Flashcards in Respiratory Dysfunction (Part 1)- Unit 2 Deck (50)
What is the leading cause of preventable death in pediatrics?
Respiratory Arrest (asthma and RSV can kill!)
Leading causes of out of hospital arrest - what are they?
Asthma, choking (9-10 months = pincer), pneumonia, poisoning, SIDS, submersion, trauma.
___% die in er, ___ die in PICU.
45% in ER, 10% in PICU
What are leading causes of in-hospital arrests?
Arrhythmia's (respiratory related), drug toxicity, metabolic disorder, respiratory failure, sepsis
What are some airway differences in pediatrics?
smaller nasopharynx (easily occluded during infection), lymph tissue grows rapidly (atrophies after 12), small oral cavity and large tongue increase risk of obstruction, small nares (easily occluded), long/floppy epiglottis, larynx and glottis are higher in neck (increasing risk of aspiration), thyroid/cricoid/tracheal cartilages can collapse, less compensable to inflammation, mucus can cause a problem,etc.
Right mainstem bronchus in children has a steeper slope than in adults. T/F?
In kids, bifurcation is at T3 level, it's T6 for adults!
Adult airway - how big?
Kid airway? how big?
adult = ~ 20mm
Kid = ~ 4 mm
so any inflammation for the kid can be bad
What's involved in keeping the pH at 7.4?
HC03 (bicarbonate) buffer system
pH of blood changes - what do the lungs and kidneys do?
They respond and change
Normal levels -
Base Excess -
pH - 7.35-7.45
PO2 - 80-100
PCO2 - 35-45
HCO3 - 22-26
Base Excess - -2 to +2
if pH is less than 7.35, it's ___
if pH is greater than 7.45, it's ____.
less than = acidosis
Greater than = alkalosis.
ROME - what is it?
Respiratory opposite, metabolic equal. That means that if the pH goes down and so does the bicarb, it's metabolic, etc.
Asthma - associated with respiratory ____.
Respiratory failure - associated with respiratory ____.
DKA - associated with metabolic ____.
Asthma - respiratory alkalosis.
Respiratory failure - respiratory acidosis.
DKA - metabolic acidosis.
What do we assess with respiratory disease?
Quality of respirations (rate, depth, ease, symmetry), auscultation, quality of heart rate (increased with respiratory distress), color and capillary refill, cough (dry, wet, brassy, croupy, productive), hydration status, behavioral changes.
Should we take shirts off kids to see if retractions are present?
What are some signs of respiratory distress?
Tachypnea, tachycardia, grunting (extended expiration), stridor (upper airway), head bobbing, flaring, inability to lie down, agitation, retractions, accessory muscles, wheezing (lower airway), sweating, prolonged expiration, apnea, cyanosis
Infants only breathe through their mouths. T/F? Until what age?
FALSE - they can only breathe through their nose until 6 months.
What are retractions?
Chest wall becomes less compliant as child ages - so until then, we see retractions.
Suprasternal retraction - might mean....
substernal retractions + subcostal - might mean....
Suprasternal retraction - might mean....upper respiratory infection
substernal retractions + subcostal - might mean....lower respiratory infection.
What are some signs of impending respiratory failure?
Reduced air entry, severe work, cyanosis despite O2, irregular breathing/apnea, altered consciousness, diaphoresis, 1000 mile stare (anxious).
If the kid has no wheezing when they should, what does this mean?
They are probably in respiratory failure...no wheezing? probably no air exchange
Why do children h ave more ear problems than adults?
Eustachian tubes are short, wide, and straight. They distend easier because of underdeveloped cartilage and they also have immature defense mechanisms.
What is otitis media?
Inflammation of inner ear. It's very common.
What are some risk factors for otitis media?
In daycare, around smoke, allergies, pacifier, winter (germs), etc.
Breast feeding - helps with otitis media. T/F?
What's otitis media with effusion?
Chronic - fluid in the middle ear without symptoms of acute infection, AFFECTS hearing. Use pneumatic otoscope when examining ears (senses movement of the ear)
What causes otitis media ?
Viruses (typically RSV), bacteria (streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis)
What are symptoms of acute otitis?
Earache (depends on age), pulling on ear, vomiting, diarrhea, crying, irritability, might be hitting ear if they are too young for words
Chronic otitis - affects hearing?