163. Ped Lower Airway Obstruction Flashcards
(38 cards)
Asthma: disease of lower airway marked by: (3)
- bronchoconstriction<br></br>- mucosal edema<br></br>- pumonary secretions
Why do kids struggle with asthma - ie what physiology?
- compliant chest wall and horiz located ribs - limited thoracic to incr vol limited<br></br>2. ventil highly dependent on diaphragmatic movement<br></br>3. FRC incr with age - so yo = min ventilation large rate dependent
Hx for a wheezing child -INITIAL important
- age<br></br>-dur and severity sx<br></br>- recent med use<br></br>- hospitalizations<br></br>-IVU need or intubation<br></br>-prev severity of intubations<br></br>- hx of diff sleep/eat/speak = mod-sev<br></br>-meds
Hx for a wheezing child - triggers
URI<br></br>cig smoke<br></br>allergies<br></br>exercise
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<div>A child who is anxious, restless, or
lethargic may be \_\_\_\_</div>
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hypoxic
Asthma: supplemental oxygen
should be provided for values __% or less
92
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Asymm wheezing suggests which 3 dx?
-PTX<br></br>-FB<br></br>-pneumonia
DDX asthma: big 3 categories?
Infx (bronchiolitis, croup, pneumonia, TB, bronchiolitis obliterans)<br></br>Anatomic/congenital (GER, CF, mediastinal mass, vascular, tracheoesophageal fistula)<br></br>Acq: FB, anaphylaxis
How to differentiate bronchiolitis from asthma?
- children <2<br></br>- sx assoc with viral illness<br></br>-asthma has atopy/allergic rxns/dermatitis
How to differentiate a cardiac wheeze?
hepatomegaly<br></br>cardiac murmur
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<div>A high or apparently normal
partial pressure of carbon dioxide (Paco2 ≥\_\_ mm Hg) in a child with
hypoxia and retractions indicates impaired ventilation and impending
respiratory failure </div>
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Mild asthma exacerbation definition
alert<br></br>slight tachypnea<br></br>mininmal accessory muscle use<br></br>o2 sat >95%
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Tx mild asthma exacerbation
- q20min saba first hour<br></br>+/- CS if don’t improve give
*Numerous clinical trials and meta-analyses over the past three
decades have consistently demonstrated that albuterol delivery by
MDI-S is as effective as NEBs among children of all ages and degrees
of illness<span>2</span>. In some studies, MDI-S use was associated with a greater
reduction in wheezing and lower hospitalization rates.
Nebulized vs MDI salbutamol dosing for kids with asthma
0.15mg/kg for max of 5mg<br></br>MDI- less clear - 2-8 puffs depending on weight
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How many mins of clinical improvement do kids need after SABA tx to be d/c home?
60
Children tx in dexamethasone in ED should receive what?
24 and 48h dosing
Moderate asthma exacerbation defn
alert tachpnea<br></br>wheezing throughout expiration<br></br>I:E 1:2<br></br>sign accessory m use<br></br>o2 sat 92-95%
Why use ipratropium bromide in moderate asthma exacerbation?
anticholinergic<br></br>blocks reflex bronchoconstriction caused by stimulation of airway cholinergic receptors
SABA and ipra bromide vs SABA alone differnce?
less adm hospital<br></br>improvement asthma scores, PFT
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<div>Moderately ill children who continue with dyspnea or significant
work of breathing or poor aeration after the first hour of albuterol and
IB therapy need continued\_\_\_therapy. </div>
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albuterol
-supplemental o2 sats >92%
- cont neb albuterol and ipratropium via NRB
- consider IV dose dex/methylpred if cannot oral
- if really bad --> epi post saba/laba
