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What symptoms are similar to those of an asthmatic?
- Increased RR
What is included in supportive therapy?
- Suction- flonase
- IV fluids
Diagnosis test for RSV?
- Nasal pharangeal aspiration
Medications for RSV?
- Steriods- (Flovent, pulmocort)
- Racemic Epinephrine
List three indications for Ribavirin therapy for RSV?
- Less than 6 weeks of age or getting worse
How is the CXR for RSV similar to asthma?
Immunization for RSV is indicated for which group of patients?
What are some of the things you can do to decrease the chances of having a baby die of SIDS?
- Have baby sleep on back
- Don't over dress baby
- Have bed clear
- Firm matress
Classification of Respiratory Disturbances associated with sleep in pediatric patients!
- Apnea in preterm infant
- Apnea in term neonates and postneonatal infants
- Respiratory control abnormality
- Obstructive sleep apnea syndrome
Apnea in preterm infants!
Secondary to specific etiology (immaturity of cardiorespirator or neurologic function or dysfunction associated with acquried disease
Apnea in term neonates and postneonatal infants!
- Secondary to specific etiology
- Apnea of Infancy
Respiratory control abnormality!
Obstructive sleep apnea syndrome!
- Secondary to anatomic disorders of the upper airway and neuromuscular disease
Etiology of infants with apnea!
- Central nervous disease
- GI disease
- Respiratory disease
- Cardiac disease
- Metabolic diseae
- Muscular disease
What things are monitored during a sleep study?
- Respiration effort and air flow
- Heart rate
Factors predisposing to obstructive sleep apnea in children!
- Enlarged tonsils and adenoids
- Cleft or high arched palate
- Chronic nasal congestion
- Subglottic obstruction
Clinicals features associated with sleep apnea!
- Datime sleepiness
- Morning headache
- Failure to thrive
- Pulmonary hypertension
What is an ALTE?
An episode of apnea, color change, and hypotonia that the observer believes to be life threathing to the infant and for which some intervention is felt to be requried
What is the risk for CF in each pregnancy?
- Pulmonary disease
- GI disease
- Elevated sweat chloride
What are the GI complications of CF?
- Pancreatic disease
- Don not produce lipase
What are the pulmonary complications of CF?
- Sticky mucus
- Airway plugging
- Cor pulmonale
What else can be done besides regular CPT to move secreations with CF?
- Hpertonic saline
What are the symptoms that make you supect CF?
- Persistent wheezing
- Chronic cough
- Frequent thisk sputum production
- Reccurent respiratory infections
Breaks down DNA
What sweat chloride is diagnostic for CF?
Greater than 60
Know CPT positions!!!
Look them up!
Early ABG's with CF!
Early PFTs with CF!
Decrease FEF 25-75
Early CXR with CF!
Late CXR wtih CF!
List three symptoms that indicate a tune up is needed with CF?
- Increased cought
- Increased sputum production
What causes the cells to sickle in sickle cell disease?
- Low oxygen
- Low pH
- Rapid temperature changes
- Hypernatremic dehydreation
What body systems are affected with sickle cell disease?
What are the pulmonary effects of sickle cell disease?
- Acute chest syndrome
- Pulmonary vascular injury
- Pulomnary infarction
- Sickle cell chronic lung disease
What are the treatment options for ACS?
- Red blood cell tranfusions
- Aerosolized beta agonist
- Nitric oxide
- Low fever
- Cool mist
- Barking cough
- AP CXR
- Viral infection
- Gradual onset
- Steeple sign
- Going home
- High fever
- Chest cxr
- Sitting up
- Thumb sign
Which lobe is often affected with foreign object aspiration?
Right middle lobe bronchi
What are the factors that determine the severity of presentation?
- The location of impaction
- The degree of airway obstruction
Can an esophageal aspiration give respiratory symptoms?
Explain how an expiratory CXR may help with the diagnosis of foreign body aspiration?
It will detect asymmetric lung hyperinflation that can result from a ball valve effect of foreign material localized in a major bronchus
According to the PALS guidelines, what symptoms suggest that immediate intervention is need with foregin body aspiration?
- Inability to speal or cry audible
- Weak ineffective cough
- High pitched sound or no sound during inhalation
- Increased WOB
- Universal chocking sign
Why didnt more albuterol help rachel?
She needed something else!
What is the rule of two?
Children should be accompanied with a friend if they are short of breath?
6 steps to control asthma?
- Intial assessment and diagnosis
- Pharmacological therapy: managing asthma long term
- Controls of factors contributing to asthma severity
- Periodic assessment and monitoring
- Education for partnership in asthma care
- Managing asthma exacerbation
A trait or disease that is passed down threw families
What organism infects CF patients?
What symptoms of ACS overlap with pneumonia?
- Patchy infiltrates
Why does recurrent pneumonia suggest the presence of an FOA?
If its something like metal it will get over looks and you will continue to get pneumonia in the same exact spot even after treatment
The development of respiratory failure: Phase 1
- The patient develops mild hypoxemia secondary to V/Q imbalance.
- The patient has a slightly increased RR
The development of respiratory failure: Phase 2
- Worsening hypoxemia will stimulate the chemoreceptors to increase breathing.
- An increase in RR and Vt will result in increases alveolar ventilation.
- This will stabilize the O2 status but will result in hyperventilation
- The patient is working hard and is compensating for the problem
The development of respiratory failure: Phase 3
- The respiratory muscles are fatigueing
- Respiratory pattern of tired muscles is increased RR and decreased Vt.
- Alveolar ventilation is decreased
- The patient is working hard but not doing as well
- The PaO2 starts to fall anf the PaCO2 starts to climb and this is impending respiratory failure
The development of respiratory failure: Phase 4
- The fatigue increases and RR begins to fall
- Vt is still reduced RR reduces
- MV decreases and PaCO2 is greater than normal
- Hypoventilation results with worsening hypoxemia
- The minute volume is not enough for adequate gas exchange
- The patient is now in respiratory failure
Where do you find the narrowest portion of the pediatric airway that may compromise endotracheal intubation?
Irreversible dilation of the bronchial tree
What combination of pneumonia to causative pathagen is incorrect?
What signs suggest ACS in a patient with sickle cell disease?
- Pleuritic pain
The major culprit for VAP appears to be what?
The incidence of asthma has done what over the past 10 years?
When educating a patient or family member it is always essential to remeber to...
Ask open ended questions
What is the purpose of a spacer?
- To slow aerosol velocity
- To minimize particle impaction in the oropharynx
- To enhance deposition in the lower respiratory tract
Omalizumab is generally dosed for patients with IgE levels between...
30 and 700
What is the best way to manage cockroaches?
Triggers to airflow obstruction include?
- Aspirin and nonsteriods antiinflammatory drugs
- Cold air
- GI reflux
- Respiratoryu infections
What are the five components of asthma?
- Acute bronchoconstriction
- Airway edema
- Mucous plugging
- Airway hyperresponsiveness
- Airway remodeling
The increased production in the viscous airway secretions of a patient with CF are caused by all of the following except!
Decreased ciliary function
Patients with severe chronic forms of CF should only be given oxygen to maintain saturations between 90% to 95% why?
- To elimante CO2 retention
- To preserve hypoxic drive
Today, the median survival rate for CF is about...
The most common upper airway problems encountered by children with CF include...