Respiratory Distress

Question 1

What are the three components of the pediatric assessment triangle?

Answer 1

appearance
breathing
circulation

Question 2

What are the 3 components of cardiopulmonary arrest in children?

Answer 2

respiratory
cardiac
circulatory volume

Question 3

What is the overall demeanor for children in respiratory distress?

Answer 3

restlessness, anxiety and combativeness suggest hypoxia. Somnolence or lethargy suggests severe hypoxia, hypercarbia or respiratory fatigue

Question 4

What is the tone of children in respiratory distress?

Answer 4

poor tone, lethargic and listlenessness

Question 5

What is the interaction of children in respiratory distress?

Answer 5

not interacting with other children and won’t play with toys

Question 6

Are children in respiratory distress consolable?

Answer 6

no

Question 7

What does the gaze of a child in respiratory distress look like?

Answer 7

unfocused, eyes rolling around

Question 8

Describe the speech/cry of children in respiratory distress

Answer 8

hoarse or muffled/ weak or absent

Question 9

What is the ominous breathing sign in a child with respiratory distress?

Answer 9

initial tachypnea followed by decrease in RR and irregular patterns of respiration

Question 10

What are some physical findings for breathing in a child with respiratory distress?

Answer 10

nasal flares
intercostal/subcostal/sternal retractions 
rocking respiration 
stridor 
diffuse wheeze 
grunting 
accessory muscle involvement 
decreased breath sounds 
tripoding

Question 11

Describe stridor

Answer 11

high pitched crowing sound, prominent in inspiration. secondary to narrowing of the larynx

Question 12

describe wheezing

Answer 12

speaking noise made by air passing through narrowed tracheobronchial airways (obstruction, bronchoconstriction, inflammation)

Question 13

describe rales

Answer 13

moist sounds heard upon auscultation resulting from air passing through narrowed bronchi (airway inflammation and mucus)

Question 14

describe grunting

Answer 14

expiratory sound heard without a stethoscope generated in an attempt to maintain airway patency.

breathing out against a partially closed golittis.

Question 15

How do we assess circulatory status in children?

Answer 15

skin exam (decreased perfusion would present as cooling of the skin peripherally. pale, mottled, cool or ashen skin are concerning)

capillary refill (less than 2 seconds)

Question 16

What is the general rule of thumb for heart rate changes in compromised patients?

Answer 16

initially we see tachycardia to compensate. but when the ability to compensate is exceeded, we see bradycardia.

Question 17

What causes a tension pneumothorax?

Answer 17

air from lung leaking into the pleural cavity

Question 18

What are the hallmarks of a tension pneumothorax? (5)

Answer 18

• severe respiratory distress
• ipsilateral chest hyperexpansion
• decreased or absent breath sounds on the side of the collapsed lung
• shift of mediastinal structures, deviation of trachea
• hyperresonance to percussion over collapsed lung

Question 19

What is a cardiac tamponade?

Answer 19

blood, serious fluid or air fill the pericardial sack with life threatening compromise of venous return and cardiac stroke volume

Question 20

What two things result from a cardiac tamponade?

Answer 20

respiratory distress and hypotension

Question 21

What is Becks triad?

Answer 21

3 signs of acute cardiac tamponade: JVD, muffled cardiac sounds, hypotension

Question 22

What is a retropharyngeal abscess?

What is a peritonsillar abscess?

Answer 22

a collection of pus behind the pharynx

a collection of pus around the tonsils

Question 23

What are the signs and symptoms of retropharyngeal and peritonsillar abscesses?

Answer 23

difficulty swallowing, local pain, swelling, hoarse voice, hot potato voice

Question 24

What is the most common cause of infectious airway obstruction in children ages 6-36?

Answer 24

croup

Question 25

most common cause of croup?

Answer 25

parainfluenza

Question 26

What breath sound do you hear with croup?

Answer 26

stridor

Question 27

What is epiglottitis caused by?

Answer 27

H influenza type B

Question 28

What is bronchiolitis caused by?

Answer 28

RSV, influenza, parainfluenza, adenovirus

Question 29

What is the epidemiology and clinical presentation of children with bronchiolitis?

Answer 29

children less than 2 years old | characterized by URI symptoms, progressive cough, wheezing/atelectasis

Question 30

What is the most common cause of pneumonia in children?

Answer 30

streptococcus pneumoniae

Question 31

What is the difference in presentation of bacterial vs viral pneumonia?

Answer 31

bacterial is more localized(lobar), high grade fever and ill appearing viral and atypical pneumonia are diffuse interstitial, with peribronchial processes on x-ray (viral and atypical can sometimes by lobar)

Question 32

What is anaphylaxis most commonly due to?

Answer 32

food or medications

Question 33

How can anaphylaxis be life threatening?

Answer 33

retropharyngeal/laryngeal edema can close the airway

Question 34

What are the three most important agents used in treatment of anaphylaxis?

Answer 34

epinephrine, oxygen and steroids

Question 35

What is the presentation of a foreign body aspiration in the trachea?

Answer 35

sudden, dramatic coughing. Stridor, drooling and choking are noted if upper airway is obstructed

Question 36

What is the presentation of a lower foreign body aspiration?

Answer 36

coughing, choking, recurrent pneumonia and chronic cough.

Question 37

What congenital or acquired CNS diseases can cause respiratory distress in kids?

Answer 37

neuromuscular (muscular dystrophy) infectious trauma medication effect