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