respiratory failure
– Defined as a paCO2 of >50 or paO2 of <60 while
breathing 40% oxygen
– Clinical definition : Severe respiratory distress with
cardiovascular manifestation and central nervous system
changes
– Cvs changes; marked tachycardia, or bradycardia,
hypotension
– Cns changes: lethargy, somnolence ,seizures and coma
9. Pathophysiologic approach to clinical conditions
causing respiratory distress
Etiology Pathophysiology Clinical conditions
Interference with air flow
(entry or exit)
Upper airway obstruction
Lower airway obstruction
Mechanical compression
Thoracic wall injuries
Aucte laryngitis, laryngotracheitis, foreign body
Bronchiolitis, asthma
Large pleural effusion, pneumothorax
Flail chest
Interference with alveolar gas
exchange
Failure of alveolar ventilation
Failure of diffusion
Pneumonia, pulmonary edema
Pneumonia, pulmonary edema
Cardiovascular problems Mechanical or inadequate function Congestive cardiac failure, arrhythmias, myocarditis,
pericarditis, Right-to-left shunts
CNS Depression of respiratory center
Stimulation of respiratory center
Neuromuscular impairment of
respiration
Raised ict
Acidosis, salicylate intoxication
Acute paralytic poliomyelitis, Guillain-Barre syndrome,
organophosphate poisonin, snake bite, diaphragmatic
paralysis
Other Insufficient oxygen supply to tissues
and/or increased oxygen demands
Compensation for metabolic acidosis
Sepsis, severe anemia, high altitude, carbon monoxide
exposure, smoke inhalation, meth-hemoglobinemia
Diabetic ketoacisosis, acute renal failure
10. Approach
– Our primary / first approach should be directed to find out the extent of
respiratory and cardiovascular dysfunction and quantify its severity.
– The assessment determines the urgency with which interventions need to be
instituted
– Assessment is aimed to deciding weather airways
– Clear
– Maintable
– Not maintable
– Any audible sound during breathing is suggestive of respiratory airway
obstruction
11. Initial general assessment
– The goal is to rapidly assess for
– a)airway patency
– B)adequacy of gas exchange
– C)circulatory status
Assessment begins with using Pediatric Assessment
Triangle
12. Pediatric Assessment Triangle
– A)Appearance ; interaction ,muscle tone, consolability,
look speech, cry
– B)Work of breathing: use of accessory muscle,
bradypnoea
– C)Abnormal skin colour: pallor and cyanosis
13. Primary general assessment
– It is done by using the assessment pentagon which
includes
Airway
Breathing
Circulation
Disability
Exposure
14. Airway
Assessment is aimed to decide whether airway is:
CLEAR: open and unobstructed
MAINTAINABLE: maintained by simple measure like
position, suction etc
NOT MAINTAINABLE: needs advance measure like
intubation
ANY AUDIBLE SOUND
17. Stridor
– Inspiratory harsh sound continuously.
Can occur during expiration (intrathoracic) or both phase of respiration.
– Asses the severity
– Drooling of saliva, respiratory distress, unable to swallow, cyanosis
– Common causes:
– Infective: epiglottitis, laryngotracheobronchitis, tracheitis, retropharyngeal abscess (rare)
– Malignancy: tumor compression, papilloma
– Allergic: angioneurotic oedema.
– Congenital: laryngomalacia, laryngeal web, vascular ring,
– Aspiration: foreign body.
– Neuronal: paralysis of vocal cord.
– Investigation
– Blood count; Lateral neck X-ray; flexible bronchoscopy.
18. Wheeze
– It is a whistling sound heard most often during expiration
indicating lower airway obstruction.
19. WHEEZE Vs RHONCHI
WHEEZE
– Continuous ,high pitched musical
sound
Heard during expiration, however can
be heard on inspiration
Produced when air flows through
narrowed airways.
RHONCHI
– Subtype of wheeze
– Low pitched, snoring quality,
continuous musical sound
– Implies obstruction of larger
airways by secretions.
20. Grunting
– Short, low pitched sound heard during expiration produced by
forced expiration against a partially closed epiglottis
it keeps small airway and alveoli open to maintain oxygen
– typically a sign of severe respiratory distress
– Sometimes grunting can be heard in fever and abdominal pain
21. 2)breathing
< 2 months > 60/min
2 months – 1 year > 50/min
1 year – 5 years > 40/min
5 years > 30/min
a) Tachypnea
22. Breathing contd…..
– 2)BRADYPNOEA: apparently normal respiratory rate
which is inappropriate for the clinical situation
– 3)RETRACTIONS:
– Suprasternal retraction-upper airway obstruction
– Intercostal Retraction – Parenchymal
– Subcostal Retraction-LOWER AIRWAY OBSTRUCTION
23. Breathing contd…..
– 4)See saw respiration it is seen in neuromuscular
weakness, but can also occur in late stage of severe
respiratory pathology
– 5)pulse oximetry measure % saturation of hb with
oxygen
–
25. 4)Disability
– Reduced O2 supply to brain affects consciousness muscle
tone and pupillary response
– Early manifestations are anxious look and irritability and
agitation followed by lethargy
26. 5)Exposure
– If indicated it is done to look for evidence of trauma,
petechae and purpura and warming
27. Categorization of severity of the
clinical condition
– Life threatening conditions
– If at any point during the assessment, a life threatening
condition is identified, appropriate interventions are
instituted, before proceeding with the rest of the
assessment.
28. Signs of life-threatening illness in a child
with respiratory distress
Airway
Breathing
Circulation
Disability
Exposure
Complete or severe airway obstruction
Apnea/bradypnea, markedly Increased work of breathing
Absence of detectable pulse, poor perfusion, hypotension, bradycardia
Unresponsiveness
Significant hypothermia or bleeding, petechae/purpura consistent with
septic shock
29. Immediate care
– The goal is to relieve hypoxemia and support respiratory functions until specific
therapy becomes effective.
– This is done by (a) Ensuring an open airway and breathing, (b) Delivering oxygen
without causing agitation, and (c) Ensuring adequacy of circulation, normal
temperature and hydration.
– Airway patency can be achieved with
a) Proper positioning (extend the neck, pull the mandible forward, to lift the
tongue),
b) Cleaning the oropharynx of any secretions (manually if necessary), and
c) Insertion of an oropharyngeal airway.
30. Ensure breathing if spontaneus normal breathing is
absent/inadequate by:
(a) Assisted ventilation by bag and mask ventilation,
(b) Endotracheal intubation as soon as adequate expertise
and equipment are available,
(c) Providing oxygen. Never delay resuscitation tor lack of
equipment or trained personnel.
31. Ventilation
– Nasal prongs are the recommended way of providing oxygen to most of the
children
– Infant 5 to 1l/min
– Child 1 to 2 litre
However there is no significant difference in oxygen administration by nasal prongs
or nasopharyngeal catheters
For older children oxygen is best given by face mask
33. Ensure circulation
– If the patient is in shock, or has signs of severe sepsis, initiate
septic shock protocol. Establish intravenous access and initiate
infusion of a saline bolus (20mg/kg).
– If venous access is not feasible, consider intrasseous infusion in
young children.
– The first dose of an appropriate antibiotic for severe infections,
including severe respiratory infection, must be administered
without delay.
34. Subsequent management
– If pneumothorax is suspected/detected, proceed with
needle thoracotomy in the second intercostal space
under water seal (using a syringe with saline), followed
by intercostal drainage.
35. Child with respiratory distress
Approach to a child with breathing difficulty
Pediatric assessment triangle
Pediatric assessment pentagone
Secure airway, start oxygen, ensure breathing, restore circulation
Is there stridor or drooling!Intubation or Tracheostomy
Yes
Is pneumothorax suspected ?Needle thoracotomy intercostal drainage
Yes
Is there fever ?First dose of antibiotic
Yes
No
No
No
Detailed clinical examination for specific cause
Pneumonia WheezingUAO
Specific investigations
Specific management
CNS MetabolicCardiac
36. Diagnostic evaluation of
respiratory distress
A- History
– Acute, recurrent or chronic and nature of progression
– Associated symptoms: cough, fever, rash, chest pain
– Preceding events : choking, foreign body inhalation
trauma/accident, and exposure of chemical or environmental
irritants.
– Family history exposure to infections, tuberculosis, atopy.
37. Contd...
B - Physical Examination
– Assess stability of the airways, and ventilatory status.
Respitatory (counted for a full minute), rhythm, depth and work of breathing
Color, level of activity and playfulness.
Chest movements, indrawing of chest wall
Stridor (suggests upper airway obstruction)
Wheezing (suggests lower airway obstruction)
Grunttng (suggests alveolar disease causing loss of functional residua) capacity)
– Tracheal position
– Segmental percussion
– Auscultation: Air entry, type of breath sounds, wheeze, rhonchi, crepitations
– Clubbing, lymphadenopathy
– Assessment of CVS and CNS C Diagnostic Work-up
38. Contd...
C – Diagnostic work - up
– Direct laryngoscopy, if upper airway obstruction is detected/suspected
– X-ray: cheat, lateral neck, and decubitus views
– Arterial blood gas analysis for hypoxemia (pa02 <60 mm Hg), hypercarbia
(paCO2 >40 mm Hg), (acidosis pH < 7.3), alkalosis (pH > 7.5, and Sa02
monitoring
– Sepsis work-up; Blood counts and culture studies
39.
40. Neurological illnesses
– Though neurological illnesses can lead to ‘breacthlessness’, it is
unlikely to be the only or chief complaint.
– Whether the neurological illness is acute (head injury, encephalitis,
meningitis), subacute or chronic (Guillian Barre syndrome, spinal
muscular atrophy) there is usually a prominent history or the
initiating/primary events which suggest the possible cause.
41. Cardiac causes
– Detection of cardiac failure, shock, or cyansosis may
suggest a cardiac cause of breathlesness and should be
managed accordingly
42. Metabolic causes
– When children manifest with kussmaul breathing a metabolic
cause should be suspected
– In such child patient would have marked tachypnoea with
minimum retraction and chest would be clear
– common causes:
– DKA
– ARF
– Severe dehydration
– Septic shock
43. Indication for urgent X-ray
– Most of the reparatory distress conditions do not require
urgent x-ray
– Its only indicated if following conditions is suspected
– Pneumothorax
– pleural effusion
– Pneumomediastinum
– Flail chest
44. Status ofABG
Arterial Blood Gas analysis: single most important lab
test for evaluation of respiratory failure.
45. Respiratory failure: Evaluation
The following parameters are important in
evaluation of respiratory failure:
PaO2
PaCO2
Alveolar-Arterial PO2 Gradient
P(A-a)O2 Gradient = PIO2 – PaCO2 / R 713 X
FiO2 - PaCO2X0.8 - PaO2
46. Laboratory investigations
Arterial BG
─ Info on oxygenation and ventilation status
─ Difficult to get in some patients
Venous BG
─ Ventilation info but not oxygenation
─ Venous – good only if obtained from free flowing site – no
tourniquet
─ PaCO2 slightly higher in VBG
Capillary – Easiest to obtain
Remember metabolic side (base deficit, [HCO3-])
47. Alveolar-Arterial O gradient
Normal 5-10 mm of Hg
A sensitive indicator gas exchange.
Useful in differentiating
extrapulmonary and pulmonary causes
of resp. failure.
48. Hypoxemia
1. Low PiO2 ~ at high altitude
2. Hypoventilation ~ Normal A-a gradient
3. Low V/Q mismatch ~ A-a gradient
4. R/L shunt ~ A-a gradient
49. Hypercapnia
Better to be defined by pH rather than pCO2 Metabolic
alkalosis can raise pCO2 without acidosis
Hypoventilation
Severe low V/Q mismatch: major mechanism of
hypercapnia in intrinsic lung disease
Can occur with many respiratory diseases, usually as
patients get tired
52. 12 yr girl with ascending weakness
Anxious on 50% oxygen
PR-120, RR-34, SpO2-99, BP-130/90,
Chest: Shallow Respiration, B/L air entry
Flaccid paralysis pH - 7.30
pCO2 - 60
pO2 - 261
A-a Gradient = 20.98
53. 12 year boy
High fever, cough and fast breathing for 5 day
PR-120, RR-42, SpO2-85 %, BP-110/68
Chest: B/L Extensive crept with bronchial
breathing, air entry
O2 by NRM (FiO2-90%)- SpO2- 98%
pH - 7.45
pCO2 - 45
pO2 - 90
A-a Gradient = 495.45
54. 12 year boy
High fever, cough and fast breathing for 5 day
PR-120, RR-42, SpO2-85 %, BP-110/68
Chest: B/L Extensive crept with bronchial
breathing, air entry
O2 by NRM (FiO2-90%)- SpO2- 98%
pH - 7.45
pCO2 - 32
pO2 - 90
A-a Gradient = 511
55. V/Q mismatch- Diagnosis
PaO2
A-a gradient is
PaCO2 may or may not be elevated
Hyperoxia Test : Response
56. 2 year boy withTOF
Fever for 2 days
P-120, RR-30, SpO2 on RA-78%,
Chest clear, CVS- Short systolic murmur at base
pH - 7.41
pCO2 - 34
pO2 - 40A-a Gradient = 556.95