Respiratory Distress in Children (Newman)

Question 1

Three components of cardiopulmonary arrest in children

Answer 1

1) respiratory (O2)
2) cardiac (pump, perfusion, BP)
3) circulatory volume (perfusion, BP)

Question 2

What is the primary cause of most pediatric arrests?

Answer 2

progressive respiratory failure or shock (asphyxial arrest)

Question 3

Progression of asphyxia

Answer 3

begins with systemic hypoxemia, hypercapnia, and acidosis. Progresses to bradycardia, hypotension and then cardiac arrest

Question 4

The pediatric assessment triangle for cardiopulmonary arrest is..

Answer 4

1) appearance
2) breathing
3) circulation

Question 5

Appearance of a child in respiratory distress that suggests hypoxia

Answer 5

restlessness, anxiety, combativeness

Question 6

appearance of a child in respiratory distress that suggests severe hypoxia, hypercarbia, and/or respiratory fatigue

Answer 6

somnolence or lethargy

Question 7

Reassuring tone of a child in respiratory distress

Answer 7

vigorous movement and good tone

Question 8

Not reassuring tone of a child in respiratory distress

Answer 8

lethargy, listlessness, poor tone

Question 9

Not reassuring interaction in a child in respiratory distress

Answer 9

not interacting with others, wont’ play with toys (not acknowledging they are there)

Question 10

Is a child distractable or consolable if they are very ill?

Answer 10

no

Question 11

Look/gaze of a child in respiratory distress (very hypoxic)

Answer 11

eyes rolling around. Unfocused gaze (decreased LOC)

Question 12

What type of speech/cry is indicative of partial airway obstruction?

Answer 12

hoarse or muffled cry

Question 13

Speech/cry of a child in severe respiratory distress

Answer 13

weak cry or no cry

Question 14

Progression of breathing in a child with severe respiratory distress

Answer 14

Initial tachypnea. Then development of slower, irregular respiratory pattern (ominous sign)

Question 15

describe stridor

Answer 15

high pitched crowing sound, most prominent with inspiration. Secondary to narrowing of larynx or trachea

Question 16

describe wheezing

Answer 16

squeaking noise made by air passing through narrowed tracheobronchial airways

• bronchoconstriction
• inflammation

Question 17

describe rales

Answer 17

moist sounds heard upon auscultation resulting from air passing through narrowed bronchi

• airway inflammation
• thick mucus

Question 18

describe grunting

Answer 18

expiratory sound heard without a stethoscope, generated in an attempt to maintain airway patency
- breathing out against a partially closed glottis

Question 19

Normal capillary refill

Answer 19

< 2 seconds

Question 20

skin findings indicative of hypoxemia or shock

Answer 20

pale, mottled, cool, or ashen skin

Question 21

heart rate changes with respiratory distress

Answer 21

• initially see tachycardia

- when ability to compensate is exceeded, see bradycardia

Question 22

When is cyanosis seen?

Answer 22

• low oxygenation of blood
• significant blood loss
• inadequate perfusion

Question 23

Hallmarks of tension pneumothorax (5)

Answer 23

1) severe respiratory distress
2) ipsilateral chest hyperexpansion
3) decreased or absent breath sounds on side of collapsed lung
4) shift of mediastinal structures (tracheal deviation)
5) hyper-resonance to percussion over the collapsed lung

Question 24

Beck’s triad (for cardiac tamponade)

Answer 24

1) JVD
2) muffled cardiac sounds
3) hypotension

Question 25

Causes of cardiac tamponade in kids

Answer 25

trauma, lupus, infection, leukemia

Question 26

Describe retropharyngeal and peritonsillar abscess

Answer 26

- typically cause sore throat, difficulty swallowing and local pain/swelling - hoarse voice (hot potato) voice is common - uvula deviation - ENT emergency

Question 27

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

Answer 27

croup (acute laryngotracheobronchitis)

Question 28

Describe croup (5)

Answer 28

1) not confined to children 2) usually caused by parainfluenza virus 3) tracheitis is often a secondary bacterial infection 4) STRIDOR on auscultation 5) steeple sign on X-ray

Question 29

What usually causes epiglottitis?

Answer 29

Haemophilus influenza B

Question 30

Clinical course epiglottitis

Answer 30

- kids SICK | - go to OR for exam and possible intubation

Question 31

What causes bronchiolitis?

Answer 31

- RSV - influenza - parainfluenza - adenovirus

Question 32

Who is bronchiolitis seen in?

Answer 32

children less than 2 y/o

Question 33

Clinical Sx bronchiolitis

Answer 33

- URI Sx - copious secretions - progressive cough - wheezing/atelectasis

Question 34

most common cause of pneumonia in kids?

Answer 34

streptococcus pneumoniae

Question 35

Bacterial pneumonia presentation

Answer 35

- lobar/more localized - generally higher fever - ill-appearance

Question 36

Viral and atypical pneumonia presentation on X-ray

Answer 36

tend to be diffuse interstitial/peribronchial

Question 37

Characteristics of asthma

Answer 37

inflammation, edema, bronchospasm, mucus

Question 38

lung sounds asthma

Answer 38

wheeze, prolonged expiratory phase

Question 39

X-ray of chest with asthma attack

Answer 39

peri-hilar thickening of bronchioles, flattening of diaphragm

Question 40

What is asked if allergy is reported?

Answer 40

what happens when exposed to allergen

Question 41

Treatment of anaphylaxis (3 things)

Answer 41

epinephrine, oxygen, steroids

Question 42

Where are foreign bodies lodged after they pass through the trachea?

Answer 42

Right mainstem bronchi

Question 43

Symptoms of foreign body in trachea

Answer 43

- sudden, dramatic coughing | - stridor, drooling, choking are often noted if upper airway is obstructed

Question 44

Symptoms of foreign body in lower respiratory tree

Answer 44

- coughing, choking when first ingested | - delayed symptoms: recurrent PNA, chronic cough

Question 45

Symptoms of esophageal foreign body

Answer 45

drooling, swallowing problems

Question 46

Notable household items that are choking hazards

Answer 46

- button batteries (erode through trachea) - coins - magnets

Question 47

Acute respiratory manifestations of sickle cell disease

Answer 47

Acute chest syndrome: - sudden onset respiratory distress and chest pain - new infiltrate on CXR - fever

Question 48

Progression of respiratory distress with congenital or acquired CNS disease

Answer 48

- with neuromuscular issues, initial respiratory compromise is most often due to chronic hypoventilation - patients will often decompensate much quicker

Question 49

What is Winter's Formula?

Answer 49

PCO2 = 1.5[HCO3] +8 +/-2

Question 50

What is winter's formula used for?

Answer 50

metabolic acidosis