2. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Understand treatment of such condition
8. • Heart rate
• Skin color
• Mental status
E EFFECTS OF RESPIRATORY INADEQUACY
9. PEDIATRIC HEART RATES
Ages Heart rates
Newborn ≥ 160 beats/min
2-month to < 2-year old ≥ 140 beats/min
2-year old to < 5-year old ≥ 120 beats/min
≥ 5-year old ≥ 100 beats/min
BACK
12. Respiratory
failure
Respiratory Circulation
Nervous
system
Chest wall
Upper Airway Lower Airway
• Stridor
• Hoarse
• Suprasternal
retraction
• Wheezing
• Rales
• Past medical
history of
CHD
• PAH, HF,
Cyanotic
episodes
• Past medical
history of ND
• SMA,
Cerebral
palsy,
Encephalitis
…
• HSV,
accidents
13. CROUP EPIGLOTTITIS PHARYNGEAL
ABCESS
LARYNGEAL
DIPTHERIA
FOREIGN BODY
ASPIRATION
Onset Gradually
(1 – 3 days)
Suddenly
(a few hours)
Gradually Suddenly Suddenly
Overall condition Good Bad Bad Bad Good
Fever Mild Severe Severe Severe No
Throat pain No Yes Yes Yes
Unable to drink No Yes
(Saliva secretion)
Yes Yes No
Specific signs Body leans
forward, head
tilts
Pseudo-
membrane
Asp. syndrome
UPPER AIRWAY OBSTRUCTION
14. PNEUMONIA BRONCHIOLITIS ASTHMA FOREIGN BODY
ASPIRATION
Age Unknown < 3yo, most < 6 mo >6 mo, most > 18mo When being able to
touch or grap things
Past medical history
of recurrent
wheezing
< 2 times ≥ 2 times
Significant clinical
findings
Fever, Cough,
Tachypnea, Crackles
Wheezing
Rhonchi
Wheezing
Rhonchi
Wheezing
Rhonchi
Significant laboratory
findings
Opacities Air trapping
bilaterally
Air trapping
bilaterally
Air trapping
unilaterally
Response to
bronchial
vasodilation
No No Yes No
LOWER AIRWAY
18. History
• D1 – 2: 38oC, cough, runny nose, wheezing, eating
well
• D3: 38oC, increasing cough & wheezing, hard-
breathing seeing the doctor & being admitted to
the hospital.
PMH
• 3 times admitted to the hospital for wheezing which
improved with bronchodilators.
• Mother was diagnosed with asthma from chilhood
Examination
T 38oC, BP 90/60, HR 160, RR 50
• Alert but restless
• Cyanotic, SpO2 80%
• Warm extremities, obvious pulse 160 b/m
• Obvious heart rate 160 b/m
• Suprasternal retraction (+)
• Hoarse cough (+)
• Stridor at rest (+)
• Chest indrawing (+)
1 CASE TO ILLUSTRATE
3-year old boy, admitted for breathlessness on 3rd day
19. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Competently draw emergency algorithm for such condition
21. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Competently draw emergency algorithm for such condition
22. Respiratory
failure
Respiratory Circulation
Nervous
system
Chest wall
Upper Airway Lower Airway
• Stridor
• Hoarse
• Suprasternal
retraction
• Wheezing
• Brhonchi
• Past medical
history of
CHD
• PAH, HF,
Cyanotic
episodes
• Past medical
history of ND
• SMA,
Cerebral
palsy,
Encephalitis
…
• HSV,
accidents
23. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Competently draw emergency algorithm for such condition
26. • RECOGNITION OF RESPIRATORY FAILURE = EFFORT
EFFICACY
EFFECTS
• CAUSES OF RESPIRATORY FAILURE = DIFFERENTIAL DIAGNOSIS IF NEEDED
• TREATMENT OF RESPIRATORY FAILURE = AIRWAY CLEARANCE IS PRIOR
CHOICE OF OXYGEN SUPPLY DEVICES
MANAGEMENT OF SPECIFIC CAUSE(S)
TAKE HOME MESSAGES
ÁNBDSJ
NFKJDF
