Unit 5 Peds Respiratory Care
An 18 month old child arrives in the ER with parents. Complaints are of an upper airway infection with runny nose, cloudy secretions, barky cough, low grade fever, and stridor. Breath sounds are clear bilaterally. A lateral neck x-ray shows subglottic swelling. Treatment for this child are this point is
Admit if signs of respiratory distress Keep hydrated Place in cool, humidified oxygen environment and deliver aerosolized racemic epinephrine to relieve symptoms
Which of the following is not appropriate for treatment of an acute asthma attack? A. Aerosolized mucomyst B. Subcutaneous epinephrine C. Steriods D. B2 agonists E. Theophylline
Aerosolized mucomyst
The risk of developing Reye's syndrome increases with the use of ___________ for the treatment of ___________
Aspirin Viral infections
Glasgow coma scale is used to
Assess level of coma
Which of the following is not true of childhood asthma? A. strong family history B. increased IgE levels C. patient often has eczema, urticaria, and allergic rhinitis D. asthma is due to overactive parasympathetic nervous system
Asthma is due to overactive parasympathetic nervous system
In epiglottitis the pathological agent most frequently the cause is
Bacterial
Sudden onset of symptoms with a temp above 38.4 degrees C is indicative of
Bacterial infection
Signs and symptoms of croup
Barky cough URI Muffled voice Drooling 6 months to 3 years
Treatment for head injuries
Begins at the scene with ABC's Low ICP Hyperventilate- 25-35 mmHg for Co2 Paralyze Do not suction Mannitol HOB elevated Keep pt cold
Children vital signs
Bp: 120/80 HR: 60-95
New born vital signs
Bp: 60/40 HR: 140-160
RSV is commonly caused by viral pneumonia and
Bronchiolitis
Signs and symptoms of astham
Bronchospasms Increased mucus production Mucosal edema Increased WOB Wheezing Pulsus paradoxus CXR will show hyperinflation
A 4 year old sustains an accidental blow to the head with a baseball bat and suffers a closed head injury. The initial injury is caused some subdural bleeding and skull fracture. What would cause a secondary brain injury
Cerebral swelling Hypotension Cerebral hypoxia Compression from the bleed
Treatment for aspiration
Chest xray Bronch
What population does RSV affect
Children under 2 years old Immuncompromised children Children with chronic lung disease Premies
You are assigned to deliver a treatment to a 8 year old CF patient. When you enter the room you would expect to note what signs
Clubbing Peripheral cyanosis Periorbitol cyanosis Small for age Barrel chest Very thin
ARDS
Condition in which fluid collects in the lungs/air sacs, depriving organs of oxygen Cytokines are released and causes inflammation
Astham
Condition where a persons airway becomes inflamed, narrows, and produces extra mucus. Maybe triggered by allergies
Treatment of epigottitis
Confirm with lateral neck xray Intubate in the OR IV antibiotics IV steriods Remain intubated for 3-4 days Extubate in the OR
Signs and symptoms of aspiration
Coughing Gagging Chocking SOB Drooling Stridor Muffled cough
Haziness seen on a lateral neck x-ray located subglottically and in the trachea, produced by mucosal edema is indicative of
Croup
A patient born with meconium illeus should be suspected for
Cystic fibosis
Treatment for CF
Dietary supplement Antibiotics- TOBI, gentamycin Bronchodilators Mucolytics- pulmozym Oxygen therapy Digitals for heart failure Bronchopulmonary hygiene Heart and lung transplant
Definition of drowning is
Drowning refers to all forms of submersion injuries leading to respirator impairment, including nonfatal events that previously have been described as near drowning
Treatment of ARDS
Early intervention Vent and O2 support Steriods (not for covid) Albumin APRV HFOV ECMO High PEEP Low Vt
Reye's syndrome includes
Encephalopathy Liver dysfunction Cerebral edema
Define submersion
Enter body is covered in water
Which leukocyte is increased in patient's having allergic asthmatic attack
Eosinophils
The infectious disorder found most frequently in babies and toddlers that result in swelling of the superaglottic structures is known as
Epiglottitis
Define immersion
Face and airway are immersed in water
RSV is a bacterial infection
False
When a patient is hypothermic, it is best to warm them quickly
False
A sweat chloride that is considered of clinical significance is
Greater than 60 mEq/l
What neuromuscular disorder is least common in pediatric patients
Guillaine-Barre
What circumstances is hyperventilation appropriate treatment
Head injury Hypoxic or anoxic brain injury
Signs and symptoms of epiglottitis
High fever Hoarseness Drooling No cough or muffled Ages 2-6
Treatment for croup
Hydration Oxygen Racemic epi Humidification
Near drowning victim is brought into the ER. How would you expect this patient to appear?
Hypothermia CNS injury Fluid aspiration Laryngo spasm Pulmonary edema Surfactant washout
Complications of near drowning
Hypoxic brain damage Aspiration of water along with gastric content Possible cervical spine injury Hypothermia ARDS
Medications that would be appropriate for treatment of an acute asthmatic attack requiring hospitalization
IV steroids B2 sympathomimetics Subcutaneous terbutaline IV aminophylline
A patient arrives in ER with a severe, closed head injury. The ER physician intubates the child and she taken to PICU and placed on the vent. The following ABG is obtained: ph 7.52, paco2 29, pao2 105. What should you do?
Increase ventilation. Paco2 should be in the 20-25 mmHg range
Laboratory findings with asthma
Increased eosinophils
It is considered a cold water drowning if the water is
Less than 20 degrees C
How do you treat a patient with ARDS
Low Vt High PEEP Low PIP APRV HFOV
Intrinsic asthma
May be triggered by non allergic: Smoke Cold air Infection Food Drugs
Signs and symptoms of CF
Meconium Ileus Recurrent pneumonia Nasal polyps Sinusitis Voracious appetite with failure to thrive Thick bulky stools
A patient arrives in the ER with a severe, closed head injury. The ER physician intubates and the child is taken to PICU and placed on mechanical vent. The physician asks you for advise on the oxygenation/ventilation status of the child. Your advise would be
Monitor CO2 and keep in the 25-30 mmHg range
Pathophysiological changes you would expect to fine in a 10 year old sever CF patient
Nasal polyps Thickening mucus of TB tree Bronchiectasis Emphysematous changes Right ventricular hypertrophy
Signs of cerebral edema
Nausea and vomiting Apnea and bradycardia Headache Disorientation Uneven or decreased pupilary reaction of light
Common triggering factors for ARDS in the pediatric patient include A. Status asthmaticus B. Near-drowning C. Hydrocarbon aspiration D. Head injury E. Smoke inhalation
Near-drowning Hydrocarbon aspiration Smoke inhalation
When taking care of a drowning victims, or anyone with hypothermia, the saying to remember is:
No one is dead, until they are warm and dead
When is RSV season
October to March
What infectious agents is most often associated with bronchiolitis
Parainfluenza RSV
23 year old African American males comes in with complaint of chest pain and SOB. The patient's SpO2 on RA is 86%. How do you treat this patient
Place on oxygen Antibiotics RBC transfusion Pain control Nitric
How do you treat neuromuscular disease in pediatric patients
Plasma floresis Treat symptoms
Causes of head injuries
Primary trauma- hematoma, laceration Secondary trauma- damage to the brain as a result of hypoxemia, hypotension, hypercarbia, swelling
5 year old patient with cystic fibrosis has a sputum culture done. The most likely infectious agent to appear is:
Pseudomonas Staphyloccocus Seratia H influenza
Instances where intervention is indicated based on cardiopulmonary status
RR > 60 Tachycardia/bradycardia Increased WOB Cyanosis Altered LOC Seizures Fever with petechia Trauma
Syrguis
RSV drug Used on babies at greater risk of catching RSV; prevention
Drug of choice for a patient with croup
Racemic epinephrine
Six month old child has been admitted for probable RSV. You are awaiting results from the nasal washing. The doctor asks you if you can administer, "that drug that is used for RSV that has to have a special machine". What drug does the doctor want?
Ribavirin
Treatment for RSV
Ribavirin vai spag Suction Oxygen or ventilation if respiratory failure
A patent ductus arteriosus that is shunting from left to right will result in
Right sided heart failure Pulmonary congestion Decreased cardiac output Venous admixture
In patients with Transposition of the Great Vessels, the aorta arises from the ___________ and the pulmonary artery arises from the ______________
Right ventricle Left ventricle
Name the symptoms of RSV
Runny nose Cough Fever Malaise Retractions Nasal flaring Tachypnea Wheezing Dehydration from decreased feedings
Sings and symptoms of RSV
Runny nose Cough Fever Respiratory distress Poor feeding
Signs and symptoms of ARDS
SOB Refractory hypoxemia Increased WOB V/Q mismatch Hypercapnia Decreased lung compliance
Treatment for acute astham
Sbucuataneous B2 Arosolized beta 2 Arosolized parasympatholytic Corticosteroid Hydration Xanthines (oral) Aminophyllin (iv) Decotrom
You tell the doctor you are unable to give Ribavirin, because the hospital no longer has a SPAG. The doctor asks you suggestion on how to proceed with this patient, assuming the patient is positive for RSV
Suction Treat symptoms Contact isolation Fluids
Characteristics of epiglottitis
Superaglottic swelling Bacterial infection Drooling Muffled voice or cry
Salt water drowning
Surfactant washout Hypovolemia
Fresh water drowning
Surfactant washout Pulmonary edema Hypervolemia Hypothermia
Laboratory testing for CF
Sweat test Genetic test PFT obstructive with restrictive
Epiglottitis
Swelling of the epiglottis and supraglottic tissue due to infection Can be life-threatening
Bronchiolitis
Swelling/inflammation of the bronchioles due to infection (RSV)
There is no true vaccine for RSV; however, we can administer antibodies to those who are at most risk of becoming ill with RSV. Name the two drugs we use to deliver antibodies
Synagis Respigam
A 8 year old patient admitted for status asthmaticus has show a change in his status. Previously his rr was 40-50, he now is breathing 20-25 bpm. Also, his high pitched wheezes have quieted and very few are heard with limited air movement. the patient had been very anxious and now appears much calmer even sedated. What is happening
The patient may be deteriorating, further evaluation is necessary
Causes of ARDS
Trauma Aspiration Near-drowning Smoke inhalation Sepsis
If is always a good idea to treat a drowning victim with antibiotics prophylactically
True
The amount of time a patient is hypoxic is related to the outcome of the patient
True
You should always be prepared for ARDS when taking care of a near drowning victim
True
You should assume all drowning victims are asphyxiated
True
The most common infectious agent for croup is
Viral
Croup
Viral infectious disorder that results in inflammation of the subglottic area of the larynx
When should you ventilate an asthmatic patient
When patient is in stage 3 or 4 ph low, co2 high, o2 low
Foreign body aspiration of organic material_____________ on x-ray
Will show no visible signs
Four ways drowning is classifed
Witnessed vs unwitnessed Immersion vs submersion Cold water vs warm water Freshwater vs salt water