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What is the difference between ventilation vs. perfusion?
- Ventilation: mechanical action of breathing
- Perfusion: 02 to tissues. Alvioli is main structure. Pneumonia will reduce perfusion by blocking alvioli.
- VQ mismatch: when adiquate ventilation but inadiquate perfusion (Q=perfusion... for some reason.)
What is the Oxy-Hemoglobin curve?
- At normal (healthy) conditions, Pa80 keeps O2 sats >95%.
- ^ blood pH, v temp, v PaO2--> ^ O2 sat. (shift left)
- v blood pH, ^temp, ^ PaO2--> v O2 sat. (shift right)
What are some age related concerns for kids with respiratory problems?
- Infants less than 4 months are obligate nasal breathers
- Infants <6 months: maternal antibodies
- 3-6 months: infection rate increases
- Toddler and preschool ages: high rate of viral
- >5 years: increase in mycoplasma pneumonia and ß-strep infections
- Increased immunity with age
- Expected RR decreases with age
What are the most common reasons for young children to visit their PCP?
- Colds (5-10 times/year)
- Coughs (4-5 times/year)
- Sore throat
What are the expected norms for RR in children?
What structure separates the sterile from the non-sterile portions of the airway?
Carina (area of trachia where bronchials bifercate to right and left.)
Why do kids tend to have more ear nfxns than adults?
Because eustatian tubes are more horizontal and shorter
What are some seasonal related respiratory concerns?
- Mycoplasmal infections more common in fall and winter
- Asthmatic bronchitis more frequent in cold
- RSV season considered winter and spring
What is the difference between stridor, wheezing, and, retractions?
What to know about grunting, agonal respirations, and Cyanosis...
- Most sensitive assessment is LOC. Will become drowsy with ^O2 levels.
How does treatment of pharyngitis and tonsillitis differ?
Tonisillitis can treat with cool mist vaporisor and salt gargle.
What is the most common childhood illness and how do you treat it?
- Otitis media (ear nfxn)
- Pathophysiology and etiology:
- Result of malfunctioning eustachian tube
- Usually preceded by viral infection
- Otoscope exam-purulent discolored with bulging
- Therapeutic management
What is "Croup Syndrome"?
- Type depends on area of edema, ie epiglottitis = swelling of epiglotis.
- Epiglottitis is the major concern because edema here occludes both stomach and lungs.
What can you do for Epiglottitis?
- DO NOT STRESS CHILD! FUTHER STRESS WILL INCREASE RR AND EXACERBATE PROBLEM.
In what population is laryngitis most prevelant?
- Older children and adolecents
- Typically caused by:
- Main complaint is hoarsness
- Is usually self-limiting and Tx'd with fluids, humidifier
What is LTB?
What are the SnSs of LTB?
How can you tell the difference between LTB and bacterial tracheitis?
Bacterial tracheitis will mimic LTB but will also present with thick, purulent discharge which may require intubation in order to suction effectively.
What are the main catagories of lower air way infections/
- RSV Bronchiolitis
- All are in "sterile" locations
- Inflamation of large airways, ie trachea and bronchii.
- Usually viral
- Dry hacking cough that gets worse at night. Becomes productive after 2-3 days.
What is Bronchiolitis (RSV)?
- Respiritory Syncytial Virus
- Mucous/exudate production
- Dx by NP swap
- Tx: cool humidified O2, fluids, airway maintanance and Rx.
- No vaccine, but Synagis can prevent RSV in at risk children during RSV season.
What are the general signs of pneumonia?
- Fever, cough, tachypnea
- Breath sounds with rhonchi or fine crackles
- Dullness with percussion
- Chest/pleural pain
- Nasal Flaring
- Pallor to cyanosis
- CXR with infiltrations
- Irritable, listless, lethargic
- Anorexia, vomiting, diarrhea
What are the SnSs of TB?
- weight loss
What is RDS?
- Respiratory Distress Syndrome
- Characterized as respiratory distress and hypoxia within 72 hours after serious injury or surgery in person with previously normal lungs
- Pathophysiology: increased permeability of the alveolocapillary membrane that results in pulmonary edema
- Lung becomes stiff and difficult to ventilate
- Treatment: mechanical ventilation, nitric oxide, surfactant, HFOV, ECMO
- Prognosis: 24% - 88% mortality
What is Status Asthmaticus?
- Respiratory distress continues despite vigorous therapeutic measures
- Emergency treatment—epinephrine 0.01 ml/kg subQ (max dose 0.3 ml)
- Concurrent infection in some cases
What is CF?
- Characterized by exocrine (mucus-
- producing) gland dysfunction that produces multisystem involvement
- Reduces the ability of the cells in the
- lungs and pancreas to transport chloride
- involves Na and Cl transport malfunction. Leaves body in constant dehydration and mucous becomes even thicker.
What two organs are primarily affected by CF?
- Respiratory tract and pancreas are
- predominantly affected
What is the best diagnostic for CF?
- Basis of the most reliable diagnostic procedure—sweat chloride test
- Sodium and chloride will be 2 to 5 times greater than the controls
What are some of the more serious events associated with CF?
Compression of pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, cor pulmonale, respiratory failure, and death
What can chronic hypoxemia lead to?
- Chronic hypoxemia--> contraction/hypertrophy of muscle fibers in pulmonary arteries/arterioles
- Pulmonary hypertension
- Cor pulmonale
How does CF effect the GI
- Mucous blocks enzymes from pancreas from entering duodenum-->
- v digestion of fat-->steatorrhea (fat in stool)
- v digestionof protiens--> azotorrhea (protein in stool)
- possible developement of DM
- Can also occlude biliary duct--> jaundice and biliary cirrhosis.
How do you treat CF in the GI
Replace pancreatic enzymes in diet.
How does CF in GI present?
- ^appetite with v weight.
- sweat gland dysfunction
- all the associated resp. problems
- failure to thrive
- progressive COPD
How does resp CF present?
- Wheezing/dry unproductive cough (mucous is too thick to be expelled.)
- Generalized obstructive emphysema
- patchy atelectasis
- Recurring bronchitis/pneumonia
Other generalized presentations of CF?
- Child tastes salty
- Delayed puberty in females
- Sterility in males
- hyponatremic/hypochloremic alkalosis
How is respiratory failure defined?
- Defined as inability of respiratory system to
- maintain adequate oxygenation
What is CDH and what sort of RF does it represent?
- Congenital Diaphramatic Hernia
- Restrictive lung disease
What are the cardinal signs of RF?
- Restlessness (aloc)
- the tachys
PPV by BVM
- Positive Pressure by Bag Balve Mask
- High Frequency Oscillatory Ventilation
- Extracorporeal membrane oxygenation
- (all are forms of Tx for RF)
T/F Children can have sudden cardiac failure just like adults
False; when cardiac arrest results in children, it is usually the terminal result of progressive RF or shock.
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