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Pedi respiratory
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- 3. Respiratory Emergencies #1cause of Pediatric hospital admissions Death during first year of life except for congenital abnormalities
- 4. Respiratory Emergencies Most pediatriccardiac arrest begins as respiratory failure or respiratory arrest
- 5. Pediatric Respiratory System Large head, small mandible, small neck Large, posteriorly- placed tongue High glottic opening Small airways Presence of tonsils, adenoids
- 6. Pediatric Respiratory System Poor accessory muscle development Less rigid thoracic cage Horizontal ribs, primarily diaphragm breathers Increased metabolic rate, increased O2 consumption
- 7. Pediatric Respiratory System Decreaserespiratory reserve + Increased O2 demand = Increased respiratory failure risk
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- 9. Respiratory Distress Tachycardia(May be bradycardia in neonate) Head bobbing, stridor, prolonged expiration Abdominal breathing Grunting--creates CPAP
- 10. Severity of Respiratory Compromise Distress Failure Arrest
- 11. General Treatments EstablishAirway Oxygen BVM ET NG tube Decompression Needle Cric
- 12. Respiratory Emergencies Croup Epiglottitis Asthma Bronchiolitis Foreign body aspiration Bronchopulmonary dysplasia
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- 14. Croup: Pathophysiology Viralinfection (parainfluenza) Affects larynx, trachea Subglottic edema; Air flow obstruction
- 15. Croup: Incidence 6months to 4 years Males > Females Fall, early winter
- 16. Croup: Signs/Symptoms “Cold”progressing to hoarseness, cough Low grade fever Night-time increase in edema with: Stridor “Seal bark” cough Respiratory distress Cyanosis Recurs on several nights
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- 18. Croup: Management MildCroup Reassurance Moist, cool air
- 19. Croup: Management SevereCroup Humidified high concentration oxygen Monitor EKG IV tko if tolerated Nebulized racemic epinephrine Anticipate need to intubate, assist ventilations
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- 24. Epiglottitis: Pathophysiology Bacterialinfection (Hemophilus influenza) Affects epiglottis, adjacent pharyngeal tissue Supraglottic edema Complete Airway Obstruction
- 25. Epiglottitis: Incidence Children> 4 years old Common in ages 4 - 7 Pedi incidence falling due to HiB vaccination Can occur in adults, particularly elderly Incidence in adults is increasing
- 26. Epiglottitis: Signs/Symptoms Rapidonset, severe distress in hours High fever Intense sore throat, difficulty swallowing Drooling Stridor Sits up, leans forward, extends neck slightly One-third present unconscious, in shock
- 28. Epiglottitis Respiratory distress+ Sore throat+Drooling= Epiglottitis
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- 31. Epiglottitis: Management Highconcentration oxygen IV tko, if possible Rapid transport Do not attempt to visualize airway
- 32. Epiglottitis Immediate Life Threat PossibleComplete Airway Obstruction
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- 35. Asthma: Pathophysiology Lowerairway hypersensitivity to: Allergies Infection Irritants Emotional stress Cold Exercise
- 36. Asthma: Pathophysiology Bronchospasm Bronchial EdemaIncreased Mucus Production
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- 38. Asthma: Pathophysiology Cast ofairway produced by asthmatic mucus plugs
- 39. Asthma: Signs/Symptoms Dyspnea Signs of respiratory distress Nasal flaring Tracheal tugging Accessory muscle use Suprasternal, intercostal, epigastric retractions
- 40. Asthma: Signs/Symptoms Coughing Expiratory wheezing Tachypnea Cyanosis
- 41. Asthma: Prolonged Attacks Increase in respiratory water loss Decreased fluid intake Dehydration
- 42. Asthma: History Howlong has patient been wheezing? How much fluid has patient had? Recent respiratory tract infection? Medications? When? How much? Allergies? Previous hospitalizations?
- 43. Asthma: Physical Exam Patient position? Drowsy or stuporous? Signs/symptoms of dehydration? Chest movement? Quality of breath sounds?
- 44. Asthma: Risk Assessment Prior ICU admissions Prior intubation >3 emergency department visits in past year >2 hospital admissions in past year >1 bronchodilator canister used in past month Use of bronchodilators > every 4 hours Chronic use of steroids Progressive symptoms in spite of aggressive Rx
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- 49. Golden Rule Pulmonaryedema Allergic reactions Pneumonia Foreign body aspiration ALL THAT WHEEZES IS NOT ASTHMA
- 50. Asthma: Management Airway Breathing Sitting position Humidified O2 by NRB mask Dry O2 dries mucus, worsens plugs Encourage coughing Consider intubation, assisted ventilation
- 51. Asthma: Management Circulation IVTKO Assess for dehydration Titrate fluid administration to severity of dehydration Monitor ECG
- 52. Asthma: Management Obtainmedication history Overdose Arrhythmias
- 53. Asthma: Management NebulizedBeta-2 agents Albuterol Terbutaline Metaproterenol Isoetharine
- 54. Asthma: Management Nebulizedanticholinergics Atropine Ipatropium
- 55. POSSIBLE BENEFIT INPATIENTS WITH VENTILATORY FAILURE Asthma: Management Subcutaneous beta agents Epinephrine 1:1000--0.1 to 0.3 mg SQ Terbutaline--0.25 mg SQ
- 56. Asthma: Management UseEXTREME caution in giving two sympathomimetics to same patient Monitor ECG
- 57. Asthma: Management Avoid Sedatives Depressrespiratory drive Antihistamines Decrease LOC, dry secretions Aspirin High incidence of allergy
- 58. Status Asthmaticus Asthma attackunresponsive to -2 adrenergic agents
- 59. Status Asthmaticus Humidifiedoxygen Rehydration Continuous nebulized beta-2 agents Atrovent Corticosteroids Aminophylline (controversial) Magnesium sulfate (controversial)
- 60. Magnesium Sulfate 25-50mg/kg over 20 minutes
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- 62. Status Asthmaticus Intubation Mechanical ventilation Large tidal volumes (18-24 ml/kg) Long expiratory times Intravenous Terbutaline Continuous infusion 3 to 6 mcg/kg/min
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- 64. Bronchiolitis: Pathophysiology Viralinfection (RSV) Respiratory Syncytial Virus Inflammatory bronchiolar edema Air trapping
- 65. Bronchiolitis: Incidence Children< 2 years old 80% of patients < 1 year old Epidemics January through May
- 66. Bronchiolitis: Signs/Symptoms Infant< 1 year old Recent upper respiratory infection exposure Gradual onset of respiratory distress Expiratory wheezing Extreme tachypnea (60 - 100+/min) Cyanosis
- 67. Asthma vs Bronchiolitis Asthma Age - > 2 years Fever - usually normal Family Hx - positive Hx of allergies - positive Response to Epi - positive Bronchiolitis Age - < 2 years Fever - positive Family Hx - negative Hx of allergies - negative Response to Epi - negative
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- 69. Bronchiolitis: Management Humidifiedoxygen by NRB mask Monitor EKG IV tko Anticipate order for bronchodilators Anticipate need to intubate, assist ventilations
- 70. Foreign Body AirwayObstruction FBAO
- 72. FBAO: High RiskGroups > 90% of deaths: children < 5 years old 65% of deaths: infants
- 73. FBAO: Signs/Symptoms Suspectin any previously well, afebrile child with sudden onset of: Respiratory distress Choking Coughing Stridor Wheezing
- 74. FBAO: Management Minimizeintervention if child conscious, maintaining own airway 100% oxygen as tolerated No blind sweeps of oral cavity Wheezing Object in small airway Avoid trying to dislodge in field
- 75. FBAO: Management Inadequateventilation Infant: 5 back blows/5 chest thrusts Child: Abdominal thrusts
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- 77. BPD: Pathophysiology Complicationof infant respiratory distress syndrome Seen in premature infants Results from prolonged exposure to high concentration O2 , mechanical ventilation
- 78. BPD: Signs/Symptoms Requiresupplemental O2 to prevent cyanosis Chronic respiratory distress Retractions Rales Wheezing Possible cor pulmonale with peripheral edema
- 79. BPD: Prognosis Medicallyfragile, decompensate quickly Prone to recurrent respiratory infections About 2/3 gradually recover
- 80. BPD: Treatment SupplementalO2 Assisted ventilations, as needed Diuretic therapy, as needed
- 81. Intubation: Tube Size Infant or Child < 2 : 4.0, 4.5, or 5 Newborn: 3 (or more for a big baby) Preemie: 2.5 or 3
- 82. Intubation: Tube Sizes Child older than 2 (16 + age in yrs) / 4 Or (age in yrs / 4) + 4
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- 88. Whooping Cough http://www.youtube.com/watch?v=wuvn- vp5InE&feature=related https://www.youtube.com/watch?v=TIV4 60AQUWk
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