Breathless Baby Flashcards
History of poor feeding
Volumes of milk (before and now) (mls/kg/day)
Timescale of decline
Why/What happens when baby stops feeding?
Sleepiness?
Parents thoughts on precipitating factor
Minumum milk requirement for a baby up to a month of age
150mls/kg/day
Young child PMH
Scans and screening
Maternal health - congenital infections, vascular episodes following antenatal bleeds, trauma, medication, teratogenic agents including high sugar
Gestation
Mode of Delivery
Weight
Post delivery complications - neonatal unit
Intial inspection of a child
- General dysmorphism
- Neuro - alert, happy, interacting, responding to voice
- colour? jaundiced, mottled
- noises - grunting, stridor, wheeze, crying
- Signs of pain?
- marks or rashes present on his face?
secretions - eyes, nasal
Increased work of breathing
What is a tracheal tug (and AKA)?
Oliver’s sign
Abnormal downward movement of the trachea during systole that can indicate a dilation or aneurysm of the aortic arch
V I N D I C A T E
Vascular Infective, Inflammation, Immune, Neoplastic Degenerative, Developmental Iatrogenic, Idiopathic Coneginital Autoimmune Trauma Endocrine, Environmental
Signs of increased work of breathing?
Nasal flaring Head bobbing, hed thrust back, leant forward Tracheal tug > RR >HR Noise - grunting, wheezing, stridor Visible chest/abdominal movement Colour changes
What is posseting?
The regurgitation of small quantities of undigested milk following each feed
What is tetralogy of fallot?
Four congenital abnormalities:
- Ventricular septal defect (VSD)
- Pulmonary Valve Stenosis
- Misplaced Aorta
- Right ventricular hypertrophy
What is paradoxical breathing?
Instead of moving out when taking a breath, the chest wall or the abdominal wall moves in. Often, the chest wall and the abdominal wall move in opposite directions with each breath.
What is recession? (sternal, intercostal, subcostal)
Recession is a clinical sign of respiratory distress which occurs as increasingly negative intrathoracic pressures cause indrawing
What is dextrocardia?
Dextrocardia is a congenital heart condition in which your heart points toward the right side of your chest instead of the left side
Where to auscultate for a PDA?
Medium pitched, high-grade continuous murmur heard best at the pulmonic position, with a harsh machinelike quality that often radiates to the left clavicle
Over left scapula posteriorly
What is respiratory splinting?
Respiratory splinting is defined as reduced inspiratory effort as a result of sharp pain upon inspiration (severe pleuritic chest pain).
Causes of abnormal respiratory examination in a child
Primary respiratory disease (bronchiolitis)
Cardiac cause - compensation for poor perfusion, hypoxia and possible acidosis
Congenital abnormality (diaphragmatic hernia)
Acute blood loss
Metabolic acidosis/alkalosis
Endocrine (DKA - Kussmauls breathing)
What is 3rd space loss?
Too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space-the nonfunctional area between cells. This can cause potentially serious problems such as oedema, reduced cardiac output, and hypotension
Investigations for children with respiratory distress
FBC U and Es LFT CRP Glucose Blood Cultures Lactate Ammonia ECG
Causes of a large heart on X-ray
Large L to R shunts - VSD, PDA Transposition of great arteries (can also be nirmal size) Tricuspid Atresia Truncus Arteriosus Ebstein's Anomaly
Causes of a small heart on X-ray
Fallot’s tetralogy
TAPVD - Infradiaphragmatic(under diaphragm into IVC)
What is TAPVD?
Total Anomalous Pulmonary Venous Drainage
TAPVD is a rare form of congenital heart disease where all four pulmonary veins drain to the systemic venous circulation
