DOCSLIB.ORG

The Respiratory System

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Respiratory System The Respiratory System The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link points to the correct file and location. Dr AE Kappos Pulmonology RCWMCH 15 Feb 2012 Respiratory illness is very important Major cause of death in childhood Most common cause of acute and chronic illness May also lead to permanent impairment of lung function and to chronic lung disease even into adulthood Cough Most important DEFENCE mechanism of the body Cough is our own personal physiotherapist Most common presenting symptom of resp illness INABILITY TO COUGH IS AN EMERGENCY Cough suppression is CONTRAINDICATED IN CHILDREN UNDER 4 YRS (ESP <2 MONTHS) Cough continued The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link points to the correct file and location. Persistent cough of >3 weeks with constitutional symptoms of weight loss and fever:RED FLAG for TB “Barking cough,honking cough”:CROUP “Whooping cough”:pertussis Tachypnoea Fever Pneumonia Anxiety Pain Dehydration (acidotic breathing/kussmaul breathing) Lung Congestion (left to right cardiac shunts) Pulmonary oedema Severe anaemia, salicylate poisoning Respiratory rate limits <2 months: 60 breaths/min 2-12 months: 50 breaths/min 1-5 years:40 breaths/min Signs of respiratory distress Tachypnoea with Lower chest retractions Nasal flaring( severe distress) Resp failure : grunting, cyanosis , depressed level of consciousness Risk factors for severe acute resp infection MEDICAL: <1 YR,Prem, Immunosuppresion SOCIAL: overcrowding,passive smoking,inadequate housing,indoor fuel exposure NUTRITIONAL: Malnutrition, lack of breastfeeding Oxygen delivery methods Humidified low flow oxygen (0.5-3l/min) applied via NP02 is usually sufficient for hypoxic children( delivers 28-35% o2) Headbox oxygen can be an alternative(does not require humidification but wastage and feeding can be problematic, FI02 delivery is unpredictable) Facemask oxygen delivery 28-65% at flow rate 6-10l/min for children, not tolerated very well by infants IN SEVERE HYPOXIA:use polymask (60-80% ) Noisy breathing Implies obstruction NB in diagnosis is pinpointing the site of obstruction and not labeling the noise as stridor/wheeze etc The kind and loudness of noise is NOT helpful Noises according to site of obstruction STRIDOR WHEEZE Nasopharynx/throat + 0 Larynx + + Trachea /bronchi + + Peripheral airways 0 + Sites of obstruction SITE COMMON CAUSES Extrathoracic 1.Nose and nasopharynx Coryza, sdb 2.Larynx CROUP,Laryngomalacia Intrathoracic 3.Trachea /bronchi Vascular ring,TB nodal compression,foreign body 4.Peripheral airways Asthma,bronchiolitis,BPN,CF,Aspiration syndromes,GOR,Chronic HIV lung disease Identifying the site of obstruction Three questions: Inspiration or expiration? If in inspiration, is the obstruction present during mouth breathing? If it is in expiration, is there air trapping present? Common resp conditions LARYNGOMALACIA Commonest cause of noisy breathing in neonates Inspiratory noise starting from birth or usually from day 10 of life Variability of obstruction with posture and breath NO EXPIRATORY COMPONENT Laryngomalacia Laryngomalacia Simple: larynx structurally normal Laxity of supraglottic tissues that are sucked into the lumen of larynx with inspiration Resolves by 1 yr of age Complex : Above symptoms with difficult drinking,dysphagia,laryngeal incompetence with pulmonary aspiration ,vocal cord paralysis May ameliorate with growth but does not resolve totally Laryngomalacia Investigations: Laryngoscopy Barium swallow if indicated Management: REASSURANCE Mostly GOR treatment if present Laser excision of excess supraglottic tissue for severe obstruction Tracheostomy in some complex cases Bronchiolitis Most common cause of severe acute viral LRTI in children< 2yrs Usually caused by RSV /Rhinovirus Highly infectious Affects the peripheral airways causing BAT and often wheeze Airway obstruction is due to inflammation and edema and not muscle constriction Spreads via contaminated hands Bronchiolitis risk factors HOST FACTORS: prematurity, congenital heart disease, CLD of prematurity, neurological disease, infants<6months, immune deficiency,lack of breastfeeding ENVIROMENTAL: Poverty, overcrowding,passive smoke exposure, Day Care attendance Bronchiolitis Prevention Avoid exposure to children and adults with colds Frequent hand washing Passive immunization with Palivizumab for premature infants and in infants with CLD and congenital heart disease (expensive and needs to be given monthly during RSV season) RSV Season CT: rainy season and between autumn and winter Gauteng: Late Feb-August KZN : Feb -March (rainy season) Bronchiolitis Symptoms History of 1-2 days of URTI symptoms of nasal congestion with progressive tachypnoea Seasonality Bronchiolitis signs Bilateral wheezing (and crackles) Bilateral air trapping with peripheral airways obstruction seen with Hoover sign and resonance with percussion over heart and upper border of liver Tachypnoea Downward displacement of liver and spleen because of hyperinflation (BAT) Bronchiolitis diagnosis Clinical diagnosis based on history and clinical examination ONLY No CXR warranted unless diagnosis doubtful and/or constitutional signs present No indication for CRP Oxygen sats in room air is important Bronchodilator response test(most do not response but some do) Bronchiolitis indications for hospitalization Oxygen sats <90% (inland), <92% (coast) Severe respiratory distress/failure(grunting,cyanosis,nasal flaring) Poor feeding Apnoea Prem infants with risk factors Underlying medical condition(Congenital heart disease,CLD,Down syndrome) Severe malnutrition Admission pre-requisites Nurse alone in a cubicle (ie “in isolation”) Or COHORT with children >2 yrs of age and no underlying risk factor for severe illness Bronchiolitis treatment No medications indicated for children not requiring hospital admission THE OBJECTIVE FOR HOSPITALIZATION IS TO MAINTAIN HYDRATION AND OXYGENATION thus Feeding: if unable to feed ,feed via NG tube (small frequent feeds to avoid overdistention) Humidified low-flow oxygen (0,5-3l/minute) VIA NASAL prongs (28-35%) is usually sufficient in hypoxic children Bronchiolitis treatment cont. Antibiotics not indicated unless severe cases,requiring ICU admission, nosocomial acquisition of RSV or cyanotic congenital heart disease,immune deficiency to cover for bacterial co-infection Bronchodilator therapy is not routinely recommended but if infants respond can be continued until symptoms improve Hypertonic saline 3% nebs has shown benefit (ideal dosage not confirmed, can be given 2-6 hr) Bronchiolitis treatment NOT INDICATED Do not give ADRENALINE Do not give ICS or oral steroids Do not do chest physiotherapy Do not institute regular suctioning Bronchiolitis discharge and follow up Discharge when drinking well and oxygen saturation is > 92% in room air Some tachypnoea,air trapping and crackels may persist for up to 4 weeks Review at outpatients 6-8 weeks after discharge by which time all airtrapping should have resolved.If still BAT consider:New infx,CF or GOR with micro-aspiration Warn parents about post bronchiolitis wheezing CROUP Pediatric equivalent of adult acute laryngitis Clinical features: Previously well, immunized against diptheria,initially runny nose, cough and difficult noisy breathing (inspiratory stridor) and chest retractions Peak incidence at 2 yrs with occurrence from 4months to 4 yrs Features that are NOT CROUP FEATURES CONDITION Sudden onset, very severe obstruction Foreign body <4 months Subglottic stenosis(congenital) Incomplete immunization Diptheria Severe oral thrush Candida laryngitis Fever, erythema Staph tracheitis Fever, sore Epiglottitis, retropharyngeal/peritonsilar throat,DROOLING,DYSPHAGIA ascess Aphonia, previously hoarse Laryngeal papillomatosis CROUP diagnosis Record oxygen saturations (sats<92% is uncommon and should warrant a re-evaluation of diagnosis) Blood gases are unhelpful and unnecessary X-ray confirmation only indicated if atypical features present: Steeple sign of AP neck view is diagnostic of subglottic narrowing Normal AP view of neck “Steeple sign” Severity of CROUP TREATMENT DEPENDS ON THE SEVERITY OF THE AIRWAY OBSTRUCTION and not on the noise (stridor) THE GRADING IS THAT OF THE AIRWAY OBSTRUCTION and not the intensity of the stridor, as that gets softer as obstruction increases!!!!!!!!! Grading Criteria Inspiratory obstruction: inspiratory noise (stridor), retractions, tracheal tug Expiratory obstruction: visible or palpable contraction of rectus abdominal muscles during expiration Pulsus paradoxus: pulse becomes weak or disappears with inspiration GRADES OF OBSTRUCTION GRADE INSPIRATORY EXPIRATORY PULSUS OBSTRUCTION OBSTRUCTION PARADOXUS I + II + + III + + + IV Extremis,marked retractions,apathy,cy anosis Treatment All grades of obstruction get CORTICOSTEROIDS (on diagnosis) Prednisone 2mg/kg stat ORALLY Dose can be repeated in 24 hours (In severely ill children who are unable to swallow one can consider giving ivi Dex 0,6mg/kg stat- in extreme situations only) If airway obstruction is worse 4 hours after steroids, diagnosis should be reviewed Steroids are CONTRA-INDICATED in measles- in such instances intubate if warranted Treatment Grade 1: can be sent home after stat dose pred with advice to return if worsening symptoms Grade 2: Admit, monitor sats, check degree of obstruction
Load more

Recommended publications
  • X-Ray Interpretation
    Objectives Describe a systematic method for interpretation of chest and abdomen x-rays List findings to accurately identify common X-ray Interpretation pathology in chest & abdomen x-rays Describe a systematic method to approach the Denise Ramponi, DNP, FNP-C, ENP-BC, FAANP, FAEN important components in interpretation of upper & lower extremity x-rays Chest X-ray: Standard Views Lateral Film Postero-anterior (PA): (LAT) view can determine th On inspiration – diaphragm descends to 10 rib the anterior-posterior posteriorly structures along the axis of the body Normal LAT film Counting Ribs AP View - Portable http://www.lumen.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/cxr_f.htm When the patient is unable to tolerate routine views with pts sitting or supine No participation from the patient Film is against the patient's back (supine) 1 Consolidation, Atelectasis, Chest radiograph Interstitial involvement Consolidation - any pathologic process that fills the alveoli with Left and right heart fluid, pus, blood, cells or other borders well defined substances Interstitial - involvement of the Both hemidiaphragms supporting tissue of the lung visible to midline parenchyma resulting in fine or coarse reticular opacities Right - higher Atelectasis - collapse of a part of Heart less than 50% of the lung due to a decrease in the amount of air resulting in volume diameter of the chest loss and increased density. Infiltrate, Consolidation vs. Congestive Heart Failure Atelectasis Fluid leaking into interstitium Kerley B 2 Kerley B lines Prominent interstitial markings Kerley lines Magnified CXR Cardiomyopathy & interstitial pulmonary edema Short 1-2 cm white lines at lung periphery horizontal to pleural surface Distended interlobular septa - secondary to interstitial edema.
    [Show full text]
  • Upper Airway Obstruction in Children: Imaging Essentials
    Acute upper airway obstruction in children: Imaging essentials Carlos J. Sivit MD Rainbow Babies and Children’s Hospital Case Western Reserve School of Medicine ►Clinical perspective ►Infections ►Foreign body ►Masses 1 Clinical Clinical ► Common cause of respiratory failure in children ► Potentially life-threatening in younger children because of smaller airway diameter ► Narrowing of upper airway has exponential effect on airflow 2 Clinical ► Majority of children are otherwise healthy ► Appropriate management results in good outcomes ► Improper management has dire consequences ► Imaging plays critical role in diagnosis Clinical ► Signs and symptoms § Respiratory distress § Dysphagia § Odynophagia § Stridor § Absence of air entry § Tachycardia 3 Stridor ► Harsh respiratory noise caused by turbulent air flow through narrowed airway ► Specific for severe upper airway obstruction ► Intensifies in inspiration ► Does not help specify nature or location Infections 4 Infections ► Acute laryngotracheobronchitis ► Acute epiglottitis ► Acute bacterial tracheitis ► Retropharyngeal abscess ► Infectious mononucleosis Croup ► Heterogenous group of acute infections characterized by brassy “croupy” cough ► May or may not be accompanied by stridor, hoarseness and respiratory distress ► Typically seen in younger children § 6 months – 5 years 5 Croup ► Parainfluenza viruses account for 75% ► Adenoviruses, RSV, influenza and measles cause most remaining cases ► Secondary bacterial infection is rare Imaging ►Imaging § Performed to exclude other conditions
    [Show full text]
  • Since January 2020 Elsevier Has Created a COVID-19 Resource Centre with Free Information in English and Mandarin on the Novel Coronavirus COVID- 19
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by IUPUIScholarWorks Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. A02842_052 4/11/06 3:59 PM Page 813 Chapter 52 Otolaryngologic Disorders William P. Potsic and Ralph F. Wetmore EAR vibrating tympanic membrane to the stapes footplate. Anatomy Stapes movement creates a fluid wave in the inner ear that travels to the round window membrane and is dissi- The ear is divided into three anatomic and functional pated by reciprocal motion to the stapes. areas: the external ear, the middle ear, and the inner ear. There are two striated muscles in the middle ear. The The external ear consists of the auricle, external auditory tensor tympani muscle lies along the side of the eustachian canal, and the lateral surface of the tympanic membrane. tube, and its tendon attaches to the medial surface of the The auricle is a complex fibroelastic skeleton that is cov- malleus.
    [Show full text]
  • Large Airway Obstruction in Children Reprinted with Revisions from Update in Anaesthesia, (2004)18:44-49
    Large airway obstruction in children Reprinted with revisions from Update in Anaesthesia, (2004)18:44-49. Originally Royal College of Anaesthetists Newsletter 1999; Issue 47: 159-162, reused with permission. N S Morton Correspondence Email: [email protected] PART 1: CAUSES AND ASSESSMENT The larynx is funnel shaped and is narrowest at the Opening and maintaining the airway is fundamental level of the cricoid ring compared with the cylindrical ommon emergencies to the treatment of all emergency situations in adult conformation, which is narrowest at the level of C paediatrics, as in adults. All resuscitation algorithms the vocal cords. The airway is more compressible as start with ABC (Airway, Breathing, Circulation) and cartilage support components are less well developed. must be qualified in trauma to include cervical spine Thus, extrinsic pressure from haematomas, neoplasms, Summary control. The commonest cause of paediatric airway vessels or enlarged heart chambers may more readily obstruction is still the child with depressed conscious compress the airway. The collapse of the laryngeal There are anatomical, level who is not positioned properly or whose airway inlet during inspiration is a feature of laryngomalacia physiological and is not opened adequately by Basic Life Support and the collapse of the trachea and/or bronchi during developmental reasons for manoeuvres. Airway foreign bodies are also common expiration occurs in tracheo-bronchomalacia. If the children to be particularly and may need rapid intervention. The pattern of intrathoracic airways are narrowed from whatever susceptible to airway obstruction. infective causes of airway obstruction has changed cause, the extra work of inspiration and of expiration since the introduction of vaccination programmes leads to large swings in intrathoracic pressure and the Rapid clinical assessment, against Haemophilus influenzae type B.
    [Show full text]
  • Common Pediatric Pulmonary Issues
    Common Pediatric Pulmonary Issues Chris Woleben MD, FAAP Associate Dean, Student Affairs VCU School of Medicine Assistant Professor, Emergency Medicine and Pediatrics Objectives • Learn common causes of upper and lower airway disease in the pediatric population • Learn basic management skills for common pediatric pulmonary problems Upper Airway Disease • Extrathoracic structures • Pharynx, larynx, trachea • Stridor • Externally audible sound produced by turbulent flow through narrowed airway • Signifies partial airway obstruction • May be acute or chronic Remember Physics? Poiseuille’s Law Acute Stridor • Febrile • Laryngotracheitis (croup) • Retropharyngeal abscess • Epiglottitis • Bacterial tracheitis • Afebrile • Foreign body • Caustic or thermal airway injury • Angioedema Croup - Epidemiology • Usually 6 to 36 months old • Males > Females (3:2) • Fall / Winter predilection • Common causes: • Parainfluenza • RSV • Adenovirus • Influenza Croup - Pathophysiology • Begins with URI symptoms and fever • Infection spreads from nasopharynx to larynx and trachea • Subglottic mucosal swelling and secretions lead to narrowed airway • Development of barky, “seal-like” cough with inspiratory stridor • Symptoms worse at night Croup - Management • Keep child as calm as possible, usually sitting in parent’s lap • Humidified saline via nebulizer • Steroids (Dexamethasone 0.6 mg/kg) • Oral and IM route both acceptable • Racemic Epinephrine • <10kg: 0.25 mg via nebulizer • >10kg: 0.5 mg via nebulizer Croup – Management • Must observe for 4 hours after
    [Show full text]
  • Radiologic Assessment in the Pediatric Intensive Care Unit
    THE YALE JOURNAL OF BIOLOGY AND MEDICINE 57 (1984), 49-82 Radiologic Assessment in the Pediatric Intensive Care Unit RICHARD I. MARKOWITZ, M.D. Associate Professor, Departments of Diagnostic Radiology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut Received May 31, 1983 The severely ill infant or child who requires admission to a pediatric intensive care unit (PICU) often presents with a complex set of problems necessitating multiple and frequent management decisions. Diagnostic imaging plays an important role, not only in the initial assessment of the patient's condition and establishing a diagnosis, but also in monitoring the patient's progress and the effects of interventional therapeutic measures. Bedside studies ob- tained using portable equipment are often limited but can provide much useful information when a careful and detailed approach is utilized in producing the radiograph and interpreting the examination. This article reviews some of the basic principles of radiographic interpreta- tion and details some of the diagnostic points which, when promptly recognized, can lead to a better understanding of the patient's condition and thus to improved patient care and manage- ment. While chest radiography is stressed, studies of other regions including the upper airway, abdomen, skull, and extremities are discussed. A brief consideration of the expanding role of new modality imaging (i.e., ultrasound, CT) is also included. Multiple illustrative examples of common and uncommon problems are shown. Radiologic evaluation forms an important part of the diagnostic assessment of pa- tients in the pediatric intensive care unit (PICU). Because of the precarious condi- tion of these patients, as well as the multiple tubes, lines, catheters, and monitoring devices to which they are attached, it is usually impossible or highly undesirable to transport these patients to other areas of the hospital for general radiographic studies.
    [Show full text]
  • Chronic Cough- Whoop It
    3/3/2016 Chronic Cough- Whoop it Cassaundra Hefner PULMONARY ANATOMY DNP, FNP-BC FryeCare Lung Center Upper Airway Nasopharynx Oropharynx Laryngopharynx Lower Larynx Trachea Bronchi Bronchopulmonary segments Terminal bronchioles Acinus (alveolar regions) Upper and Lower Airway are lined with cilia which propel mucus and trapped bacteria toward the oropharynx Cough COUGH ACTION Protective reflex that keeps throat clear allowing for mucocilliary clearance of airway secretion Intrathoracic process of air from a vigorous cough through nearly closed vocal cords can approach 300mmHG, the velocities tear off mucus from the airway walls. The velocity can be up to 500mph 4 Cough/Sputum Defense mechanism to prevent aspiration- cough center stimulated- cough begins with deep inspiration to 50 % vital capacity- maximum expiratory flow increases coil - decreasing airway resistance- glottis opens wide and takes in large amount of air - glottis then rapidly closes - abdominal and intercostal muscles contract- increases intrapleural pressure - the glottis reopens- explosive release of air the tracheobronchial tree narrows rips the mucous off the walls = sputum 1 3/3/2016 Chronic Cough Defined (AACP, 2016) Effects of cough that prompts visit Talierco & Umur, 2014 Acute Sub-acute Chronic Fatigue 57% Cough Cough 3-8 Unexplained chronic less than weeks cough(UCC) Insomnia 45% 3 weeks Excessive perspiration 42% Cough lasting greater Incontinence 39% than 8 weeks in 15 yo or older MSK pain 45% Cough lasting greater Inguinal herniation than 4 weeks in Dysrhythmias those under the Headaches age of 15 Quality of life questionnaires are recommended for adolescents and children (CQLQ) Work loss Data Institute (NCG) (2016) Cough Referral to Pulmonology 80%-90% chronic cough Most common symptom for PCP visits in the U.S.
    [Show full text]
  • Viral Croup Amisha Malhotra, MD,* Objectives After Completing This Article, Readers Should Be Able To: and Leonard R
    Article infectious disease Viral Croup Amisha Malhotra, MD,* Objectives After completing this article, readers should be able to: and Leonard R. Krilov, MD† 1. Clarify the definition and terminology of viral croup. 2. List the etiologic agents associated with viral croup. 3. Describe the pathogenesis of viral croup. 4. Delineate the clinical signs and symptoms associated with viral croup. 5. Differentiate epiglottitis from viral croup. 6. Discuss the identification and management of viral croup. Introduction Croup is a common respiratory illness in children. The word croup is derived from the Anglo-Saxon word kropan, which means “to cry aloud.” The illness commonly is mani- fested in young children by a hoarse voice; dry, barking cough; inspiratory stridor; and a variable amount of respiratory distress that develops over a brief period of time. Definition and Terminology The term “croup syndrome” refers to a group of diseases that varies in anatomic involvement and etiologic agents and includes laryngotracheitis, spasmodic croup, bacte- rial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Al- though the terms “laryngotracheitis” and “laryngotracheobronchitis” frequently are used interchangeably in the literature, they represent two different disease states. The most common and most typical form of the viral croup syndrome is acute laryngotracheitis, which involves obstruction of the upper airway in the area of the larynx, infraglottic tissues, and trachea and is due to an infectious agent. The lung parenchyma is involved occasion- ally. Among the noninfectious etiologies of this syndrome are foreign body aspiration, trauma (eg, due to intubation), and allergic reaction (eg, acute angioneurotic edema). Acute viral infection is the most common cause of croup, but bacterial and atypical agents also have been identified.
    [Show full text]
  • Sore Throat: Volume 3, Number 9 Inflammatory Disorders of the Author Charles Stewart, MD, FAAEM, FACEP Pediatric Airway Emergency Physician, Colorado Springs, CO
    September 2006 A "Killer" Sore Throat: Volume 3, Number 9 Inflammatory Disorders Of The Author Charles Stewart, MD, FAAEM, FACEP Pediatric Airway Emergency Physician, Colorado Springs, CO. Peer Reviewers “It’s only a kid with a sore throat.” The triage nurse said at 0100. Sharon Mace, MD Associate Professor, Emergency Department, Ohio You had a full ED and she assured you that the 13-year-old with a recent State University School of Medicine, Director of Pediatric Education And Quality Improvement and extraction of her wisdom teeth was fine. You put the sore throat to the Director of Observation Unit, Cleveland Clinic, Faculty, back of the rack and took care of “more serious“cases. When you saw the MetroHealth Medical Center, Emergency Medicine Residency. patient four hours later, her respiratory rate was 36, her pulse was 160, Paula J Whiteman, MD and she had retractions at rest. You noted a substantial swelling of her Medical Director, Pediatric Emergency Medicine, anterior neck. You started her on high-flow oxygen, stat paged the ENT Encino-Tarzana Regional Medical Center; Attending Physician, Cedars-Sinai Medical Center, doctor, set up for a possible cricothyrotomy or tracheostomy, ordered blood Los Angeles, CA cultures, chest x-ray, and neck x-ray, and told the nursing supervisor to CME Objectives get an OR crew in soon. Upon completing this article you should be able to: 1. Describe the anatomy of the throat. 2. Discuss the potential causes of sore throats in ore throats represent one of the top ten presenting complaints pediatric patients. 3. Discuss the treatment options available for bacterial 1 Sto the ED in the US.
    [Show full text]
  • Andrea Kline Tilford Phd, CPNP‐AC/PC, FCCM
    Acute Care Pediatric Nurse Practitioner Review Course 2020 Andrea Kline Tilford PhD, CPNP‐AC/PC, FCCM C.S. Mott Children’s Hospital Ann Arbor, Michigan ©202 0 Disclosures • I have no financial relationships to disclose • I will not discuss investigational drug use ©202 0 Objectives • Discuss general principles of pediatric respiratory physiology • Discuss the presentation and evaluation of common pediatric respiratory diseases • Identify appropriate management strategies for common pediatric respiratory diseases ©202 0 Basic Anatomy • Upper Airway • Supraglottic (nose, nasopharynx, epiglottis) • Glottis (vocal cords, subglottic area, cervical trachea) • Humidifies inhaled gases • Warms inhaled gas • Site of most resistance to airflow • Conducting airways (dead space) • Lower airways • Thoracic trachea, bronchi, bronchioles and alveoli (gas exchange) ©202 0 Anatomical Considerations in Children • Pediatrics • Small mouth • Large tongue • In relation to mandible • Floppy epiglottis (infants) • Large occiput • Infants are obligate nose breathers (until ~ 6 months of age) • Cricoid ring narrowest portion of airway in infants and young children ©202 0 Bronchus • Bifurcates into right and left bronchus • RIGHT side generally more straight and more likely to be site of aspiration www.med.umich.edu ©202 0 Alveoli • Continue to multiply until ~ 8 years of age Covered in capillaries Site of gas exchange oac.med.jhmi.edu ©202 0 Basic Physiology • Goal of respiration = Oxygen in and carbon dioxide out • Oxygen ʻinʼ • For cell use • Carbon dioxide ʻoutʼ • Produced by cells ©202 0 Gas Exchange • Inhalation • Active; requires contraction of several muscles (e.g. diaphragm, intercostals) • Exhalation • Passive • Relaxation of intercostals and diaphragm, return of rib cage, diaphragm, and sternum to resting position, increases pressure in lungs and air is exhaled **PEARL: Some conditions, such as status asthmaticus, interfere with passive exhalation.
    [Show full text]
  • COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2021
    COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2021 Key Terms Date Title Journal / Source Type of Summary & Key Points Specific Observations Full Citation Published Publication This represents the final version (updated 30 April, 2021). New publications since our last update have been highlighted in blue. COVID-19; 29-Apr-21 A COVID-19- Pediatric Letter to The authors described the case of a SARS-CoV-2-positive infant in The authors described the case Pierre L, Kondamudi N, pediatric; Positive Infant Emergency Care the Editor the United States presenting with sudden cardiac arrest [date not of a SARS-CoV-2-positive infant Adeyinka A, et al. A COVID-19- cardiac arrest; Presenting With specified]. The 36-day-old infant was found unresponsive and not in the United States presenting Positive Infant Presenting With United States Sudden Cardiac breathing, and emergency medical services were called. Cardio- with sudden cardiac arrest. Sudden Cardiac Arrest. Pediatr Arrest pulmonary resuscitation, including endotracheal intubation, The infant manifested a robust Emerg Care. 2021;37(5):e280- ventilation, and intra-osseous access, was initiated in the field. The inflammatory response which e281. spontaneous return of circulation was accomplished in is suggestive of MIS-C, but with doi:10.1097/PEC.00000000000 approximately 5 min. The patient was asymptomatic before the absence of fever and skin 02432. onset of this catastrophic event and with no bacterial pathogen rashes. detected in the initial workup. The infant manifested a robust inflammatory response evidenced by high white blood cell count, elevated C-reactive protein, abnormal coagulation, elevated D- dimer levels, low fibrinogen, elevated ferritin, and positive SARS- CoV-2 IgG antibody.
    [Show full text]
  • Mehlmanmedical Hy Pulmonary
    MEHLMANMEDICAL HY PULMONARY MEHLMANMEDICAL.COM HY Pulmonary - 58F + 6-month Hx of shortness of breath and non-productive cough + 2-year Hx of worsening dysphagia + 20-yr Hx of hands turning white when exposed to cold; what lung condition is this patient most at risk of developing? à answer = pulmonary hypertension à pulmonary fibrosis common in CREST syndrome (scleroderma; limited systemic sclerosis) à pulmonary fibrosis seen in both diffuse and limited types of systemic sclerosis; the latter is sans the renal phenomena) à can lead to cor pulmonale, which is right-heart failure secondary to a pathology of lung etiology (i.e., the left heart must not be causative). - What will the USMLE frequently say in the Q if they’re hinting at pulmonary hypertension? à HY vignette descriptors are loud S2 or P2 (pulmonic valve slams shut when the distal pressure is high); dilation of proximal pulmonary arteries; increased pulmonary vascular markings (congestion + increased hydrostatic pressure). - When is “pulmonary hypertension” important as the answer? à notably in Eisenmenger syndrome and cor pulmonale. o Regarding Eisenmenger: the reversal of the L to R shunt across the VSD such that it’s R to L requires the tunica media of the pulmonary arterioles to hypertrophy secondary to chronic increased preload à proximal backup of hydrostatic pressure à increased afterload on the right heart à now the right heart starts to significantly hypertrophy à shunt across the VSD reverses R to L. This is important, as RVH is not the most upstream cause of Eisenmenger; the pulmonary hypertension is. o Regarding cor pulmonale: as mentioned above, cor pulmonale is right heart failure secondary to a pathology of pulmonary etiology (e.g., COPD, cystic fibrosis [CF], fibrosis, etc.); however it must be noted that the most common cause of right heart failure is left heart failure; so for cor pulmonale to be the diagnosis, the left heart must not be the etiology of the right heart failure; the lungs must be the etiology.
    [Show full text]