Flashcards in Pediatric Pulmonology Deck (31)
What are the 3 components of the pediatric assessment triangle?
Appearance, breathing and circulation
What are the 3 components of cardiopulmonary arrest in children?
Respiratory (O2), cardiac (pump, perfusion, BP), circulatory volume (perfusion, BP); occurs when there is ineffective ventilation, circulation or both
What can cause wheezing/cough in a pediatric pt?
Foreign body, oropharyngeal dysphasia, tracheoesophageal dysphagia, GERD, cystic fibrosis, vocal cord dysfunction, bronchitis/RAD, pneumonia, alpha 1 anti-trypsin deficiency
What are asthma action plans?
Game plan for dealing with asthma exacerbations; want everyone in the green zone which means having the sx of intermittent asthma (Sx <2 days/week, night time awakenings <2 times a month, SABA use <2days/week, no interference with normal activity)
What is poorly controlled asthma?
If the pt is not in the green zone with intermittent asthma, then it is poorly controlled; also if pt is seemingly doing well but are having >2 exacerbations/year needing systemic steroids they are poorly controlled and need tx added to their regimen; any pt who has >2 exacerbations requiring steroids in the same year
What is the tx for a pt suffering an acute asthma exacerbation?*
Albuterol (+/- ipratropium), steroids, oxygen
What are the components that need to be evaluated in the appearance of pt when assessing their degree of respiratory distress?
Interaction with environment (bad sign if not aware of surroundings), consolability (bad sign if highly irritable, panicky or agitated), looking at things/gaze (bad sign if eyes rolling around, lack of focus), speech/cry (bad sign if unable to speak, weak/gasping cry)
What is a bad sign when evaluating the respiratory rate in a pt?
Hypoxia will be compensated with tachypnea as long as the body can keep up, but when fatigue sets in, RR will start to become slow and irregular
What are some signs of increased work of breathing?
Nasal flaring, intercostal, subcostal, suprasternal retractions, rocking respirations, stridor, diffuse/localized wheeze, rales, grunting, accessory muscle involvement, decreased breath sounds, tripod/leaning forward position
What should be evaluated in the circulatory status when assessing a pt's degree of respiratory distress?
Perfusion (capillary refill), cyanosis, pale/mottled/ashen skin (can be signs of hypoxemia/shock)
What is viral croup?
usually caused by parainfluenza virus; laryngeal/tracheal swelling, possible stridor; kids don't act super sick
What is the MCC of infectious airway obstruction in kids 6-36 months old?
What is the MCC of epiglottitis?
H. influenza type B (but rarely seen anymore due to vaccine); kids will be febrile, leaning forward, inability to swallow own secretions
What is bronchiolitis?
Wheezing caused by a viral infection (RSV the most notorious*); kids <2 yo get the sickest, really hard on former premature infants
What pathogens are most likely to cause pneumonia in newborns?*
Group B strep, listeria, gram - rods
What pathogens are most likely to cause pneumonia in infants/children?*
What pathogens are most likely to cause pneumonia in adolescents?*
What are the sx of pneumonia in children?
fever, tachypnea, cough, wheeze/rales
What is the tx for anaphylaxis?*
Epinephrine, oxygen, steroids
What are the sx of anaphylaxis?
retropharyngeal/laryngeal edema, facial edema and urticarial, bronchospasm
How does aspiration pneumonia usually present?
Respiratory distress following a choking/gagging/coughing episode
What is the inheritance pattern for cystic fibrosis?*
autosomal recessive; if both parents are carriers there is a 1/4 chance of a child having the dz
What are the signs and sx seen with cystic fibrosis?
chronic respiratory sx/infections (sinusitis, bronchitis, pneumonia, bronchiectasis), pancreatic enzyme insufficiency and resulting trouble with nutrition/growth, malabsorption, clubbing of the fingers, sterility in males (congenital absence of the vas deferens), *meconium ileus
Cystic fibrosis is the MC in which population?*
Ashkenazi jews (carrier frequency 1/24)
What are the common pathogens causing respiratory infections in those with cystic fibrosis?
Staph aureus and H influenza in early childhood; pseudomonas by the 2nd-3rd decade
Why do pts with cystic fibrosis require fat soluble vitamins?*
Because they have trouble absorbing fats due to a pancreatic enzyme deficiency and therefore fat soluble vitamins as well
What is the importance for universal newborn screening?
The earlier metabolic, hematologic, endocrine, and genetic abnormalities are IDed the earlier they can be treated and the better the outcome will be
What do positive newborn screening tests require?*
What is the prognosis for pts with cystic fibrosis?
Median age of survival is approx 40 yo; 80% of pts should reach adulthood
What is the MCC of death in cystic fibrosis pts?*
respiratory failure/cor pulmonale