Cardiorespiratory Care

Question 1

Physiology Cardiorespiratory System Children

Answer 1

Overall - easier for sputum to become stuck, harder to clear
trachea smaller in diameter
collateral ventilation channels not yet developed
less cartilage in bronchial walls - more floppy and narrow
ribs horizontal
reduced slow twitch fibres respiratory muscles - fatigue easily
higher chest wall compliance

Question 2

Normal Values Children

Answer 2

HR - 120bpm
Tachycardia - >180bpm 
Bradycardia - <100bpm 
Normal HR = 30-40bpm 
Tachypnoea - >60bpm

Question 3

Signs of Respiratory Distress

Answer 3

flaring nostrils 
intercostal muscle retractions 
distended abdomen - has seasaw effect with the abdomen 
blood pooling posteriorly 
tracheal tug and recession 
tripod splinting when older - lean forwards on UL 
expiratory grunting 
altered breath sounds

Question 4

Implications for Treatment

Answer 4

take caution with techniques that generate negative thoracic pressure (Suction, cough, vibrations)
use in conjunction with techniques that increase positive pressure

Question 5

Positioning

Answer 5

CHILDREN - air flow to the non-dependent lung
become desaturated in side lying if targeting the top lung, as air not flowing to the working lung
Best positions
- prone
- supine with head and shoulders elevated

Question 6

Manual Techniques

Answer 6

Percussions - not for premies
- mainly for children who are unconscious or can’t follow instructions due to neurological deficits
- increase tidal volumes
vibrations
- increase effectiveness of expiration
- can cause airway closure as they increase closing volume - 2-3 expirations max

Question 7

CIs/Precautions Manual Techniques

Answer 7

rib fractures
low bone density 
haemoptysis 
pneumothorax 
acute chest pain 
heart surgery

Question 8

Breathing Mechanics Children

Answer 8

ribs horizontal - mechanical disadvantage, can’t use intercostal muscles in inspiration
abdominal distension - greater pressure, ahrder to expand
accessory muscles - require control for use that children don’t have
children with coordination/control difficulties - struggle to cough and maintain airway clearance
may have compromised elastic recoil - impacts expiratory force and airway clearance

Question 9

Congenital Cardiac Abnormalities

Answer 9

very common condition
Handling - need to pick up from bottom, not from their chest wall
prone positioning not allowed post op

Question 10

What makes a good cough?

Answer 10

ability to take deep breath in 
close epiglottis 
forceful contraction of abdominals, PFM and respiratory muscles 
increased pressure against epiglottis 
forces it open 
air expelled out - cough sounds