| Flap 1 | Flap 2 |
| Anatomical differences of the upper airway in peds | larger tongue and more lymphoid tissue, epiglottis is larger & less flexible, larynx higher, narrowest point is cricoid ring, trach narrower and shorter |
| Physiological considerations of upper airway | larger tongue and lymph tissue make infants obligate nose breathers, causing secretions or inflammation to increase resistance and WOB, increased risk of occlusion, susceptible to trauma |
| Larger tongue and more lymphoid tissue causes | increased risk of upper airway occlusion, is the reason infants are obligate nosebreathers |
| An infants epiglottis is susceptible to trauma because | it is larger and less flexible than an adult, and lies more horizontal |
| An infant’s larynx is higher or lower in the neck in relation to the cervical spine? | higher |
| The narrowest part of the infants larynx (airway) is the | cricoids cartilage (ring), adult is glottis |
| Infants sternum and ribs are mostly made up of | cartilage, less stability to chest (movement of diaphragm or RR determines VT) |
| Infants VE comes from | increase in RR, not VT |
| Low pulmonary reserve in infants is due to | 1 heart is large so lung volume is smaller, 2 instability of thoracic cage (VT not increased with chest expansion but RR), 3 proportionately large abdomen (pushing up diaphragm) |
| Infant Metabolism differences | infants have higher BMR, infants have unpredictable response to medications do to BMR |
| Higher BMR in infants leads to | higher caloric requirements and increased O2 expenditure in proportion to body size compared to adults |
| Infant BMR and Med dose caution | unpredictable responses due to BMR means time and dose must be adjusted for each individual pt |
| Large surface area of skin compared to body weight in infants leads to | prone to heat loss or difficult temperature control, and difficult maintenance of hydration |
| What percent of a newborns total body weight is H2O? | 80 |
| How many grams in 1 lbs? | 454 grams per lbs |
| What weight of preemie is now considered viable? | 500 grams |
| Barriers to good communication are | language, culture and education level |
| Children presenting with what signs need to have a history taken? | dyspnea and respiratory distress |
| Question to ask during history | 1 chronic, 2signs of infection, 3fever, 4Rx, 5family Hx, 6 Hx of resp probs 7 Hx of GI reflux 8 character of cough 9 breathing pattern 10 Hx wheezing 11cyanosis 12 chest pain 13 sputum 14 growth 15 environment 16 meds |
| Cyanosis presence with O2 delivery indicates | R-L shunting |
| Complaints of chest pains may be an indication of | pneumonia |
| 3 primary goals in assessment of the pulmonary system in pediatric patient are | localize the disease, observe the adequacy of gas exchange, determine nature of pt’s respirations |
| How do we localize the disease | gather Hx, additional testing ie CXR, auscultation, percussion, palpation, symmetric chest movement, trachea at sterna notch |
| How to we observe for adequacy of gas exchange | ABG (not often, but sometimes heal stick), pulse ox, transcutaneous/end tidal CO2 monitors |
| How do we determine nature of pt’s respirations | rate and pattern, increased WOB, LOC, skin color wheezing accessory muscles etc |
| Pediatric Asthma is | reversible airway obstruction, airway inflammation and airway hyperresponsiveness to a variety of stimuli |
| The majority of ped pt’s have extrinsic or intrinsic asthma? | extrinsic associated with allergies |
| Asthma exacerbation characteristics are | dry hacking cough with wheezing on auscultation, with cough becoming wetter and productive, increased RAW, audible wheeze, decreased PaO2 early due to V/Q mismatch, decreased PaCO2 due to hypoxia and accessory muscle use |
| The best way to gage if therapy is working in asthma attack is | % change in Peak Flow |
| Change in peak flow calc is | (post – pre/ pre)x100 acceptable change is 12 to 15% so anything greater than 12% is good |
| If pt stops wheezing what does this mean? | impending respiratory failure |
| Most common asthma allergens are | pollutants, dust mites, feathers, smoke, pet dander, house dust, cockroaches, food preservatives (sulfurs) |
| Decreased PaO2 early in an acute asthma attack | V/Q mismatch |
| What does RT look for to measure severity of asthma attack | PaCO2, 35 or less is mild, 40 or less is moderate, above 40 is severe and resp is imminent |
| First line treatment for asthma | 1. O2 (maintain SpO2 above 95%, 2. beta adrenergic (first two back to back then go to continuous neb) epi or terbutaline possible depends on doc 3 anti inflammatory (IV or inhaled) 4. Heli |
| Modality in ER to avoid intubation | continuous neb with albuterol for enough for 8 treatments. Decreases need for intubation and perhaps decrease need for IV bronchodilators and terbutaline |
| Oxygen delivery or CAO2 equation | CAO2 EQUALS (HGB*1.34*SAO2)+(PAO2*.003) |
| Why is the infant chest less stable? | because the sternum and ribs are mostly cartilage |
| Adventitious BS | wheezes, rhonchi, crackles/rales, stridor |
| Wheezes | high pitched and musical sound, usually on expiration ( can be heard on inspiration with asthma), produced by air moving thru partially obstructed airways, seen in asthma, pulm edema, foreign body, airway tumor, external compression by vascular ring |
| Rhonchi | produced by air moving through airways with a large amount of secretion, low pitched and rumbling (straw in milk) heard in bronchiectisis, pneumonia, CF |
| Crackles (rales) | sounds like popping of bubble wrap or sandpaper, only heard on inspiration, caused by air moving through fluid filled alveoli, or deflated alveoli re expanding, associated with atelectasis and pulm edema |
| Stridor | produced as air flow past the partial obstruction of the upper airway during inspiration, high pitched like wheezes, seen in croup, post exudation and foreign body aspiration |
| How do you tell the difference between stridor and wheezes | listen over larynx and chest, stridor heard over trachea and wheezes heard over chest |
| Normal Vitals | HR nb-100-180 inf 100-160 tod 80-110 sch 65-110, adol 60-90, BP age*2+80over .57 * syst, perfusion state equals capillary refill greater than 3 seconds is low rate, urine 1-2 ml/kg/hr, RR NB 30-60 inf 24-40 tod 20-30 sch 20-25 5-12 16-20 adol 12-16 |
| CXR consolidation and infection is what color? | white |
| CXR of airtrapping is what color? | dark distal to plugging |
| Dull percussion note | consolidation |
| High pitched “tympanic” percussion note | hyperaerated (airtrapping) |
| What is the best way to evaluate gas exchange? | ABG |
| What are the physical signs of hypoxemia | tachycardia, cyanosis, labored breathing, deterioration in mental state |
| Peak flow change equation is | change equals (post-pre)/pre* 100 (great than 12 % is acceptable change |
| Signs of hypercarbia are | rapid, bounding pulse, confusion, muscular twitching |
| What are the steps in a pt scenario? | History, examination (localization, accessing gas exchange, nature of respiration) diagnose and plan the treatment |
| Why does HGB saturation take so long to show signs of hypoxia? | the lower the HGB count the longer it takes (5 grams) |
| When does a pt assessment start? | as you enter the room |
| 2 year old on peds floor is sleeping with RR of 70, what is the cause? | Decreased PaCO2 |
| (voice vibrations)that can be felt. increased by solids like consolidation and atelectasis | fremitis |
| Heart Rate Normals | NB 100-180, INF 100-160, TOD 80-110, SCH 65-110, ADOL 60-90 |
| Resp Rate Normals | NB 30-60, INF 24-40, TOD 20-30, SCH 20-25, age 5-12 16-20, ADOL 12-16 |
| Adventitious Breath Sounds | (abnormal Breath Sounds) Crackles/rales, Rhonchi, Wheeze, Pleural Friction Rub, Stridor, Diminished |
| Bronchial Breath Sounds | (normal breath sounds) E |
| bronchophony | (99 or 123 will be louder) increased intensity and clarity of vocal resonance, more tissue density than air (consolidation), easier to detect unilaterally, dull percussion, increased vocal fremitus bronchovesicular breath sounds |
| crackles/rales | (adventitious BS) bubbling-crackling sounds, mainly on I, air flow through fluid, discontinuous-specific locations, does not clear with cough. caused by pulmonary edema, pneumonia, emphysema, atelectasis, pulmonary fibrosis |
