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Child Resp Disease
Childhood Respiratory Diseases
| Question | Answer |
|---|---|
| What is Croup (Laryngotracheobronchitis)? | an acute inflammation of the larynx, trachea, and bronchi caused by parainfluenza and influenza viruses |
| Pathophysiology of Croup | the virus invades tissues causing edema and swelling of the upper airway |
| How do you diagnose Croup? | steeple sign see on x-ray caused by sloping of the subglottic region |
| Clinical signs of croup are | ill for several days, runny nose, low grade fever, barky cough, stridor, retractions, flaring and sometimes cyanotic |
| Tx for Croup | Tx the symptoms: low flow O2, cool mist, iv hydration, steroids, racemic epi, intubate and vent if necessary |
| How can you tell if the subglottic swelling has gone down in a croup baby that has been intubated | air leak will be heard around the ETT |
| What is epiglottitis and what causes it? | acute infection of supraglottic structures caused by Hemophilus Influenza Type B bacteria |
| What occurs during epiglottitis | edema and swelling of soft tissues of the larynx and epiglottis, closes glottic opening and causes upper airway obstruction |
| What would you see on an x-ray of a child with epiglottitis? | tell tale thumb shaped epiglottic shadows |
| Clinical signs of Epiglottitis | sudden fever, severe sore throat, difficulty swallowing, drooling, muffled voice, stridor, retractions, flaring and sudden desire to sit upright |
| Tx for Epiglottitis | nonthreatening environment, ABT immediately, If intubation necessary take to OR |
| Why will the tube size be smaller for epiglottitis intubation | smaller bc of swelling |
| What is Bronchiolitis and what causes it? | viral inflammation of bronchioles, very contagious. caused by RSV (80%), adenovirus, rhinovirus, influenza |
| Pathophysiology of Bronchiolitis | inflammation produces edema causing mucus plugging, airway obstruction, atelectasis, hyperinflation, V/Q mismatch, hypoxemia and poor feeding |
| Age group and time of year Bronchiolitis tends to occur | 1 month to 2 yrs, Oct-Apr |
| How would you diagnose Bronchiolitis | Antigen detenction assays, Elisa (enzyme linked immunosorbent assay), X-ray |
| What would you see on the x-ray of a child with bronchiolitis | hyperinflation, flattened diaphragm, some patchy infiltrates |
| Clinical signs of Bronchiolitis | cough, tachypnea >60, retractions, flaring, exp wheeze, cyanosis, fever, dehydration |
| Tx for Bronchiolitis | O2 PRN, hydration, upper airway clearance, Bronchodilators (not recommended), Ribavirin |
| What is Ribavirin and how do you administer it? | aerosolized antiviral agent given with SPAG |
| Ribavirin is for use in what type of patients | high risk pt (BPD, Cardiac, young) |
| Disadvantages of Ribavirin | very expensive and teratogenic (causes birth defects) |
| Foreign body aspiration occurs most in children of what ages | 1-3 yrs old |
| What are the most commonly aspirated items and where do they tend to lodge | hot dogs, nuts, coins, pins. lodge in right mainstem |
| Diagnosing foreign body aspiration(initially and chronically) | intial-choking, violent cough, resp distress, wheezing; chronic-lingering cough, low grade fever |
| What would you see on a cxr of a pt that aspirated a foreign object? | hyperinflation if partial blockage (ball-valve obs), and re-absorption of air leading to atelectasis if complete blockage |
| How would yo initially attempt to remove the foreign body in a child up to 1 yr old? | back blows and chest thrust |
| How would you initially try to remove a foreign body aspirated by a child > 1 yrs old? | heimlich and finger sweep(only if seen) |
| After stabilizing the pt how would you attempt to remove the foreign body that the child aspirated | bronch or surgery |
| What could you do after the foregin body has been removed to tx the atelectasis | CPT |
| What are some things that cause burn or smoke inhalation | CO, sulfur dioxide, Hudrochloric acid |
| Signs and symptoms of burn/smoke inhalation | central cyanosis, singed nasal hairs, facial burns, reddened pharynx, soot deposits, crackles/wheezes |
| 4 things smoke damage causes | edema, necrosis, sloughing of necrotic epithelium, bronchospasm |
| What is Stage I of smoke inhalation injury | Respiratory distress, resembles upper airway obs |
| Stage II of smoke inhalation injury | 8-36 hours, pulmonary edema |
| Stage III of smoke inhalation injury | 2 days - 3 weeks, bacterial pneumonia |
| Tx of burns or smoke inhalation | insure patent airway, O2 PRN, vigorous CPT, correct acidosis, pain meds, steroids, bronchodilators |
| Common substances that cause poisoning | plants, iron tabs, organophosphates, hydrocarbons (gas), vitamins, acetaminophen, salicylates, theophylline, CO |
| Tx of poisoning includes | stabilize pt, limit further absorption, enhance elimination, drug antagonists (Narcan) |
| Ways to limit further absorption of poison include | NSS lavage, remove gastric contents, emesis, activated charcoal, mag citrate(causes diarrhea) |
| ways to enhance elimination of poison | force diuresis, hemodialysis, peritoneal dialysis |
| What is Sickle Cell? | a form of hemolytic anemia that affects 1 in 400 american blacks with sickle shaped erythrocytes |
| What percentage are carriers of the sickle cell trait? | 7-10% |
| Sickle cell- Acute chest syndrome is characterized by what? | increased RR, pain, cough, fever, hypoxia, bone marrow emboli and bacterial pneumonia |
| What would you see on a chest x-ray of a person with sickle cell- acute chest syndrome? | infiltrates and atelectasis |
| Tx for sickle cell crisis includes | pain relief, O2, ABT, exchange transfusion, and hydration |
| SIDS occurs in __ out of every 1000 births | 2 |
| What are the risk factors for SIDS | prone sleeping, 1-4 months of age, Winter, prematurity, BPD, male (5 per 100), Black race, low maternal age and smoking |
| Hypotheses as to what causes SIDS | sleep apnea/ obstruction ( |
| What do sleep studies monitor? | cardiorespiratory activity during sleep |
| This is a time consuming and expensive multi channel, 12 hr monitoring of EEG and ECG | Polysomnography |
| What is a neumocardiogram? | most popular overnight study that monitors transthoracic movements and heart rate |
| Disadvantage of pneumocardiogram | no environmental control |
| Monitoring is usually done for __ to __ months | 4-6 |
| Common type of monitoring is _______ type and what 3 things does it monitor? | impedence; chest movement, HR, and Sat |
| What is ALTE? | apparent life threatening event of apnea with change in color and muscle tone |
| ALTE is AKA | near miss or aborted SIDS |
| What is cystic fibrosis? | An autosomal recessive hereditary disease that affects all exocrine glands leading to excessive secretions |
| CF occurs in __of 2000 births | 1 |
| Varying mutations of CF gene on chromosome __, over 150 abnormal forms | 7 |
| CF causes abnormal function of what? | transmembrane regulator protein(chloride ion transport, secretory cells become dehydrated) |
| CF causes plugging and dysfunction of what organs | pulmonary, GI, reproductive and sweat glands |
| CF effects on pulmonary system include | excessive secretions, mucus plugging, obstruction, V/Q mismatch, hypoxemia, chronic infection, hyperinflation and bronchiectasis |
| CF effects on the GI system include | malnutrition, pancreatic insuff, small bowel obs, thick bile and cirrhosis |
| 98% of CF pts have a sweat chloride test >__mEq/L | 60 |
| What is a later sign of CF? | clubbing |
| Sputum culture of CF pt's usually have what bacteria in them? | pseudomonas |
| 5 Steps to managing CF | indivualize per pt, adequate nutrition, aggresive pulmonary care, prevention of pulmonary complications and psychosocial support of pt and family |
| Common therapies for CF include | O2, aerosol, pulmozyme, PD, CPT, ABT, high calorie diet, Vitamin/supplements, pancreatic enzymes, lung transplant, Gene therapy |
| How many children does Asthma affect? | 5-10% or 1 in 12 school age |
| What is Extrinsic asthma? | exposure to allergens |
| What is Intrinsic asthma? | associated with resp tract infections |
| 6 Clinical signs of asthma | Resp distress, increased AP diameter, Crackles, wheezing, productive cough, and possible cyanosis |
| Abg results for an asthmatic patient | depend on severity |
| An asthmatics chest xray will show what | hyperinflation, atelectasis and infiltrates |
| A CBC with diff will show an increased number of which WBC's in an asthmatic? | eosinophils |
| Treatment of asthma in children includes what 3 things? | identification and elimination of aggravating factors, pharmacologic therapy and education of pt and family |
| Tx for moderate asthma with example | anti inflammatory; Cromolyn |
| Tx for mod to severe asthma with examples | inhaled steroids; vanceril, flovent, pulmicort, theophylline |
| Drowning= dies of submersion within __ hours | 24 |
| What is near drowning? | any victim surviving > 24hrs |
| Drowning is the __ leadind COD in children >__ months old | 2nd; 9 months |
| What are the peak ages of drowning victims and where? | 4yrs and under (pools), 15-19 (lakes and rivers) |
| 90% of drownings occur in what type of water? | fresh water |
| Risk factors for drowning | inadequate supervision, exhaustion, seizure d/c, drugs/alcohol(teens) |
| What is the clinical course of injury from drowning? | hypoxia, pulmonary injury, hypothermia |
| Outcome for survival from drowning depends on what 3 factors | time in water, water temp and initial resuscitation |
| What is the limiting factor in the outcome for drowning? | CNS damage |
| Worse cases of drowning develop what 2 things | aspiration and ARDS |
| Tx for drowning | intubate, O2, treat for ARDS(PEEP), warm pt with heated gases, blankets, peritoneal irrig, neuro mgmt, icp monitor, hyperventilate, keep sedated |
| ARDS in children occurs from what types of injury to the lungs and is associated with what % mortality | direct or indirect lung injury, 60% mortality |
| 8 common causes of ARDS | trauma, sepsis, aspiration, infectious pneumonia, near drowning, O2 toxicity, burns and shock |
| Pathophysiology of ARDS | pulmonary injury, A/C membrane leakse causing edema. A change in pulmonary surfactant, alveolar collapse. Fibrotic change impairs gas xchange, acidosis, hypoxemia, increased PaCO2 |
| MGMt of ARDS | o2 prn but beware of toxicity (reabsorbtion leads to atelectasis), intubate if >60% O2, used PEEP instead of O2, Increase Vt to decrease PaCO2, bronchodilators, cpt, fluid mgmt |
| what is the goal in ARDS mgmt? | wean O2 by increaseing FRC |
| What is a last resort for ARDS mgmt | ECMO |
| What is BPD and who is at risk? | chronic lung disease in infants who require increased levels O2 and mechanical ventilation, at risk premature, RDS and barotrauma |
| 2 contributing factors to BPD | positive pressure vent and o2 toxicity |
| Pathophysiology of BPD | alveolar wall thikening/fibrosis, airway hyperactive, decreased ciliary action |
| How do you diagnose BPD | confirmed by radiologic changes, clinical signs and required Tx |
| Stage 1 of BPD: CLinical symptoms and x-ray pattern | 2-3 days, acute resp distress on o2 and vent, ground glass, air bronchs and atelectasis |
| Stage 2 of BPD:CLinical symptoms and x-ray pattern | 4-10 days, edema, PDA, increased support, infiltrates and atelectasis |
| Stage 3 of BPD:CLinical symptoms and x-ray pattern | 10-30 days, transition into chronic, o2 dependent, failed weaning, compensated ABG's, small cyst formation on cxr |
| Stage 4 of BPD: CLinical symptoms and x-ray pattern | >1 month, no improvement, rt heart failure, trach helpful, large cyst formation and hyperinflation on CXR |
| What can occur during stage 4 of BPD? | acute spells of severe cyanosis and/or bronchospasm requiring hand bagging and O2 |
| Tx for BPD | O2, mech vent, Sx, surfactant(in stage 1), bronchodilators, CPT, HFV and ECMO(if severe), sedation, fluid balance, diuretis, digoxin, steroids |
| Complications of BPD | air leaks, cor pulmonale, GERD, NEC, IVH, Neuro damage, death |
Created by:
Dabi2
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