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Similar to The child with respiratory distress under aesthesia
The child with respiratory distress under aesthesia
- 1. The child withrespiratory distress
- 2. What is thischild’s problem?
- 3. Respiratory Distress Lung /Airway Disease • Acute Pneumonia • PTB • HIV • Stridor: – Croup (LTB) – Epiglottitis Systemic Disease • Malaria • Severe Anaemia • Severe dehydration • Heart Disease • Renal Disease
- 4. How severe isrespiratory distress – Cough or Difficult Breathing 1 Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Pneumonia Severe Pneumonia Pneumonia None of the above? No Pneumonia Y Y Y Y
- 5. How severe isrespiratory distress – Cough or Difficult Breathing 2 Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Very Severe Pneumonia Y High Risk of Death High Risk of Hypoxaemia = Need Oxygen May need fluid / feeding support Require Broad Spectrum Antibiotics
- 6. How severe isrespiratory distress – Cough or Difficult Breathing 3 Lower chest wall indrawing? Severe Pneumonia Y Some Risk of Death = Need Admission Can feed orally Require Simple Antibiotics = Penicillin, and Observe for improvement / deterioration
- 7. How severe isrespiratory distress – Cough or Difficult Breathing 4 RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Pneumonia Y Not severely ill = Outpatient care Can feed orally Require Simple Antibiotics = Co-trimoxazole (Amoxicillin), and Review in 2-3 days for improvement / deterioration
- 8. Respiratory distress –Cough or Difficult Breathing Critical Clinical Signs Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Pneumonia Severe Pneumonia Pneumonia None of the above? No Pneumonia Y Y Y Y
- 9. Cause of RespiratoryDistress 1? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide
- 10. Cause of RespiratoryDistress 2? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide Very Severe Pneumonia Difficult breathing and AVPU = P
- 11. Cause of RespiratoryDistress 3? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing AVPU = P, and +ve Blood Slide
- 12. Cause of RespiratoryDistress 4? 12 months Difficult Breathing, AVPU = P Indrawing +ve Blood Slide Severe Pallor Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing, AVPU = P, and +ve Blood Slide
- 13. Cause of RespiratoryDistress 4? 12 months Difficult Breathing, AVPU = P Indrawing +ve Blood Slide Severe Pallor Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing, AVPU = P, and +ve Blood Slide Severe Anaemia Respiratory distress plus severe pallor
- 14. Cause of RespiratoryDistress 5? 12 months Difficult Breathing, Cannot drink Indrawing Wheeze ++ -ve Blood Slide Very Severe Pneumonia Difficult breathing, cannot drink and indrawing
- 15. Cause of RespiratoryDistress 5? 12 months Difficult Breathing, Cannot drink Indrawing Wheeze ++ -ve Blood Slide Very Severe Pneumonia Difficult breathing, cannot drink and indrawing Very Severe Asthma Difficult breathing, Indrawing, Wheeze, and Cannot drink.
- 16. Causes of respiratorydistress - summary Pneumonia Malaria Anaemia Asthma Dehydration
- 17. Causes of respiratorydistress Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turgor, Acidosis Wheeze Crackles
- 18. Causes of respiratorydistress Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turogor, Acidosis Wheeze Crackles Difficulty Breathing Indrawing Tachypneoa Consciousness?
- 19. How severe isrespiratory distress – Cough or Difficulty Breathing Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Pneumonia Severe Pneumonia Pneumonia None of the above? No Pneumonia Y Y Y Y
- 20. Wheeze – howsevere is the asthma? Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Asthma Severe Asthma Mild Asthma Y Y Y
- 21. Respiratory distress &Malaria Conscious level OK Deep / acidotic breathing Indrawing / Deep acidotic breathing PLUS severe pallor or Hb <5g/dl? Severe Malaria Life threatening anaemia plus malaria Y Y
- 22. Key Respiratory Symptomsand Signs • Cough or Difficulty Breathing • Respiratory Rate • Indrawing • Grunting (infants) • Wheeze • Acidotic / Deep Breathing • Cyanosis • Ability to drink / conscious level (AVPU) • Severe pallor
- 23. Additional Respiratory Symptomsand Signs • Duration of Cough - > 3 weeks? • Recurrence of Pneumonia? • Stridor • Sunken Eyes / Skin turgor
- 24.
- 25. Summary • Key clinicalsigns define the severity of respiratory distress • There are several common causes that are hard to distinguish • Define severity and treat appropriately ALL likely problems.
Editor's Notes
- #2 1) The point of showing this video is to get people to think about the possible different causes of respiratory distress and that it is hard to be sure….we need a good clinical examination for a starting point….
- #3 1) This is a non-exhaustive list of possible causes of respiratory distress, clearly divided into respiratory tract problems and others.
- #4 As a result of this research the WHO proposes a classification of pneumonia based on key signs – this is part of the IMCI (and previously the ARI) programme. Working from the severe end downwards one can check for only a few signs in a child with cough and difficulty breathing and classify into one of four categories that provide a measure of the severity of the child’s disease. Once the severity is classified it becomes easier to decide who should be in hospital – only those with severe or very severe pneumonia. There is evidence that this classification works to identify those at greatest risk of death and thus most in need of hospital care (see pneumonia severity of disease summary).
- #5 As a result of this research the WHO proposes a classification of pneumonia based on key signs – this is part of the IMCI (and previously the ARI) programme. Working from the severe end downwards one can check for only a few signs in a child with cough and difficulty breathing and classify into one of four categories that provide a measure of the severity of the child’s disease. Once the severity is classified it becomes easier to decide who should be in hospital – only those with severe or very severe pneumonia. There is evidence that this classification works to identify those at greatest risk of death and thus most in need of hospital care (see pneumonia severity of disease summary).
- #6 As a result of this research the WHO proposes a classification of pneumonia based on key signs – this is part of the IMCI (and previously the ARI) programme. Working from the severe end downwards one can check for only a few signs in a child with cough and difficulty breathing and classify into one of four categories that provide a measure of the severity of the child’s disease. Once the severity is classified it becomes easier to decide who should be in hospital – only those with severe or very severe pneumonia. There is evidence that this classification works to identify those at greatest risk of death and thus most in need of hospital care (see pneumonia severity of disease summary).
- #7 As a result of this research the WHO proposes a classification of pneumonia based on key signs – this is part of the IMCI (and previously the ARI) programme. Working from the severe end downwards one can check for only a few signs in a child with cough and difficulty breathing and classify into one of four categories that provide a measure of the severity of the child’s disease. Once the severity is classified it becomes easier to decide who should be in hospital – only those with severe or very severe pneumonia. There is evidence that this classification works to identify those at greatest risk of death and thus most in need of hospital care (see pneumonia severity of disease summary).
- #8 As a result of this research the WHO proposes a classification of pneumonia based on key signs – this is part of the IMCI (and previously the ARI) programme. Working from the severe end downwards one can check for only a few signs in a child with cough and difficulty breathing and classify into one of four categories that provide a measure of the severity of the child’s disease. Once the severity is classified it becomes easier to decide who should be in hospital – only those with severe or very severe pneumonia. There is evidence that this classification works to identify those at greatest risk of death and thus most in need of hospital care (see pneumonia severity of disease summary).
- #16 1) This serves to re-emphasise that there are many possible causes of respiratory distress and we need to think about them all.
- #17 1) Some signs are more associated with one diagnosis than others eg. wheeze.
- #18 1) Many key signs are common to all causes of respiratory distress and are certainly not specific for pneumonia.
- #19 The point of putting this slide up again is that whatever the cause of respiratory distress we must consider how severe it is….and the same pneumonia signs are a very good basis for this.
- #20 So in a wheezing child we can classify the level of respiratory distress in the same way Note, we may not be able to confirm the diagnosis of asthma but we will probably have to treat a severely ill wheezing child as though they have asthma. For those with more experience and perhaps if you know the patient it would be reasonable to treat the wheeze / asthma first and then see if the child improves what the classification is and whether additional treatment for pneumonia is required.
- #21 If a child with malaria has deep / acidotic type breathing even if they are alert then they have severe malaria and need quinine. Their chance of dying is high. If a child with malaria and severe anaemia has indrawing or deep breathing then they need IMMEDIATE transfusion. The risk of death without treatment is very high.
- #22 1) There are not too many signs we have to look for when deciding on treatment for a child with respiratory distress but we cannot classify severity or consider the common causes without looking for all of them.
- #23 1) These signs may make us think of specific diseases, eg recurrent pneumonia and HIV