1. Central Apnea 2. Obstructive 3. Mixed Apnea

1 - Systematic Approach Flashcards by B B

4 Types of Respiratory Problems

Upper Airway Obstruction
Lower Airway Obstruction
Lung Tissue Disease
Disordered Control of Breathing

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4 Types of Circulatory Problems

Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock

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ABCDE

Airway
Breathing
Circulation
Disability
Exposure

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Signs of Maintainable Airway

Airway is obstructed but can be maintained by simple measures - head tilt-chin lift

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Signs of not Maintainable Airway

Airway obstruction that cannot be maintained without advanced interventions - intubation

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Signs of upper airway obstruction

Increased inspiratory effort with retractions
Abnormal inspiratory sounds (snoring or high pitched stridor)
Resp effort but no airway/breath sounds

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Ways to position a responsive child for optimal breathing

Allow the child to assume a position

2. Elevate HOB

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Ways to position an unresponsive child for optimal breathing

Turn child on side if you do not suspect cervical injury

Use a head tilt-chin or jaw thrust

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Foreign Body? <1 year of age

5 Back slaps and 5 Chest thrusts

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Foreign Body? >1 year

Give abdominal thrusts

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Fast Respiratory rate possibly reasons

Sepsis
Fever
Pain
Dehydration
CHD
Anemia

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What is an ominous clinical sign of impending arrest in infant or children

Bradypnea or irregular RR in acutely ill children

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Three types of apnea

Central Apnea
Obstructive
Mixed Apnea

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Central Apnea is…

No respiratory effort

Central nervous system is not send signals regularly or at all

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Obstructive Apnea is…

Inspiratory effort without airflow

Obstruction is in the way

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Mixed Apnea is…

Periods of obstructive and central apnea

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When do agonal gasps present in a child?

Very late deterioration

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Increased respiratory rate is from

conditions that increase resistance to airflow

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Examples of conditions that increase resistance to airlfow

Bronchitis
Asthma
Anything that causes stiff lungs and difficult to inflate

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3 objective signs of a child trying to compensate and increase respers

Nasal Flaring
Retractions
Head bobbing/seesaw respirations

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Retractions

inward movement of the chest wall/tissues/sternum during inspiration. Trying to move air into the lungs

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Retractions w/ stridor or an inspiratory snoring

Upper Airway Obstruction

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Retractions by expiratory wheezing

Lower Airway Obstruction

obstruction during both ins and exp

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Retractions WITH

grunting or labored respirations

Lung Tissue Disease - Grunting to keep the alveoli open

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Head Bobbing is using what muscles

neck muscles

Seesaw respirations are seen in children w/

neuromuscular disease

Tidal volume measurement

5 to 7ml/kg

Minute Ventilation Equation

RR X Tidal Volume

Stridor/Reason

High pitched - Upper Airway Obstruction

Snoring reason

Soft tissue swelling or dec LOC

Grunting/Reason

Low pitched sound during expiration Exhale against a partially closed glottis Lung Tissue Disease Pain from abd pathology

Gurgling/Reason

Bubbling sound during insp and exp | Upper airway obstruction due to secretions, vomit, blood

Wheezing/Reason

Whistling - mostly during expiration | Usually intrathoracic

Isolated inspiratory wheezing suggests

a foreign body / upper ariway/trachea

Crackles mainly during exp or insp?

Inspiratory | Fluid filled alveoli opening causing crackles

Wet crackles

Fluid filled alveoli

Dry crackles

Atelectasis or interstitial lung disease (Scaring of the lung tissue) Cause of RUBBING

Infant/child develops "Barking"

Upper Airway Obstruction

O2 saturation does not indiacte

02 delivery

Profoundly anemic?

Saturation could be 100% but 02 content in the blood and 02 delivery may be low

What to be careful with CO posioning

Falsely high 02 saturation bc it counts the carboxyhemoglobin as fully saturated hemoglobin

What is methemoglobin

When the iron in the body is in the ferrite state not the normal ferrous Cannot bind oxygen meaning - no O2 to tissues

Methemoglobin clinical signs

if methemoglobin concentrations are above 5% - the pulse ox will read approximately 85% regardless of the degree of methemoglobinemia

Some drugs that can cause methemoglobin

Nitrates, Topical anesthetics (benzoincaine), local anesthesia

Pulsus Paradoxus

Cardiac Tamponade Dec pulse strength (and BP) during inspiration More than 10mmhg decrease systolically due to the preload causing the septum wall to curve in towards the left ventricle

What is and Causes of cardiac tamponade

What is: Excessive accumulation of fluid within the pericardial sac Cancer, Kidney failure TB, pericarditis

Beck's Triad

1. Low BP 2. Increased JVD 3. Muffled heart sounds

Hypotension w/ hemorrhage is how much of a loss of circulation blood volume

20-25%

UO for infants and young children

1.5 to 2ml/kg per hour

UO for older children and adolescents

1 ml/kg per hour

Disability is evaluating

neurologic function

Standard evaulation

1. APVU (alert, responsive to voice, responsive t pain, unresponsive) 2. GCS 3. Pupil reaction 4. BS

Eye Opening GCS

(4) Spontaneous (3) Speech (2) Pain (1) No response

Verbal GCS

(5) Oriented (4) Confused (3) Inappropriate Words (2) Incomprehensible Words (1) No Response

Motor GCS

(6) Obeys Commands (5) Localizes Pain (4) Withdraws from pain (3) Abnormal Flexion (Decorticate Rigidity) (2) Abnormal Extension (Decerebrate Rigidity) (1) No Response

AVPU And GSC equivalent

Alert = 15 Verbal = 13 Painful Stimulation = 8 Unresponsive = 6

Pinpoint puppils

Narcotic Ingestion

Dilated puppils

Cocaine, ICP | Sympathetic autonomic activity

Unilaterally dilated pupils w/ AMS

Ipsilateral (same side) uncal herniation (lateral herniation of the temporal lobe)

Hypoglycemia in an infant vs child

infant: <45 child: <60

Petechiae suggests

low PLT count

Petechia and Purpura may be signs of..

Septic Shock

Secondary Assessment Consists of

1. Focused Hx 2. Focused PE 3. Ongoing Reassessment

Focused Hx mnumonic

SAMPLE

``` S/S Allergies Medications PMH Last Oral Intake Events ```

Focused PE

Brief head to toe

Infants compensate for hypercarbia through

renal retention of bicarb

Arterial Lactate means...

Metabolic acidosis - associated w/ tissue hypoxia | Anaerobic Metabolism

What is lactic acid

When there is not enough oxygen to break down glucose/glycogen and the body instead breaks down carbohydrates for energy

What lactic acid level is abnormal

Retractions WITH Stridor or Snoring

Upper Airway Obstruction

Retractions WITH Expiratory Wheezing

Lower Airway Obstruction (Asthma/Bronchitis)