Breathing difficulty Flashcards
1
Q
How to distinguish between distress caused by lung disease vs cardiac disease
A
Cyanosis that is not improved when given O2 is likely to be due to congenital heart disease with right to left shunting
2
Q
Ddx for a child with breathing difficulties
A
URTI - viral Pharyngitis/tonsillitis Croup Epiglottitis Tracheitis Peri tonsillar abscess Foreign body Asthma whooping cough Bronchiolitis Pneumonia Chronic lung disease e.g. chronic lung disease of infancy, Cystic fibrosis, Bronchiectasis, aspiration pneumonia Cardiac failure
3
Q
DDX for child with cough
A
Pneumonia Asthma URTI Bronchiolitis Croup Whooping cough Inhaled FB
4
Q
DDX for child with wheeze
A
Bronchiolitis
Asthma
Heart failure
Inhaled FB
5
Q
DDX for child with Acute stridor
A
Croup
Anaphylaxis,
Inhaled FB
Epiglottitis
6
Q
DDX for child with Chronic stridor
A
Laryngomalacia
Laryngeal anomalies eg vocal cord palsy
Tracheal abnormality e.g. subglottic stenosis, vascular ring.
7
Q
Disorders included in URTI
A
Rhinitis, Tonsillitis Pharyngitis Epiglottitis Laryngitis Sinusitis
8
Q
Common pathogens infecting nasopharynx
A
Rhinovirus Parainfluenza RSV Adenovirus Corona Influenza B,C
9
Q
Common pathogens in oropharynx
A
GAS, Corynebacterium, EBV, Adenovirus
10
Q
Common pathogens in larynx and trachea
A
parainfluenza,
Staph aureus
11
Q
Common pathogens in bronchi
A
influenza
Strep pneumonia
H influenza
12
Q
Hx Q of viral URTI
A
Hx of sneezing, sore throat, cough, headache, runny or blocked nose, malaise and fever
13
Q
who get tonsillopharyngitis
A
Common 5-14yr
14
Q
Hx of pharyngitis/tonsillitis
A
Fever
absence cough
difficulty swallowing
foul breath
15
Q
Examination of pharyngitis/tonsillitis
A
Tonsillar exudate and swelling
anterior LN - cervical
16
Q
Modified censor criteria
A
1 - tonsillar exudate or erythema 1- anterior cervical adenopathy 1 - cough absent 1 - Fever present 1 if age 3-14 0 if age 15-45 -1 if >45yrs Score 4-5 treat with ABx Scor 2-3 preform rapid antigen test if + then ABx. if - then culture. Score 0-1 Symptomatic relief only
17
Q
ABx for GAS pharyngitis
A
Phenoxymethyl penicillin BD for 10 days or Roxithromycin if allergic
18
Q
Mx for pharyngitis/tonsillitis
A
ABx if indicated
Analgesics
Corticosteroids if severe pain - dexamethasone
Admit if suspected airway obstruction or systemically unwell or signs of cx.
19
Q
cause of Croup
A
RSV Parainfluenza Adenovirus Metapneumonvirus Rhino virus
20
Q
who gets croup
A
6m to 5yrs
21
Q
Hx Q for croup
A
Coryza +/- Seal like barking cough Inspiratory stridor \+/- respiratory distress \+/- fever Worse at night and on 2or3 night
22
Q
Characteristics of mild croup
A
Behaviour - normal Stridor - barking cough and stridor only when active or upset RR - normal Accessory muscle use - non or minimal O2 - none required
23
Q
Characteristics of moderate croup
A
Behaviour - some/intermittent irritability
Stridor - some stridor at rest
RR - ⇑ + tracheal tug + nasal flaring
Accessory muscle use - moderate chest wall retraction
O2- none required
24
Q
Characteristics of severe croup
A
Behaviour - Increasing irritability and or lethargy
Stridor - at rest
RR - Marked⇑or⇓ tracheal tug, nasal flaring
Accessory muscle use - Marked chest wall retraction
O2 - Hypoxia is a late sign of significant Upper airway obstruction
25
Examination for croup
behaviour
Resp - stridor, effort, rate, O2 stats,
ENT - mininal
26
Ix for croup
none
27
Mx of croup
```
Safety net
- ABCD
- Check with supervisor
- return if concerned
minimal handling
Steroid - dexamethasone once or 2 doses of prednisolone
Observe for half an hour
Fluid/ food
Discharge once stridor free at rest
Severe: Nebuliser adrenalin 1ml+3ml NS
Dexamethasone
observe for 4hr
discharge after stridor at rest and >4hr of post adrenalin.
Safety net
```
28
What causes epiglottitis
Haemophilus influenza
| Strep pneumonia,
29
Who gets it epiglottitis
Child 1-6yr
| Unimmunised or vaccine failure
30
Hx of epiglottitis
```
Acute high Fever
dysphagia
drooling
Lethargy
Hoarseness
Stridor - soft inspiratory stridor and rapidly increasing Resp effort
Cough- not prominent or absent
```
31
Examination of epiglottis
```
Acutely ill and anxious child
most are septicaemia, toxic and pale looking, Poor peripheral circulation
Quiet shallow breathing
Head forward
Triad position
extension of neck
```
32
Mx of epiglottis
Minimal handling and stay by the bed
Don’t examine, or X-ray
Resus trolley or transfer to therapy to intubate
ICU care
IV antibiotics - sepsis, IV ceftriaxone
Rifampicin prophylaxis for contacts if no contraindications if HIB.
33
```
DDX for child with
breathing difficulties
high fever
Hyperextension of neck
Dysphagia
Pooling of secretion in throat
```
Epiglottitis
| Retropharyngeal/peritonsillar abscess
34
DDX for child with breathing difficulties
Toxic appearing child
Markedly tender trachea
Bacterial tracheitis
35
DDX for infant with breathing difficulties and preexisting stridor
Congenital abnormality eg floppy larynx, haemangioma/subglottic stenosis
36
Presentation of bacterial tracheitis
```
Toxic
Tender trachea
+/- viral prodrome eg influenza
Most commonly Stapy aureus , strep or HiB
Croupy cough
Sick child
High temperature
absence of drooling
```
37
Tx of bacterial tracheitis
ICU
Maintenance of airway - many require intubation
Maint - O2 and fluid balance
IV antibiotics- flucloxacillin?
38
Cause of Quinsy (retropharyngeal/peritonsillar abscess)
Polymicrobial - staph aureus and strep pyogenes
39
Who gets it Quinsy
teenagers and young adults
40
Presentation of quinsy
```
Starts as tonsillitis followed by difficulties swallowing with truisms (spasm of jaw = lock jaw)
High fever
Dysphagia
Odynophagia
Stridor
typical signs of respiratory distress
```
41
Examination of quinsy
Pooling of secretion treat
Difficulty moving or unwilling to move their neck
Hyperextension of neck - usually unilateral
42
Tx of quinsy
Admit to hospital
ABx - procaine penicillin IM or clindamycin
Surgery - aspiration or drainage
43
Hx of Foreign body in airways
```
Complete obstruction
- coughing, shaking, +/-Vomiting
- LOC and Cardiorespiratory arrest.
Partial obstruction
- Persistent wheeze, cough, fever or dyspnoea
- Recurrent or persistent pneumonia
- Unilateral wheeze
```
44
Examination of foreign body in airways
```
ABCD
Partial
- asymmetrical chest movement
- tracheal deviation
- Chest signs - wheeze or decrease breath sounds
May be normal
```
45
Mx of foreign body in airway
Complete
- ABCD - remove if you can see it
- send for help
- Prone with head down
- 5 blows to back with open hand to inter scapular area
- turn child face up
- 5 chest thrust (chest compression technique)
- Check mouth - remove if possible
- if not relieve repeat
- still not fixed try Positive pressure ventilation or surgical airway
Partial
- leave in comfortable position and arrange surgery for urgent removal (bronchoscopy)
46
Features of mild asthma
Normal mental state
Subtle or no ↑ WoB, accessory muscle use or recession
Able to talk normally
47
Features of moderate asthma
Normal mental state
Some ↑WoB with accessory muscle use/recession
Tachycardia
some limitation to talk
48
Features of severe of asthma
Agitated/distressed
Moderate/marked ↑WoB with accessory muscle use/recession
Tachycardia
Marked limitation of ability to talk
49
Features of Critical Asthma
```
Confused/drowsy
Maximal WoB
Exhaustion
Marked tachycardia
Unable to talk
Silent chest
```
50
Features of Status Asthmaticus
Severe hypoxia, hypercapnia and acidosis
| done to hyperinflation and blocks airways due to excess mucous.
51
Ix for Asthma
Acute - none
Adult - PEFR, Pulse oximetry,
Blood gases (low O2, Low CO2, alkalosis. In severe it can go normal CO2)
CXR (exclude pneumothorax)
Chronic and older then 6 yr
FEV/FVC of less than 70% which does improve with inhaled bronchodilators by more than 15%
52
Mx of mild Asthma
Salbutamol by MDI/Spacer - give once and review after 20mins,
Good response - discharge on B2-agonist an needed
Poor response - treat as moderate
Oral prednisolone for acute episodes which do not respond to bronchodilator alone - 2mg/kg (max 60mg) initally, only continuing with 1mg/kg daily for1-2 days if regular salbutamol is needed.
53
Mx of moderate Asthma
O2 if sats are less then 92%
less then 6yr - 6 puffs every 20min for 1 hour.
More then 6 yrs - 12 puff
RV 10-20 min after 3rd dose to decide on timing of next dose.
Oral prednisolone - 2mg/kg (max of 60) initially, then continuing with 1mg/kg daily for 1-2 days if salbutamol is ongoing.
54
Mx of severe Asthma
```
O2 if less than 92%
Salbutamol 1 dose every 20mins for 1 HR
Ipratropium 4 puff if under 6, 8 puffs if over 6yr. Every 20min for 1hr
Aminophylline 10mg/kg if deteriorating
MgSO4 IV
Oral prednisolone
Involve senior staff
Arrange admission after initial assessment
```
55
Mx of Critical Asthma
*Involve senior staff
*O2
*Continuous nebuliser salbutamol - 2x5mg/2.5L nebules
*Nebuliser ipratropium 250mcg 3 times in 1st hour only (20minutely
*Methylprednisolone 1mg/kg IV 6 hrly
*Aminophylline as above
*MgSO4 - as above
*May consider IV Salbutamol
Beware of salbutamol toxicity = tachycardia, tachypnoea, metabolic acidosis. High lactate, might required stopping or reduces therapy if it occurs
Aminophylline, magnesium and salbutamol must be given via separate IV line
ICU for respiratory support
56
When to discharge pt after asthma attack
* Assess patient for clinical improvement 1hr following initial therapy and discharge if clinical well. if necessary reassess in 30 mins
* Adequate oxygenation - O@ sat less then 92% should not preclude discharge if patient is clinically well and has responded well to treatment.
* Adequate oral intake
* Adequate parental education and ability to administer salbutamol via spacer
* given an action plan
* observe correct inhaler use
* outpatient RV with GP within 48 hrs
57
Step wise approach to Asthma medication outside of acute attack
SABA
+ ICS
+LABA
+Higher doses and referral
58
Mx of infrequent episodic asthma
59
Mx of frequent episodic asthma
Episodes every 2-4 wk
Tx SABA then attack
Use low dose ICS
60
Mx of persistent asthma
> 3 episodes/wk with cough at night/morning
Tx SABA + LABA + ICS
May need Oral steroids or leukotriene inhibitors
61
Cause of Whooping cough
Bordetella pertussis
62
Presentation of whooping cough
Classic - cough and coryza for one week (catarrhal phase) followed by more pronounced cough in spells or paroxysms (paroxysmal phase)
Other - vomiting due to cough, apnoea, cyanosis, sick contact
Immunisation
Sever pneumonia/encephalpathy
63
Examination finding in whooping cough
Often no signs, appears well between coughs
| Fever is uncommon
64
Ix whooping cough
Not needed as clinical diagnosis
Lymphocytotis
Per nasal swab PCR
Serology IgA- 2 wk after onset
65
Mx of whooping cough
Admit if 21 days or 14 days from last exposure if unimmunised
Prophylaxis - same as treatment.
Notify
66
Cx of whooping cough
Pneumonia, cyanosis, apnoea or encephalopathy
67
Cause of bronchiolitis
```
Viral
RSV - most common
Metapneumovirus
adenovirus
influenza
parainfluenza
```
68
Who gets it bronchiolitis
less then 2 years old and higher in winter
69
Risk factors for bronchiolitis
```
You're infant especially less than 6weeks
Ex-prem
CHD
Chronic Respiratory illness
Down’s syndrome
Neurological problems
Pulmonary hypertension
Immunological condition
```
70
Hx Q for bronchiolitis
```
Age - less then2 years
+/- hx of contact with URTI
Starts with Coryza/URTI
then Cough
then Chesty - Wheezy/crackles
then Respiratory distress
+/- Decrease feeding - ask about the feeding and urine output hydration
+/- apnoea in infants, changes in colour
Determine if fish factors for severe illness
Duration of illness
FH atopy, eczema, asthma (+exposure to smoking)
Full paed hx
Sick contacts at child care/home
```
71
what to examine for in bronchiolitis
General inspection - colour, apnoea, behaviour, alertness, irritability, increase work of breathing, sough, where
vital obs including oxygen saturation - +/-fever increase HR, RR, BP, CRT peripheral and central, Wt
+/- Coryza
Increased work of breathing (or tiredness)
+/- signs of dehydration
Apnoea
widespread Wheezes and fine crackles
over expansion of chest
72
Features of mild bronchiolitis
```
Behaviour - N
RR - N
Accessory muscle use- Nill or minimal
Feeding - N
O2 - none >95%
Apnoea episodes - none
```
73
Features of moderate bronchiolitis
Behaviour - some/intermittent irritability
RR - ↑RR +Tracheal tug +nasal flaring
Accessory muscle use - Moderate chest wall retraction
Feeding - Difficulty or reduced
O2 - Mild hypoxemia corrected by O2 90-93%
Apnoea episodes - may have brief.
74
Features of severe bronchiolitis
Behaviour - ↑irritability and or lethargy, fatigue
RR - Marked ↑or↓RR +tracheal tug + nasal flaring
Accessory muscle use - Marked chest wall retraction
Feeding - reluctant or unable to feed
O2 - hypoxemia, may not be corrected by O2 (
75
Ix for bronchiolitis
```
Not needed
NPA
CXR - hyperinflation, peribronchial thickening and patchy consolidation and collapse
BG
U&E - if IV fluids required
```
76
Mx of bronchiolitis
Oxygenation
fluid intake
minimal handling
Comfort oral feeds
77
Mx of mild bronchiolitis
Outpatients
Advice parent to return if any concerns or worsening
Fact sheets
Education on expected course of illness - self limiting, worse by 3-4-5 night, resolve by day 10. cough may last 4 wks.
Smaller more frequent feeds
RV with GP in 24hr or sooner
78
Mx of moderate bronchiolitis
Admit to paediatric
isolation
O2 vis nasal prongs - aim for 92-93% sats
Continue fluid either oral/NGtube/ IV (2/3 maintenance to prevent SIADH)
Paracetamol
1-2hourly observations
79
Mx of severe bronchiolitis
```
same as moderate plus
Cardiorespiratory monitoring
close nursing supervision
O2 and fluids
ICU and CPAP or ventilation
```
80
Common causes of Pneumonia
```
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Viral - most common in children
- RSV, influenza
Newborns - GBS, E.Coli, Listeria
```
81
Prevention of pneumonia
```
Pneumococcal conjugate (13vPCV)or (23vPPV) high risk. at 2, 4, 6 months (12-18 months ATSI)
Pneumococcal polysaccharide (23vPPv) for medically at risk and ATSI). 4,15, 50,65+yrs
Haemophilus influenzae type B. 2, 4, 6, 12months
Yearly influenza vaccine
```
82
Red flags of pneumonia in children
```
Signs of sepsis
Lethargic and unwell
Temp >38.5
go off their food
Signs of respiratory distress
Noisy breathing
Cough may be absence
Tachycardia especially if higher than fever should make it
```
83
Hx of pneumonia in children
```
Children with short hx of
fever, cough, or
tachypnoea, nasal flaring, lower chest indrawing or recession, consolidation or effusion, or
persistent fever or
fever and upper abdominal pain.
Grunting common in infants
```
84
Signs of pneumonia
↑WoB, pallor, shocked, leaning forward,
Vitals - tachypnoea, tachycardia, hyperpyrexia, reduced O2
Prolonged CRT
Cyanosis
Respiratory distress
↑tactile fremitus and reduced chest expansion
dull precision, crackles, bronchial breath sounds and increase vocal resonance
85
Mx of children with pneumonia
Pneumonia in children
almost all those 70, intermittent apnoea, not feeding
older children - RR>50, Grunting, signs of dehydration
Both groups - O2 sat 24m penicillin or roxithromycin
Severe - flucloxacillin IV + cefotaxime IV +/- roxithromycin
86
Cause of Cystic fibrosis
recessive genetic disorder - CFTR gene on Chromosome 7 causes a defect in a cellular membrane chloride channel which leads to excessively thick mucus in many body systems
87
Presentation of cystic fibrosis
```
Presentation
neonatal screening
Weight filtering
Diarrhoea
Chest infection
```
ENT - Nasal polyps, Sinusitis
Recurrent chest infections
Cough, purulent sputum, pneumonia, chronic pseudomonas infection, bronchiectasis, chest deformity, eventual respiratory failure
Finger clubbing
Liver disease - Obstructive jaundice in neonatal period (rare), Biliary stasis (may need tx with ursodeoxycholic acid). Eventually liver cirrhosis
Skin - High salt losses in sweat, salty taste to skin, risk of salt-losing crisis during very hot weather.
Development- Poor growth - Require 40% extra energy intake, Poor weight gain, short statue, malabsorption.
GIT
Pancreatic insufficiency, poor fat absorption, steatorrhoea, distended abdomen, rectal prolapse, distal intestinal obstruction syndrome (can mimic acute appendicitis), Diabetes, Meconium ileum at birth (15%).
Male infertility - Congenital absence of the vas deferent.
delayed puberty
88
Q to ask on Hx of cystic fibrosis
```
Failure to thrive with ravenous appetite
Cough and wheeze
Recurrent chest infections and sinusitis
Bulky. pale, offensive smelling stools, often difficult to flush away
wt loss may indicate CF
Delay puberty
FmHx
cystic fibrosis
```
89
Examination for cystic fibrosis
GI - Wasting, short statue, Respiratory distress, submit vascular access devices
Vital
Hands - Clubbing, pallor, Warm and well perfused
Face -
Resp - Chest wall deformity, consolidation, crackles Clubbing,
Abdo - Gastrostomy tube, Hepatosplenomegaly
genital - Delayed puberty
90
Diagnosis of CF
antenatal - chorionic villus biopsy or amniocentesis
Newborn - newborn blood spot screening
Gene testing - CFTR gene
Sweat test - collected by passing a small electric current across the skin.
91
Mx of CF
```
Maintenance
- Pancreatic enzymes and Vit ABDECK
- Abx prophylaxis
- Increase calorie intake
- Chest physio
- B agonist
- Mucolytic trail - Nebuliser dornase alfa
- rhGH
- Immunisation
Tune up
- Admit - eg tobramycin
- Chest physic with saline daily
- Spirometry
- Abx - based on colonisation,
- Isolation and precaution
Acute exacerbation
- Abx - Pip-taz (Piperacillin/tazobactam)
```
92
Defined bronchiectasis
permanent and abnormal widening of the bronchi due to walls becoming inflamed, thickened and irreversibly damage following obstruction followed by infection
93
Symptoms of bronchiectasis
```
Chronic cough that worse on walking
Mild disease = yellow or green sputum only after infection
advanced disease
profuse purulent offensive sputum- green, yellow
persistent halitosis (bad breath)
recurrent febrile episodes
Malaise, wt loss or suboptimal Wt gain
Sputum production related to position
PmHx - pneumonia,
Haemoptysis
```
94
Signs of bronchiectasis
```
GI - cachexia
Vitals -fever
Hands - Clubbing (severe cases)
Face - sinusitis, cyanosis
Neck - tracheal midline
Resp
Commonly affects lower lobe but may have one or more lobes at once
I - slight reduction in chest expansion
P - normal or decrease vocal femitus
P - may be resonant or dull.
A - Late inspiratory coarse crackles +/- localised wheeze. bronchial breath sounds.
```
95
Ix for bronchiectasis
- Sputum culture = mix of normal flora - bacteria don’t cause it they just grow once it is blocked. Done to exclude TB
Streptococcus pneumoniae, pseudomonas aeruginosa, Haemophilus influenzae (commonest)
Spirometry meter
Diagnosed = CT scan to visulise larger bronchi
CXR - normal or bronchial changes
Cytology - rule out neoplasm
96
Mx of bronchiectasis
Explanation and preventative advise
Postural drainage eg lie over side of bed with head and thorax down for 10-20 minutes 3 times a day
ABx according to organism - need to eradicate infection to halt progress of disease
Amoxycillin or roxithromycin
Bronchodilators indicated if evidence of bronchospasm.
97
Complication in a infant with cystic fibrosis
Meconium ileus
Neonatal jaundice - prolonged
Hypoproteinaemia and oedema
98
Cx in a child with Cystic fibrosis
```
recurrent lower respiratory tract infection
Bronchiectasis - occasionally
Poor appetite
Rectal prolapse
Nasal polyps
Sinusitis - rarely with symptoms
```
99
Cx in an adolescence with Cystic fibrosis
```
Bronchiectasis
Diabetes mellitus
Cirrhosis and portal HTN
Distal intestinal obstruction
Pneumothorax
Haemoptysis
Allergic bronchoplumonary aspergillosis
Male infertility
Arthropathy
Psychological problems
```
100
MDT member for mx CF
```
paediatric pulmonlogist
Physiotherapist
dietician
Nurse liaison or practitioner in CF
primary care team
teacher
psychologist
```
101
What to educate a parent who smokes around their children
research children who are exposed to passive smoking are at increased risk of croup, SIDS, bronchitis, pneumonia, ear infections, learning difficulties, behavioural difficulties and childhood asthma
102
Tx for asthma that occurs infrequently or episodic
SABA
103
Tx for frequent asthma attacks that occur more then once every 6 weeks.
SABA
Inh corticosteroid
If not improving ensure complicance and then increase dose.
104
Tx for asthma who has a daily symptoms
```
SABA
Inh corticosteroid
LABA
Increase doses
Ref to respiratory specialist
```
105
Pathogenesis of Asthma
Acute phase response- Vascular leakage and smooth muscle contraction. 1-2 hrs, Histamine, tryptase, leukotrienes, Platelet activating factor, chemokine and cytokines
Late response - eosinophilic and lymphocytic infiltration of bronchial mucosa. 6hrs post and continue for 24hr. IL5, Eosinophilia, TH2 lymphocytes.
Long term structural changes
- loss of surface epithelium
- Increased basement membrane thickness
- Marked increase in smooth muscle mass
- Marked local inflammatory cell infiltrate,
- Increase vascular permeability
- Remodelling of the airways.
106
When to ask for help when treating asthmatic
exhaustion, LOC, blood gases showing respiratory alkalosis being replaced by hypoxia, hypercarbia and acidosis .
107
Common problems is management of CF
Chest infection - mucus plug increase chronic respiratory infection especially by Pseudomonas aeruginosa or Burkholderia cepacia. Lead to rapid deterioration in lung function.
Tx involve regular bronchodilators, antibiotics (oral, nubulised or intravenously which can be delivered at home via indwelling central line). Steroid to suppress lung inflammation. Nebuliser DNase enzymes can help break down mucus in the lung.
Airway clearance
Preventive physiotherapy - exercise, autogenic drainage, positive expiratory pressure, inhalation therapy and postural awareness.
prophylactic immunisation against influenza and pneumococcus is recommended
Bronchodilators, Nebuliser dornase alfa.
Malabsorption - due to pancreatic failure
ectocrine - defect in Vit A, D, E, K. tx with pancreatic enzyme capsules and high calorie diet from infancy
Diabetes melitus - 25%-> impaired glucose tolerance. tx as optimisation of blood glucose is associated with an improvement in lung function
Salt loss - needs monitoring tx with salt tablets
Liver disease - due to sluggish bile flow = biliary disease and rarely cirrhosis - tx Ursodeoxycholic acid.
Pseudo obstruction of bowel mistaken for appendicitis tx pancreatic enzymes or osmotic laxatives.
Sub fertility - Most men have no vas deferens.
108
Signs of Respiratory distress
```
Intercostal recession, subcostal retraction, sternal retraction
Tachypnoea
Cough
Noisy breathing (stridor or wheeze)
Chest pain
Poor feeding
Change in colour
Poor tone
Altered conscious level
```
109
Difference between child and adult airways
Anatomy: tongue is larger, soft tissue, short neck, higher larynx, relatively large head, narrowest portion of the airway is at the cricoid ring and smaller airway
Compliance chest wall (decreased efficiency of breathing)
Fewer alveoli in early childhood (V/Q mismatch)
Obligatory nose breathers
Diaphragm is the principal respiratory muscle, it is flatter and has muscle fibres more vulnerable to fatigue
Increased metabolic demands
Immature immune system
Increased frequency of viral illnesses
110
Investigations for a child with respiratory distress
Pulse oximetry
May be difficult in agitated patient
May be falsely decreased in very anemic patients
Imaging
Chest X Ray: Consider in patients with focal lung findings or respiratory distress of a unknown etiology
Soft tissue radiograph of lateral neck: May identify a retropharyngeal abscess or radiopaque foreign body
Labs
ABG/VBG
Chemistry: calculate anion gap
Urine toxicology and glucose if patient has altered mental status
111
DDX for respiratory distress
```
Anaphylaxis
FB
Retropharyngeal abscess
Tracheitis
Asthma
pneumonia
```
112
prevention of asthma
No smoking in pregnancy and passive exposure
Probiotics
Food allergen avoidance
House dust mite avoidance
Breast feeding/hydrolysed formula/normal cow's milk formula, omega fatty acid
