Newman Flashcards
(125 cards)
1
Q
Respiratorty distress in children
A
Ok
2
Q
Most emergencies in kids
A
Are respiratory
3
Q
Untreated respiratory distress
A
Cardiac arrest, cardiopulmonary failure
So want to intervene before it gets to that point
-bag or intubate
4
Q
Cardiac arrest in kids
A
Usually due to progressive respiratory failrue->bradycardia, hypotension, cardiac arrest
5
Q
What caues cardiopulm arrest in kids
A
Respiratory failure, cardiac failure, trauma, infection blah blah
6
Q
At door what see
A
Appearance, breathing, circulation
The pediatric triangle
7
Q
Flaring, gasping, dyspnea, pale, cyanotic, mottling pale, doesn’t always mean poor circulation, can be cold)
A
Nostrils flare indication of respiratory distress
8
Q
Somnolent, lethargic, not moving, not interacting
A
Severe hypoxia, hypercarbia, Andorra respiratory fatigue
9
Q
If haven’t intervened and HR goes down
A
Dwindle
10
Q
If incosable by mom or nurse or if kid don’t want to be touched
A
Bad sign
11
Q
Take note of all the info before you
A
Examine
12
Q
Kid grunt
A
Effort to keep airway open longer
RSV season
Progressive-closing glottis to keep airway open
13
Q
Slow, irregular respiratory pattern int he setting of respiratory distress is
A
Ominous sign
14
Q
Body position in respiratory distress
A
Lean forward try to expand intrathoracici volume
15
Q
Stridor
A
Croup, foreign body, inspiratory Barky cough
Narrow larynx or trachea
16
Q
Wheezing
A
Squeaking noise by air in narrow tracheobronchial airway
17
Q
Rales
A
Crackles, air passing through narrowed bronchi
-air through fluid, pneumonia
18
Q
HR changes
A
Up with respi compromise then lose ability to compensate(hypoxia sets in) get bradycardia
Always O2 sat
19
Q
Normal O2 sat
A
95 or higher
20
Q
Hypercarbia
A
In resp distress co2 goes up, pH goes down , acidic , body hates this
21
Q
Severely upper airway obstruction
A
Foreign body-doodling cant cough
Angioedema, epiglottis
22
Q
Tension pneumothorax
A
Intervening can be lifesaving
Causes shift of mediastinal to side away from air leak, compresses the heart and good lunge
Can’t see lung markings
23
Q
Signs of tension pneumothorax
A
Heart drop, sat droppping , respiratory distress
Put needle in and swoooooosh
24
Q
Cardiac tamponade
A
Blood, serous fluid, air fill pericardial sack with life threatening compromise of venous return and cardiac stroke volume
Lupus with pericarditis, post op
Rare in kids
25
Becks triad of cardiac tamponade
Jugular venous distention, muffled cardiac sounds, hypotension (1/3 with cardiac tamponade)
26
Reropharyngeal and peritonsillar abscess
Sore throat, difficulty swallowing and oral pain, swelling
Hoarse voice
Can obstruct airway
Base of uvula shifted away from inflammation think peritonsilar absence
Retropharyngeal-of pharynx pushed up towards you
27
Croup
Acute laryngotracheobronchitis
Most common cause of infectious airway obstruction in kids 6 -36 months
Usually parainfluenza virus, or allergiv(less common)tracheitis is most often a secondary bacterial infection to croup kids
STRIDOR-CROUP
October to March
Vocal cord
28
Bronchiolitis
RSV
Wheeze
Less than 2
No treat-just supportive can wheeze forever
29
Mycoplasma viral
Can cause lobar pneumia and pleural effusions
30
Asthma
Inflammation, edema, bronchospasm, mucus
Triggers: infection, exercise, environmental irritants, stress GERD
Sudden worsening
Sudden changes can be due toalveolar disease and/atelectasis
31
Highest risk group for asthma for sudden death from asthma
Adolescence-teens , they don’t want to carrry medicine
32
Bronchioles
Asthma
33
Asthma cxr
Perihilar junkiness , bronchioles, rest of lungs kind of streaky,
34
CXR asthma attack
Lung expansion bilateral flattening of diaphragm
35
What most commonly causes anaphylaxis in kids
Food or meds
Life threatening, lips tingle, throat close,
*epinephrine !!!!!!!!!!!!!! Drug of choice
36
Foreign body resp distress
Sudden dramatic choking
37
Trachea body
Coughing, choking when FB is first ingested
Stridor, drooling choking if upper airway obstructed
38
Past carina where is foreign body
Right mainstem bronchus
Lower foreign body-cough, choking with first ingested
Delayed symptoms..recurrent pneumonia, chronic cough
39
Esophagus foreign body
Drooling swallowing problems
40
40% foreign bodies
No one knows there, no one saw it
41
Age group at risk for foreign body aspiration
1.5-3
42
Choking hazard
Button batteries if into trachea or esophagus within four hours corrode the mucosa and get tracheoesophageal fistula
43
How get foreign body out of trachea
Bronchoscopy
44
What happens when something gets in right mainstem bronchus
Ballvalve, air trapped, inspiratory and expiratory film can see!!!!!!
Put it together with ingestion and think right mainstem bronchus
45
Congenital or acquired CNS disesase
Neuromuscular delay-respiratory distress usually from chronic hypoventilation, infectious, trauma, medication, cerebral palsy
46
Reckless cell disease
Acute chest syndome-> sudden onset respiratory distress and chest pain, new infiltrates on cxr, fever
47
Sickle cell
If see kid with new infiltrate on x ray and have fever and resp distress think acute chest syndrome........ACUTE CHEST SYNDROME
Hostpital antibiotics, oxygen, and pain control
48
Asthma is ___
Reversible
49
Diagnose asthma
Reversibility either spontaneously or with bronchodilator therapy
Limitation of airflow on pulmonary function testing or positive broncho-privation challenge
-methacholine challenge
Cough at night, cough exercising-make sure bronchospasm is part of differential
50
Asthma
Tightening smooth muscle that lines airway
Obstruction/inflammation
Mucus plugs
51
Exposure to allergen with asthma
Triggers it!! Mast cells are involved-mast cells produce leukotrienes (smooth msucle constrictors)
52
Leukotriene
Smooth msucle constrictor
53
If lot of allergies
Eosinophil up
54
Asthma path in prolonged status asthmaticus
Curshmann spirals and Charcot laymen crystals
55
Airway remodel asthma
Then airway, fibrosis, hypertrophy, may contribute to irreversible
56
Atopy FAMILY HISTORY so important
Strongest predisposing factory
Exposure to inhaled allergens
- dust mites
- cockroaches
- seasonal polllen
57
Asthma and family history
YES very likely
58
Copd vs asthma with tratment
Fev1 FEV1/FVC return with therapy
NO with cops
Asthma it can
59
Copd airflow limitation
Partially reversible
60
Asthma airflow lmitation
Reversible
61
Asthma key indicators cough
Worse at night, exercising-bronchospasm
Usually early in life
62
Asthma vs copd age of presentation
Kid asthma
| Copd older
63
Obstructive spirometers
Swooping, see screen shot
Give b2 agonist improved rule
Prolonged inspiratory phase
64
Vocal cord dysfunction
Truncated inspiratory loop
Get abnormal closure of vocal cords, usually on inspiration, exercise triggers,
Treating for asthma and nothing work, flattened inspiratory flow
65
Sound like asthma look like asthma
Do spiroemtry, and get truncated inspiratory loop vocal cord dysfunction treated with behavioral techniques
66
Obstructive vs restrictive spirometry
See screen shot
67
Treat asthma
SABA sort acting beta 2 agonist
-albuterol, levabuterol
Relaxes smooth msucles, airway open,
68
Steroids for asthma
Cut down inflammation
69
What is your rescue medicine for asthma
B2 agonist
70
Long term treat asthma
Inhaled corticosteroids
Leukotriene modifiers
71
If need albuterol more than 2 x a week
ICS sometimes LABA-but not to be used alone use after try ICS or in conjunction,
72
Leukotriene modifiers
Released by mast cells
| Lukasts and leukotriene receptor antagonists
73
Signs and symptoms of child in impending respiratory failure/arrest
Breathlessness, cant talk bc breathing so hard, not crying not making noise, seem drowsy, RR>30, unable to recline, use of accessory muscles, abdomen goes up when breath out PARADOXICAL MOVEMENT
Right before cardiac arrest have baby with alt hese signs HR up at first, in resp distress then go down as tire
HR down-really close to arresting
74
Most arrest of kids
Respiratory
75
Goal of verge of cardiac arrest or failure
Stabilize respiration
76
Intermittent asthma
<2 days/week symptoms
Nighttime awakening<2x a month
Use albuterol <3 days a week (or equal)
No interference in normal activity
Normal spirometry
77
When someone goes to persistent to intermittent
When not intermittent
78
Risk asthma severity
How many times in last year have had exacerbation that required oral or iv corticosteroids
79
1 and symptoms less than 2
Intermittent
80
If hospital 2 or more times and need steroids
Persistent category
81
Ass soon as one impairment markers is hit
Persistent and need long term controller
82
Initial treatment
SABA
83
Wheeze
Can be asthma can be other
84
Educate parents on asthma
Yes please
85
If on ICS
You are persistent
86
Acute exacerbation treat
O2
SABA
Oral steroid-if asthma attack that haven’t been able to pop out of with albuterol at home
87
If choking 2 yo
Think foreign body do x ray
88
14 yo girl high achiever athlete, cant breath when run not responding to asthma treatment
Vocal cord dysfunction
89
Kid with no thromboembolism except exercise
Recommend Saba before exercise
-if use before every time still intermittent asthma
90
5 yo new diagnosis of asthma can give all prescriptions and parents hesitant about ICS
Need to educate about side effects less effects than other
91
ICS risk
Thrush, rinse mouth out with water after you use it
92
Salty skin
CF
93
CF who is it high in
Ashkan AZt jews
94
CF
AR
CFTR encodes a chloride channel in epithelial cells on mucosal surfaces
Long arm chromosome 7
Most common mutation 3 nucleotides
Exocrine gland function
95
CF resp
Thick mucous in lung, chronic infections, colonized with bacteria
96
Ethnic distribution CF
Askanazi Jew 1/24
97
Inheritance CF
AR
98
Dad and mom carrier what percentage of kids will have no disease or no carrier
25%
50% carriers
25% have it
99
What happen with bad gene
Decreased Cl secretions
| Increased reabsorption of Na and water , less water in mucus thicker
100
Does cf present same way in everyone
Poor penetrance NO
101
Env causes of CF
May effect penetrance
102
Most commmon presentation CF
Chronic and progressive lung disease
Exocrine pancreatic insuffiency
103
Why doesn’t CF present same
Modifier genes, env factors, nutrition
104
When most commonly see intestinal blockage
In nursery...muconium ileus
105
Clincial presentation baby
Lungs normal just after birth
a repeating cycle of infection and neutrophilic inflammation
-staph aureus and nontrpable HI
-pseudomonas aeruginosa is usually isolated from the respiratory sectretions
-not good
So usually meconium ileus is when suspect
New born screens-screens for sickle cell, CF, ...
106
CF
Pseudomonas
107
Presence of bacteria in secretions for so long is ___ but as get older it is _____
Aureus younger
Pseudomonas eventually
108
Lung __ inflated with CF
Hyper
Air trapping and lungs big and diaphragma flat
109
Spirometry exhalation Curve in obstructive
Scoop
110
Most common cause of death CF
Respiratory death
111
Cf x ray
Expanded lung field flattened diaphragm, hazy and junky
Junk in upper lobes more
Hyperaeration in submediastinal area
112
Clubbing with cf
Ya
113
GI
Neonatal in nursery meconium ileus-not pooping when 36 hours old
Do newborn screen
114
If no poop 36-48 hours
CF, hershprungs
115
Older more stools
Malabsorption
116
Pancreas and CF
95% insuffiency
Pancreatic enzymes are prevented from reaching gut (reduced water content of secretions, precipitation of proteins, plugging of ductules and acini_
=fat soluble vit ADEK
-malabsorption of fat-steatorhea
Carb, protein
Failrue to thrive, foul smelling poop
History of jaundice or GI tract bleeding as a result of hepatobiliary involvement
117
What supplene ta CF patient
ADEK
118
Liver
Jaundice ductules plugged
119
Diabetes
8-12% get
120
Anything with a duct
Can be effected by CF
121
Most men with CF
Azospermic secondary to agenesis of the vas deferens
122
CF what have more of
Prolapsed rectum,
| NASAL POLYPS
123
Criteria for diagnosis CF
Positive new born screening test, next step...perform confirmatory test
Plus positive cl test of sweat
-have more Cl in sweat , more cl and na stays in ductal lumen
124
Positive newborn screen and elevated sweat chloridex2
CF
125
Test for immunoreactive trypsinogen
Elevated in kids with CF
| ——-this is the screening in all states
