Question Answer
What is Croup (Laryngotracheobronchitis)? an acute inflammation of the larynx, trachea, and bronchi caused by parainfluenza and influenza viruses
Pathophysiology of Croup the virus invades tissues causing edema and swelling of the upper airway
How do you diagnose Croup? steeple sign see on x-ray caused by sloping of the subglottic region
Clinical signs of croup are ill for several days, runny nose, low-grade fever, barky cough, stridor, retractions, flaring and sometimes cyanotic
Tx for Croup Tx the symptoms: low flow O2, cool mist, iv hydration, steroids, racemic epi, intubate and vent if necessary
How can you tell if the subglottic swelling has gone down in a croup baby that has been intubated air leak will be heard around the ETT
What is epiglottitis and what causes it? acute infection of supraglottic structures caused by Hemophilus Influenza Type B bacteria
What occurs during epiglottitis edema and swelling of soft tissues of the larynx and epiglottis, closes glottic opening and causes upper airway obstruction
What would you see on an x-ray of a child with epiglottitis? tell tale thumb shaped epiglottic shadows
Clinical signs of Epiglottitis sudden fever, severe sore throat, difficulty swallowing, drooling, muffled voice, stridor, retractions, flaring and sudden desire to sit upright
Tx for Epiglottitis nonthreatening environment, ABT immediately, If intubation necessary take to OR
Why will the tube size be smaller for epiglottitis intubation smaller bc of swelling
What is Bronchiolitis and what causes it? viral inflammation of bronchioles, very contagious. caused by RSV (80%), adenovirus, rhinovirus, influenza
Pathophysiology of Bronchiolitis inflammation produces edema causing mucus plugging, airway obstruction, atelectasis, hyperinflation, V/Q mismatch, hypoxemia and poor feeding
Age group and time of year Bronchiolitis tends to occur 1 month to 2 yrs, Oct-Apr
How would you diagnose Bronchiolitis Antigen detenction assays, Elisa (enzyme linked immunosorbent assay), X-ray
What would you see on the x-ray of a child with bronchiolitis hyperinflation, flattened diaphragm, some patchy infiltrates
Clinical signs of Bronchiolitis cough, tachypnea >60, retractions, flaring, exp wheeze, cyanosis, fever, dehydration
Tx for Bronchiolitis O2 PRN, hydration, upper airway clearance, Bronchodilators (not recommended), Ribavirin
What is Ribavirin and how do you administer it? aerosolized antiviral agent given with SPAG
Ribavirin is for use in what type of patients high-risk pt (BPD, Cardiac, young)
Disadvantages of Ribavirin very expensive and teratogenic (causes birth defects)
Foreign body aspiration occurs most in children of what ages 1-3 yrs old
What are the most commonly aspirated items and where do they tend to lodge hot dogs, nuts, coins, pins. lodge in right mainstem
Diagnosing foreign body aspiration(initially and chronically) intial-choking, violent cough, resp distress, wheezing; chronic-lingering cough, low grade fever
What would you see on a cxr of a pt that aspirated a foreign object? hyperinflation if partial blockage (ball-valve obs), and re-absorption of air leading to atelectasis if complete blockage
How would yo initially attempt to remove the foreign body in a child up to 1 yr old? back blows and chest thrust
How would you initially try to remove a foreign body aspirated by a child > 1 yrs old? heimlich and finger sweep(only if seen)
After stabilizing the pt how would you attempt to remove the foreign body that the child aspirated bronch or surgery
What could you do after the foregin body has been removed to tx the atelectasis CPT
What are some things that cause burn or smoke inhalation CO, sulfur dioxide, Hudrochloric acid
Signs and symptoms of burn/smoke inhalation central cyanosis, singed nasal hairs, facial burns, reddened pharynx, soot deposits, crackles/wheezes
4 things smoke damage causes edema, necrosis, sloughing of necrotic epithelium, bronchospasm
What is Stage I of smoke inhalation injury Respiratory distress, resembles upper airway obs
Stage II of smoke inhalation injury 8-36 hours, pulmonary edema
Stage III of smoke inhalation injury 2 days – 3 weeks, bacterial pneumonia
Tx of burns or smoke inhalation insure patent airway, O2 PRN, vigorous CPT, correct acidosis, pain meds, steroids, bronchodilators
Common substances that cause poisoning plants, iron tabs, organophosphates, hydrocarbons (gas), vitamins, acetaminophen, salicylates, theophylline, CO
Tx of poisoning includes stabilize pt, limit further absorption, enhance elimination, drug antagonists (Narcan)
Ways to limit further absorption of poison include NSS lavage, remove gastric contents, emesis, activated charcoal, mag citrate(causes diarrhea)
ways to enhance elimination of poison force diuresis, hemodialysis, peritoneal dialysis
What is Sickle Cell? a form of hemolytic anemia that affects 1 in 400 american blacks with sickle shaped erythrocytes
What percentage are carriers of the sickle cell trait? 7-10%
Sickle cell- Acute chest syndrome is characterized by what? increased RR, pain, cough, fever, hypoxia, bone marrow emboli and bacterial pneumonia
What would you see on a chest x-ray of a person with sickle cell- acute chest syndrome? infiltrates and atelectasis
Tx for sickle cell crisis includes pain relief, O2, ABT, exchange transfusion, and hydration
SIDS occurs in __ out of every 1000 births 2
What are the risk factors for SIDS prone sleeping, 1-4 months of age, Winter, prematurity, BPD, male (5 per 100), Black race, low maternal age and smoking
Hypotheses as to what causes SIDS sleep apnea/ obstruction (
What do sleep studies monitor? cardiorespiratory activity during sleep
This is a time consuming and expensive multi channel, 12 hr monitoring of EEG and ECG Polysomnography
What is a neumocardiogram? most popular overnight study that monitors transthoracic movements and heart rate
Disadvantage of pneumocardiogram no environmental control
Monitoring is usually done for __ to __ months 4-6
Common type of monitoring is _______ type and what 3 things does it monitor? impedence; chest movement, HR, and Sat
What is ALTE? apparent life threatening event of apnea with change in color and muscle tone
ALTE is AKA near miss or aborted SIDS
What is cystic fibrosis? An autosomal recessive hereditary disease that affects all exocrine glands leading to excessive secretions
CF occurs in __of 2000 births 1
Varying mutations of CF gene on chromosome __, over 150 abnormal forms 7
CF causes abnormal function of what? transmembrane regulator protein(chloride ion transport, secretory cells become dehydrated)
CF causes plugging and dysfunction of what organs pulmonary, GI, reproductive and sweat glands
CF effects on pulmonary system include excessive secretions, mucus plugging, obstruction, V/Q mismatch, hypoxemia, chronic infection, hyperinflation and bronchiectasis
CF effects on the GI system include malnutrition, pancreatic insuff, small bowel obs, thick bile and cirrhosis
98% of CF pts have a sweat chloride test >__mEq/L 60
What is a later sign of CF? clubbing
Sputum culture of CF pt’s usually have what bacteria in them? pseudomonas
5 Steps to managing CF indivualize per pt, adequate nutrition, aggresive pulmonary care, prevention of pulmonary complications and psychosocial support of pt and family
Common therapies for CF include O2, aerosol, pulmozyme, PD, CPT, ABT, high calorie diet, Vitamin/supplements, pancreatic enzymes, lung transplant, Gene therapy
How many children does Asthma affect? 5-10% or 1 in 12 school age
What is Extrinsic asthma? exposure to allergens
What is Intrinsic asthma? associated with resp tract infections
6 Clinical signs of asthma Resp distress, increased AP diameter, Crackles, wheezing, productive cough, and possible cyanosis
Abg results for an asthmatic patient depend on severity
An asthmatics chest xray will show what hyperinflation, atelectasis and infiltrates
A CBC with diff will show an increased number of which WBC’s in an asthmatic? eosinophils
Treatment of asthma in children includes what 3 things? identification and elimination of aggravating factors, pharmacologic therapy and education of pt and family
Tx for moderate asthma with example anti inflammatory; Cromolyn
Tx for mod to severe asthma with examples inhaled steroids; vanceril, flovent, pulmicort, theophylline
Drowning= dies of submersion within __ hours 24
What is near drowning? any victim surviving > 24hrs
Drowning is the __ leadind COD in children >__ months old 2nd; 9 months
What are the peak ages of drowning victims and where? 4yrs and under (pools), 15-19 (lakes and rivers)
90% of drownings occur in what type of water? fresh water
Risk factors for drowning inadequate supervision, exhaustion, seizure d/c, drugs/alcohol(teens)
What is the clinical course of injury from drowning? hypoxia, pulmonary injury, hypothermia
Outcome for survival from drowning depends on what 3 factors time in water, water temp and initial resuscitation
What is the limiting factor in the outcome for drowning? CNS damage
Worse cases of drowning develop what 2 things aspiration and ARDS
Tx for drowning intubate, O2, treat for ARDS(PEEP), warm pt with heated gases, blankets, peritoneal irrig, neuro mgmt, icp monitor, hyperventilate, keep sedated
ARDS in children occurs from what types of injury to the lungs and is associated with what % mortality direct or indirect lung injury, 60% mortality
8 common causes of ARDS trauma, sepsis, aspiration, infectious pneumonia, near drowning, O2 toxicity, burns and shock
Pathophysiology of ARDS pulmonary injury, A/C membrane leakse causing edema. A change in pulmonary surfactant, alveolar collapse. Fibrotic change impairs gas xchange, acidosis, hypoxemia, increased PaCO2
MGMt of ARDS o2 prn but beware of toxicity (reabsorbtion leads to atelectasis), intubate if >60% O2, used PEEP instead of O2, Increase Vt to decrease PaCO2, bronchodilators, cpt, fluid mgmt
what is the goal in ARDS mgmt? wean O2 by increaseing FRC
What is a last resort for ARDS mgmt ECMO
What is BPD and who is at risk? chronic lung disease in infants who require increased levels O2 and mechanical ventilation, at risk premature, RDS and barotrauma
2 contributing factors to BPD positive pressure vent and o2 toxicity
Pathophysiology of BPD alveolar wall thikening/fibrosis, airway hyperactive, decreased ciliary action
How do you diagnose BPD confirmed by radiologic changes, clinical signs and required Tx
Stage 1 of BPD: CLinical symptoms and x-ray pattern 2-3 days, acute resp distress on o2 and vent, ground glass, air bronchs and atelectasis
Stage 2 of BPD:CLinical symptoms and x-ray pattern 4-10 days, edema, PDA, increased support, infiltrates and atelectasis
Stage 3 of BPD:CLinical symptoms and x-ray pattern 10-30 days, transition into chronic, o2 dependent, failed weaning, compensated ABG’s, small cyst formation on cxr
Stage 4 of BPD: CLinical symptoms and x-ray pattern >1 month, no improvement, rt heart failure, trach helpful, large cyst formation and hyperinflation on CXR
What can occur during stage 4 of BPD? acute spells of severe cyanosis and/or bronchospasm requiring hand bagging and O2
Tx for BPD O2, mech vent, Sx, surfactant(in stage 1), bronchodilators, CPT, HFV and ECMO(if severe), sedation, fluid balance, diuretis, digoxin, steroids
Complications of BPD air leaks, cor pulmonale, GERD, NEC, IVH, Neuro damage, death