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Pediatrics - Respiratory Emergencies PowerPoint Presentation

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Description : Check out this medical presentation on Pediatrics, which is titled "Pediatrics - Respiratory Emergencies", to know about the Respiratory Emergencies in childhood.

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Published on : Aug 03, 2021 | Views : 1213 | Downloads : 31

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Slide 1-

Pediatrics Respiratory Emergencies
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Respiratory Emergencies #1 cause of Pediatric hospital admissions Death during first year of life except for congenital abnormalities
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Respiratory Emergencies Most pediatric cardiac arrest begins as respiratory failure or respiratory arrest
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Pediatric Respiratory System Large head, small mandible, small neck Large, posteriorly-placed tongue High glottic opening Small airways Presence of tonsils, adenoids
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Pediatric Respiratory System Poor accessory muscle development Less rigid thoracic cage Horizontal ribs, primarily diaphragm breathers Increased metabolic rate, increased O2 consumption
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Pediatric Respiratory System Decrease respiratory reserve + Increased O2 demand = Increased respiratory failure risk
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Respiratory Distress
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Respiratory Distress Tachycardia (May be bradycardia in neonate) Head bobbing, stridor, prolonged expiration Abdominal breathing Grunting--creates CPAP
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Respiratory Emergencies Croup Epiglottitis Asthma Bronchiolitis Foreign body aspiration
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Laryngotracheobronchitis Croup
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Croup: Pathophysiology Viral infection (parainfluenza) Affects larynx, trachea Subglottic edema; Air flow obstruction
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Croup: Incidence 6 months to 4 years Males > Females Fall, early winter
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Croup: Signs/Symptoms “Cold” progressing to hoarseness, cough Low grade fever Night-time increase in edema with: Stridor “Seal bark” cough Respiratory distress Cyanosis Recurs on several nights
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Croup: Management Mild Croup Reassurance Moist, cool air
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Croup: Management Severe Croup Humidified high concentration oxygen Monitor EKG IV tko if tolerated Nebulized racemic epinephrine Anticipate need to intubate, assist ventilations
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Epiglottitis
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Epiglottitis: Pathophysiology Bacterial infection (Hemophilus influenza) Affects epiglottis, adjacent pharyngeal tissue Supraglottic edema Complete Airway Obstruction
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Epiglottitis: Incidence Children > 4 years old Common in ages 4 - 7 Pedi incidence falling due to HiB vaccination Can occur in adults, particularly elderly Incidence in adults is increasing
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Epiglottitis: Signs/Symptoms Rapid onset, severe distress in hours High fever Intense sore throat, difficulty swallowing Drooling Stridor Sits up, leans forward, extends neck slightly One-third present unconscious, in shock
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Epiglottitis Respiratory distress+ Sore throat+Drooling = Epiglottitis
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Epiglottitis: Management High concentration oxygen IV tko, if possible Rapid transport Do not attempt to visualize airway
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Epiglottitis Immediate Life Threat Possible Complete Airway Obstruction
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Asthma
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Asthma: Pathophysiology Lower airway hypersensitivity to: Allergies Infection Irritants Emotional stress Cold Exercise
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Asthma: Pathophysiology Bronchospasm Bronchial Edema Increased Mucus Production
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Asthma: Pathophysiology
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Asthma: Pathophysiology Cast of airway produced by asthmatic mucus plugs
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Asthma: Signs/Symptoms Dyspnea Signs of respiratory distress Nasal flaring Tracheal tugging Accessory muscle use Suprasternal, intercostal, epigastric retractions
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Asthma: Signs/Symptoms Coughing Expiratory wheezing Tachypnea Cyanosis
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Asthma: Prolonged Attacks Increase in respiratory water loss Decreased fluid intake Dehydration
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Asthma: History How long has patient been wheezing? How much fluid has patient had? Recent respiratory tract infection? Medications? When? How much? Allergies? Previous hospitalizations?
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Asthma: Physical Exam Patient position? Drowsy or stuporous? Signs/symptoms of dehydration? Chest movement? Quality of breath sounds?
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Asthma: Risk Assessment Prior ICU admissions Prior intubation >3 emergency department visits in past year >2 hospital admissions in past year >1 bronchodilator canister used in past month Use of bronchodilators > every 4 hours Chronic use of steroids Progressive symptoms in spite of aggressive Rx
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Asthma SILENT CHEST= DANGER OF RESPIRATORY FAILURE
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Golden Rule Pulmonary edema Allergic reactions Pneumonia Foreign body aspiration ALL THAT WHEEZES IS NOT ASTHMA
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Asthma: Management Airway Breathing Sitting position Humidified O2 by NRB mask Dry O2 dries mucus, worsens plugs Encourage coughing Consider intubation, assisted ventilation
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Asthma: Management Circulation IV TKO Assess for dehydration Titrate fluid administration to severity of dehydration Monitor ECG
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Asthma: Management Obtain medication history Overdose Arrhythmias
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Asthma: Management Nebulized Beta-2 agents Albuterol
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POSSIBLE BENEFIT IN PATIENTS WITH VENTILATORY FAILURE Asthma: Management Subcutaneous beta agents Epinephrine 1:1000--0.1 to 0.3 mg SQ
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Asthma: Management Use EXTREME caution in giving two sympathomimetics to same patient Monitor ECG
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Asthma: Management Avoid Sedatives Depress respiratory drive Antihistamines Decrease LOC, dry secretions Aspirin High incidence of allergy
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Status Asthmaticus Asthma attack unresponsive to -2 adrenergic agents
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Status Asthmaticus Humidified oxygen Rehydration Continuous nebulized beta-2 agents Atrovent Corticosteroids Aminophylline (controversial) Magnesium sulfate (controversial)
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Status Asthmaticus Intubation Mechanical ventilation Large tidal volumes (18-24 ml/kg) Long expiratory times Intravenous Terbutaline Continuous infusion 3 to 6 mcg/kg/min
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Bronchiolitis
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Bronchiolitis: Pathophysiology Viral infection (RSV) Inflammatory bronchiolar edema Air trapping
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Bronchiolitis: Incidence Children < 2 years old 80% of patients < 1 year old Epidemics January through May
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Bronchiolitis: Signs/Symptoms Infant < 1 year old Recent upper respiratory infection exposure Gradual onset of respiratory distress Expiratory wheezing Extreme tachypnea (60 - 100+/min) Cyanosis
Slide 50-

Asthma vs Bronchiolitis Asthma Age - > 2 years Fever - usually normal Family Hx - positive Hx of allergies - positive Response to Epi - positive Bronchiolitis Age - < 2 years Fever - positive Family Hx - negative Hx of allergies - negative Response to Epi - negative
Slide 51-

Bronchiolitis: Management Humidified oxygen by NRB mask Monitor EKG IV tko Anticipate order for bronchodilators Anticipate need to intubate, assist ventilations
Slide 52-

Foreign Body Airway Obstruction FBAO
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FBAO: High Risk Groups > 90% of deaths: children < 5 years old 65% of deaths: infants
Slide 54-

FBAO: Signs/Symptoms Suspect in any previously well, afebrile child with sudden onset of: Respiratory distress Choking Coughing Stridor Wheezing
Slide 55-

FBAO: Management Minimize intervention if child conscious, maintaining own airway 100% oxygen as tolerated No blind sweeps of oral cavity Wheezing Object in small airway Avoid trying to dislodge in field
Slide 56-

FBAO: Management Inadequate ventilation Infant: 5 back blows/5 chest thrusts Child: Abdominal thrusts