Sudden, brief, now resolved episode in child < 1 year old, with: - cyanosis or pallor - absent or irregular breathing - change in tone - altered responsiveness

Respirology Flashcards by maya hs

Definition of apnea

Respiratory pause > 20 sec, or associated with pallor, cyanosis, bradycardia

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Differential diagnosis of apnea (ie. causes)

CNS infection - meningitis, encephalitis
Seizure
Head trauma
Intracranial bleed
ICP
Breath-holding spell
Pertussis
Botulism
Sepsis
Toxins

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Low risk features of a BRUE

age > 60 days
born > 32 weeks gestation, and cGA > 45 weeks
no CPR required
event lasted < 1 min
first event

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Definition of a BRUE

Sudden, brief, now resolved episode in child < 1 year old, with:

cyanosis or pallor
absent or irregular breathing
change in tone
altered responsiveness

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Suggested management of a low-risk BRUE

education
CPR training
may obtain pertussis swab, 12 lead ECG
may briefly monitor with Sat monitor and serial observations

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Anatomic/ physiologic differences of infant airway vs. older individuals

Obligate nasal breathers < 4 months old
Larynx is higher, softer, more elastic
Trachea has smaller diameter
Chest wall more compliant
Respiratory control system is more immature

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Laboratory criteria for respiratory failure (list 3)

PaCO2 > 50 with acidosis (pH < 7.25)
PaCO2 > 40 with severe distress
PaO2 < 60 (or O2 sat < 90%) on 40% FiO2

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List 6 life-threatening causes of stridor

epiglottitis, RPA, diphtheria, tracheitis, foreign body, anaphylaxis, neck trauma, neoplasm, caustic or thermal injury, hereditary angioedema

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List 6 congenital causes of stridor

laryngomalacia, laryngeal webs, laryngeal diverticula, vocal cord paralysis, subglottic stenosis, tracheomalacia, vascular anomalies (double aortic arch, vascular sling)

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List 4 typical viral causes of bronchiolitis

RSV, rhinovirus, parainfluenza, adenovirus, influenza, coronavirus, humanmetapneumovirus

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List causes of pneumonia

viral causes most common

bacterial (S. pneumo, S. aureus, mycoplasma, chlamydia, group A strep)

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Chronic wheezing not responsive to asthma management, consider these 4 diagnoses

CF (recurrent wheeze, FTT, chronic diarrhea –> sweat chloride test)
GERD
Recurrent aspiration
Retained airway foreign body
Mediastinal tumor

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Management of brionchiolitis

Recommended: oxygen, hydration
Equivocal: epi nebs, nasal suction, epi+dex
Not recommended: ventolin, steroids, antibiotics, antivirals, hypertonic saline, chest physio, CXR, NP swab

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Features associated with mycoplasma pneumonia

age > 5 years, insidious onset, headache, sore throat, prominent cough, diffuse rales, bilateral interstitial infiltrates

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ED management of asthma

o Inhaled beta-2 agonists (ie. Salbutamol) via MDI (preferred over neb)
o Inhaled anticholinergics (ie. Atrovent = ipratropium bromide) –> reduced hospitalizations
o PO corticosteroids (IV if vomiting, NPO)
o IV MgSO4
o Continuous Ventolin nebs
o IV Ventolin
o Heliox (contraindicated in pneumothorax – obtain CXR prior)
o Terbutaline bolus and infusions
o CPAP or BiPAP to prevent intubation
- Discharge on inhaled corticosteroids

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DDx of resp distress in cystic fibrosis

viral illness
bacteria infection
bacterial colonization and subacute exacerbation
GERD
pneumothorax
hemoptysis
allergic bronchopulmonary aspergillosis (ABPA)

Most common newborn presentation of CF

Meconium ileus

Common CF infectious organisms

staph aureus, MRSA, pseudomonas aerugiona, stenotrophomonas maltophilia, B. cepacia, A. xylosoxidas, non typable H influenza

Management of severe hemoptysis in CF

get IV access, CBC/INR/PTT/liver and renal function/gas/type and cross/sputum culture; emergency bronchoscopy to locate site of bleed; consider activation MTP if severe; IV antibiotics (most pulmonary exacerbation); placing bleeding lung dependent position

Causes of pulmonary hemorrhage

acute infection, exacerbation of pulmonary disease (CF), thoracic trauma, vasculitis (GPA, Goodpasture’s), non-lung sources (hematemesis/GI bleeding, tonsillar or nose bleed)

Diagnostic test for PE in children

CT-angiography

Which body systems are affected by sarcoidosis

lungs, lymph nodes, joints, eyes, skin, liver, spleen

What is Hamman’s sign

crunching sound obscuring heart sounds (occurs in pneumomediastinum)

Typical location of diaphragmatic hernia

Usually posterior left side (Bochdalek = back to the left)

Less common Morgagni on the right

How to perform a needle thoracostomy

2nd intercostal space, midclavicular line. Use a 14 or 16G needle with 10 mL syringe attached with some water (bubbling), insert perpendicular to chest, over the rib. Remove the needle (keep catheter in place). Prepare for a chest tube. Don’t close the catheter (keep it open to air), or pneumothorax will re-accumulate

List 4 complications of chest tube insertion

bleeding, damage to lung (pneumothorax), bronchopleural fistula, damage to visceral organs, re-expansion pulmonary edema

Management of trach obstruction

suction, assess if cannula is in place (may be false tract in recent change), apply O2. Change the trach if no response to suctioning

Describe the difference between BiPAP and CPAP and when would you use each modality?

CPAP: fixed positive pressure throughout the cycle (use in Acute pulmonary edema, Obstructive sleep apnea, Acute respiratory failure with normal lung function) BiPAP: Different levels of pressure during inspiration and expiration (use in Complex msk disease with weak respiratory muscle function, Asthma in resp failure)

List four factors that determine oxygen delivery by the orofacial delivery route

Oxygen concentration given Mixing (non-rebreather vs simple mask) Patency of nares and mouth Ability to self-ventilate

List 6 clinical findings of respiratory failure

Vital signs: tachycardia, tachypnea or bradypnea, hypoxemia General appearance: cyanosis, diaphoresis, confusion, restlessness, fatigue, shortness of breath, apnea, grunting, stridor, retractions, decreased air entry, wheezing Pulsus paradoxus > 30 mmHg

DDx (causes) of pulmonary edema - list 6

Cardiogenic and non-cardiogenic (ARDS) are 2 broad categories By etiology: - CHD associated left sided HF: hypoplastic left heart syndrome, severe AS, coarctation of the aorta, MS, HOCM - Over circulation within pulmonary vasculature: VSD, PDA - Iatrogenic: overaggressive administration of IV fluids - Neurogenic pulmonary edema: increase ICP or seizure - Decrease plasma oncotic pressure: nephrotic syndrome, protein losing enteropathy, massive burns, severe malnutrition - Breakdown alveolar-capillary barrier: ARDS, toxins - Negative pressure pulmonary edema/post obstructive pulmonary edema

List 4 central (CNS) causes of respiratory depression

1. Intoxication (ex alcohol, benzos, opioids) 2. CNS malformation (ex hydrocephalus) 3. Immaturity 4. Trauma: Intracranial/brain stem bleed 5. Mass (ex brainstem tumor, intracranial with raised ICP) 6. Infection (ex meningitis)

List 3 signs and 3 symptoms of HAPE

HAPE = high altitude pulmonary edema 3 symptoms: SOB, cough, decreased LOC 3 signs: tachypnea, tachycardia, hypoxia, chest crackles

Emergency management of total upper airway obstruction (ie. unable to phonate)

- Heimlich maneuver or back blows for infant - start CPR when unconscious - Emergency laryngoscopy, intubation, cricothyrotomy or tracheostomy

Resistance to airflow in the airway is inversely proportional to what? What is the corresponding law called?

Radius of airway lumen | Poseuille's law

What condition should be ruled out when nasal polyps are found?

Cystic fibrosis

A chest Xray shows honeycombing, atelectasis, and increased bronchial markings. What is the diagnosis?

Interstitial lung disease/ bronchiectasis

Name 2 mechanisms for acidosis in severe Asthma

- increased CO2 = respiratory acidosis | - ventolin --> lactic acidosis

Name main mechanism for decreasing O2 sats after beta agonist treatment in asthma

V:Q mismatch