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RCVII > PAEDS > Flashcards

PAEDS Flashcards

1
Q

2 types of NIV

A

CPAP
BiPAP

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2
Q

Benefits of BiPAP

A

Treats hypoventilation of whatever cause- Pressure to support respiratory failure- May be used to improve airway clearance- Rate to overcome lack of central drive

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3
Q

HFNC

A

Humidified High flow nasal cannula

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4
Q

what does HFNC administer

A

Humidified High flow nasal cannula
heated and humidified blend of air and oxygen higher than pts inspiratory flow
generally 6ml/min

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5
Q

signs of respiratory distress of WOB in children

A

Tachypnoea
Nasal flare
Tracheal tug
Recession
intercostal, subcostal, substernal
Mild / moderate/ severe
Grunting (adduction of laryngeal muscles to try and increase auto PEEP & FRC)

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6
Q

paradoxical breathing

A

lower ribs sucked in during inspiration as the diaphragm pull on non
compliant lungs)

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7
Q

normal peak cough flow in adults

A

> 400L/min

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8
Q

interpret peak cough flow of <270ml

A

Unable to clear secretions during LRTI

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9
Q

interpret peak cough of <160L/min

A

Unable to clear secretions on a daily basis

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10
Q

expulsive flow - normal cough mechanism

A

irritation trigger
deep inspiration - 80-90% normal capacity
0.2 s of glottis closure with simultaneous contraction to generate pressure ~ 190cm H2O
Opening of glottis
effective contraction of expiratory muscles

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11
Q

list the physiological difference of child vs adult lung

A

↑ Compliance in chest wall, ↓ compliance of lungs
↓ % of type 1 (Fatigue resistant) muscle fibres in diaphragm (Child 30% vs. adult 50-60%)
Poorly developed intercostal muscles
↑metabolic rate of 02 consumption
Preferential ventilation of upper lung when positioned in side lying
reduced diameter of airway
preferential nasal breathers
proportionally larger tonsils and tongue
floppy cartilage

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12
Q

what is implied if the child has ↑ Compliance in chest wall, ↓ compliance of lungs

A

↓ FRC and ↑ work of breathing

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13
Q

what is implied if the child has ↓ % of type 1 (Fatigue resistant) muscle fibres in diaphragm (Child 30% vs. adult 50-60%)

A

Diaphragm more prone to fatigue → less able to withstand respiratory distress

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14
Q

what is implied if the child has poorly developed intercostal muscles

A

Near solely reliant on diaphragm for respiration

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15
Q

what is implied if the child has ↑metabolic rate of 02 consumption

A

Hypoxia develops more rapidly

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16
Q

what is implied if is child has Preferential ventilation of upper lung when positioned in side lying

A

Ensure Sa02 maintenance when repositioning

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17
Q

what is implied with reduced airway diameter

A

↑ airway resistance → ↑respiratory difficulties with any inflammation of airways

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18
Q

what is implied with preference of nasal breathing

A

NG tubes etc. narrows diameter and ↑ WOB. Ensure nasal passages are cleared of secretions

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19
Q

what is implied with proportionally larger tonsils and tongue

A

increased airway obstruction

20
Q

what is implied with floppy cartilage

A

predispose to airway collapse

21
Q

Airway resistance is inversely proportional to the fourth power of the radius of the airway - Poiseuilles law
Halving the internal diameter of the trachea will increase the resistance (reduce air flow) by __

A

16

22
Q

anatomical difference in children lungs

A

Immature cilia
↓alveolar surface area (24 million vs. 300 million at 8 years)
↑ heart size in infants
More horizontal ribs and more cylindrical
Poor collateral ventilation in infancy

23
Q

implication for cilia

A

↑ accumulation of secretions, mucus plugging

24
Q

implication for reduced alveolar surface area

A

reduced space for gas exchange

25
Q

implication for increased heart size

A

less room for lung expansion

26
Q

implication for horizontal ribs and more cylindrical

A

Lack of bucket handle and pump handle movement, unable to increase lung volumes

27
Q

implication of poor collateral ventilation in infancy

A

increased risk of atelectasis of RTI

28
Q

Pores of Kohn

A

inter alveolar

29
Q

Canals of Lamber

A

brionchar-alveolar

30
Q

channels of martin

A

interbronchiolar

31
Q

benefits of sidelying positioning

A

Ventilation better in non dependent lung but still receives blood flow
Dependent lung is compromised due to compliant chest wall
Head up reduces pressure from abdominal contents so diaphragm can move more freely

32
Q

benefits of prone positioning

A

Less compression of lung tissue from heart
Helps with drainage of secretions and redistribution of oedema

33
Q

benefits of supine positioning

A

Ventilation best anteriorly, with perfusion best posteriorly
V/Q mismatch
Avoid head down tip as risk of reflux and aspiration

34
Q

contrindications of manual techniques

A

Undrained pneumothorax
Raised intracranial pressure
Rib fractures
Osteopenia/Osteoporosis
Platelets of <40
Pulmonary haemorrhage

35
Q

benefits of manual hyperinflation

A

Prevent atelectasis and recruit areas of collapsed lung
Improve lung compliance and gas exchange
Increases movement of pulmonary secretions toward central airways
Prevent airway mucus plugging

36
Q

how is manual hyperinflation performed

A

2 breaths at PIP/PEEP on ventilator, 3rd breath 10% above PIP

Followed by end inspiratory hold with quick release to increase expiratory air flow

37
Q

indications of manual assisted cough

A

Secretions causing respiratory compromise that patient is unable to effectively clear
* Reduced PCF
Considerations:
* Position dependant, requires skill
* Risk of abdominal trauma and reflux
* Need to time with cough

38
Q

contraindications of manual assisted cough

A

Rib fractures
Raised ICP
Undrained pneumothorax
Osteopenia / Osteoporosis

39
Q

how oropharyngeal suctioning meaured

A

Measure corner of mouth to ear lobe and add approx 2 cms

40
Q

how is nasopharyngeal suctioning measured

A

Measure tip of nose to ear lobe to thyroid cartilage

41
Q

benefits of beta 2 agonists

A

Bronchodilates airways
Reduces inflammation
Improve mucocillary clearance

42
Q

effects of mucolytics

A

Rehydrate secretions
- Improve mucocilliary clearance
- Stimulate cough

43
Q

benefits of pulmozyme

A

Targets and cleaves the extracellular DNA to ↓mucus viscosity and ↑ sputum clearance

44
Q

reasons for paediatric trache

A

Airway
Congenital or acquired e.g tracheomalacia

Breathing
Respiratory muscle weakness
CLD
Chest wall deformities

Circulation
Ongoing cardiac support required

Disability/Neuro
Congenital or acquired injury e.g high SCI, severe TBI
Central hypoventilation syndrome

45
Q

aims of long term ventilation

A

Maintain airway patency
Maintain adequate lung recruitment
Reverse hypoventilation
Reduced WOB
Reduce frequency of respiratory infections
Promote clinical stability
Transition to home environment
Allow neurodevelopmental progress

46
Q

GDD

A

Global developmental delay

RCVII (6 decks)

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