What symptoms are similar to those of an asthmatic?
Increased RR
Retractions
Cyanosis
Wheezes
What is included in supportive therapy?
Suction- flonase
IV fluids
O2
Diagnosis test for RSV?
CXR
Nasal pharangeal aspiration
History
Medications for RSV?
Albuterol
Steriods- (Flovent, pulmocort)
Racemic Epinephrine
List three indications for Ribavirin therapy for RSV?
Cardiovascular
BPD
Less than 6 weeks of age or getting worse
How is the CXR for RSV similar to asthma?
Hyperinflated
Immunization for RSV is indicated for which group of patients?
BPD
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!
Congential
Acquired
Obstructive sleep apnea syndrome!
Secondary to anatomic disorders of the upper airway and neuromuscular disease
Primary
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
Oxygenation
Ventilation
Factors predisposing to obstructive sleep apnea in children!
Enlarged tonsils and adenoids
Micrognathia
Macroglossia
Cleft or high arched palate
Hypotonia
Chronic nasal congestion
Subglottic obstruction
Clinicals features associated with sleep apnea!
Datime sleepiness
Morning headache
Insomnia
Obesity
Failure to thrive
Hypertension
Polucythemia
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
Malnurashed
What are the pulmonary complications of CF?
Sticky mucus
Airway plugging
Emphysema
Cor pulmonale
What else can be done besides regular CPT to move secreations with CF?
Vest
Hpertonic saline
Pulmozyme
What are the symptoms that make you supect CF?
Persistent wheezing
Chronic cough
Frequent thisk sputum production
Reccurent respiratory infections
Pulmozyme
Breaks down DNA
What sweat chloride is diagnostic for CF?
Greater than 60
Know CPT positions!!!
Look them up!
Early ABG's with CF!
Hypoxemia
Early PFTs with CF!
Decrease FEF 25-75
Early CXR with CF!
Hyperinflation
Late ABG's with CF!
Hypocarbia
Hypoxemia
Late PFTs with CF!
FEV1
Late CXR wtih CF!
Bronchiectasis
Hyperinflation
List three symptoms that indicate a tune up is needed with CF?
Increased cought
Increased sputum production
Hemoptysis
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?
Lungs
Heart
Kineys
Splean
What are the pulmonary effects of sickle cell disease?
Pneumonia
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
ECMO
Nitric oxide
O2
Croup
Low fever
Cool mist
Barking cough
AP CXR
Viral infection
Vapo
Gradual onset
Steeple sign
Going home
Epiglottis
High fever
Intubation
Chest cxr
Sitting up
Bacterial
Antibiotics
Thumb sign
ICU
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?
Yes
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
Cyanosis
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
Autosomal recessive!
A trait or disease that is passed down threw families
What organism infects CF patients?
Pseudomonas
What symptoms of ACS overlap with pneumonia?
Patchy infiltrates
Fever
Cough
Hypocemia
Atelectasis
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?
Cricoid cartilage
Bronchiectasis!
Irreversible dilation of the bronchial tree
What combination of pneumonia to causative pathagen is incorrect?
Atypical pneumonia
MRSA
What signs suggest ACS in a patient with sickle cell disease?
Fever
Pleuritic pain
Tachypnea
The major culprit for VAP appears to be what?
ETT
The incidence of asthma has done what over the past 10 years?
Increased
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?
Boric acid
Triggers to airflow obstruction include?
Aspirin and nonsteriods antiinflammatory drugs
Excersise
Cold air
Irritants
GI reflux
Respiratoryu infections
Stress
What are the five components of asthma?
Inflammation
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...
36 years
The most common upper airway problems encountered by children with CF include...