Respiratory Upper and Lower

Question 1

Main causes of death in children worldwide

Answer 1

Question 2

Main causes of respiratory and circulatory failure leading to cardiac arrest in kids?

Answer 2

Question 3

What are the three E’s of assessing a child breathing

Answer 3

Effort of breathing
-Looking for intercostal, subcostal and suprasternal recession
-Looking for accessory muscle use
-Determining the rate of breathing
-Listening for inspiratory and expiratory noises such as wheezing and stridor
-Fatigue
-Cerebral depression
-Neuromuscular disease

Efficacy of breathing
-Observing chest expansion
-Listening for air entry
-Performing pulse oximetry

Effects of respiratory inadequacy on other organ systems that may be present
- Heart rate. Initially hypoxia will cause a tachycardia however if it is severe and prolonged the heart rate will fall: this is a pre-terminal event.
- Skin colour. Hypoxia will cause vasoconstriction and skin pallor. Cyanosis is a late sign.
- Mental status. Initially hypoxia will cause agitation and distress. As it progresses the child will become more drowsy and finally unconscious. Hypercarbia will cause drowsiness as well.

Question 4

Normal heart rates in kids

Answer 4

Question 5

Normal blood pressures in kids

Answer 5

Question 6

rapid assessment of conscious level in kids?

Answer 6

AVPU

A Alert

V responding to Voice

P responding to Pain OR

U Unresponsive

Question 7

Type of rash?

Answer 7

Urticaria - allergy

Question 8

Type of rash am i?

Answer 8

Non blanching purpuric rash Eg meningococcal sepsis

Question 9

In the rapid assessment of the seriously ill child How do you assess?

Answer 9

A+B
-Effort of breathing
-RR + rhythm
-Stridor/wheeze
-Auscultate
-Skin colour

C
-HR
-Pulse volume
-CRT
-BP
-Skin temp

D
-AVPU
-Posture
-Pupils

E
-Fever
-Rashes
- Trauma

Question 10

Why are children more susceptible to severe respiratory illness

Answer 10

1. Immunity - lack of immunity to organisms adults have acquired immunity to
2. Both upper and lower airways are narrower in children and are more easily obstructed.
3. The thoracic cage of young children is more compliant leading to recession with respiratory obstruction and less support for the maintenance of lung volume
4. There are fewer alveoli present in early childhood.
5. The respiratory muscles of young children are relatively inefficient leading to muscle fatigue and apnoea.

Lack of immunity in a small airways that have less alveoli with small muscles and a soft chest wall

Question 11

The initial resuscitation of a child with breathing difficulties always involves:

Answer 11

opening the airway,
giving oxygen and
providing ventilatory support if necessary.

Question 12

Features of acute severe asthma and Life-threatening asthma in kids

Answer 12

Question 13

First steps for management of asthma? If they don’t respond to this?

Answer 13

Assess ABC and give high flow oxygen via face mask
Administer salbutamol via spacer or via nebuliser
Administer oral prednisolone or IV hydrocortisone.

Continue inhaled salbutamol up to continuous nebulised
Consider inhaled ipratroprium
Commence intravenous therapy – this may be one or more of:
-Magnesium Sulphate
-Salbutamol
-Aminophylline

Question 14

Paeds asthma doses of
Salbutamol neb
Ipatroprium neb
Prednisolone
Hydrocortisone
Salbutamol IV
Magnesium IV
Amiophiline IV

Answer 14

Salbutamol neb - 2.5-5mg continuous if needed
Ipatroprium neb - 125-500mcg every 20mins
Prednisolone - 1mg/kg (max 40mg) for 3 days
Hydrocortisone - 4mg/kg every 6 hours (max 200mgQDS)
Salbutamol IV - 1-5mcg/kg/hr
Magnesium IV - 50mg/kg = 0.2mmol/kg = (0.1ml of 50%) over 20 mins
Amiophiline IV - 10mg/kg over 1 hour

Question 15

Signs of severe bronchiolitis

Answer 15

Question 16

Anaphylaxis management in kids 1st

Answer 16

Adrenaline 10mcg/kg (0.01 mls/kg of 1/1,000) IM

Question 17

Rule of 4s in blood gasses

Answer 17

ph 7.4
PCO2 40
HCO3 24

Question 18

How does PCO2 reflect as pH

Answer 18

Every increase of 10 in pCO2 - pH decreases by 0.1

Every decrease of 10 in pCO2 - pH increases by 0.1

Question 19

If a PCO2 is 60 what would you expect the pH to be

Answer 19

20 high = decrease in pH by 0.2

= pH of 7.2

Question 20

For every chronic increase of pCO2 of 10 what will HCO3 do? Decrease pCO2 by 10

Answer 20

Increase pCO2 by 10 - Increase HCO3 by 3-4

Decrease pCO2 by 10 - Decrease HCO3 of 2-3

Question 21

Why does bicarbonate decrease in acidosis

Answer 21

The bicarbonate is low as it has combined with hydrogen ions produced by the poor peripheral perfusion.

Question 22

In respiratory acidosis how do you get a rise in your bicarb

Answer 22

Renal retention of HC03- and the high C02 from poor ventilation

Question 23

Why do you get low K+ in vomiting

Answer 23

The low K+ is a consequence of the renal retention of H+ as compensation, and loss of potassium

[H+ ions are exchanged for K+ ions in the kidney in an attempt to correct the alkalosis.]

Question 24

Barking cough, harsh stridor and hoarsness of voice are usually preceded by fever and coryza for 1-3 days?
Usual causes?

Answer 24

Croup - laryngotracheobronchitis

parainfluenza, respiratory syncytial virus or adenovirus

Question 25

Management of mild croup? Severe? how do the doses of meds change?

Answer 25

Mild/mod Dex 0.15mg/kg Severe Dex 0.6mg/kg (max 12mg) Adrenaline nebulised - 5mls 1:1000

Question 26

Unwell child. Rx?

Answer 26

Intubation IV antibiotics

Question 27

What is Laryngomalacia? Tracheomalacia? Relevance?

Answer 27

Laryngomalacia is a congenital abnormality of the larynx, specifically the supraglottic structures, with collapse on inspiration causing stridor in infancy. Tracheomalacia refers to a similar collapse of a compliant trachea. Viral upper respiratory infections may affect children with these conditions more severely and worsen airway obstruction.

Question 28

Choking child algorithm? First thing you check?

Answer 28

*Heimlich is not recommended as may damage abdominal organs

Question 29

How are chest thrusts done in choking child ? Back blows?

Answer 29

Like compressions in BLS (but slower rate - approx 1/second) Heel of palm and strike firmly using gravity

Question 30

An 18 month old toddler presents to the emergency dept with severe stridor, increased work of breathing (RR - 40, intercostal recession) and an oxygen saturation of 89%. There is a 48 hr history of an URTI with a "croupy" cough. Correct management includes?

Answer 30

Adrenaline 5 mls of 1/1,1000 (5 mg) via nebuliser is an urgent priority in management Dexamethasone 0.6 mg/kg Minimise distress to the child, as this can worsen upper airway obstruction

Question 31

A toddler swallowed a pen top and is brought into the ED by her parents. She is gasping with a weak cough and appears cyanosed. The most correct immediate management is?

Answer 31

5 back blows then 5 chest thrusts and reassess

Question 32

Acute bronchiolitis management

Answer 32

Aim Sats 92% Glucose Monitor for apnea

Question 33

Anaphylaxis algorithm Dose of drugs? Fluids?

Answer 33

Question 34

Often easy analgesic in an infant other than nasal fentanyl

Answer 34

Oral sucrose