| Pediatric Pulmonary Emergencies | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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INDICATIONS FOR ENDOTRACHEAL INTUBATION HOW TO INTUBATE HOW TO EXTUBATE | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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What do you look for first when a pediatric patient presents to you in respiratory distress? What are some of the tools that physicians can use to work through and manage respiratory distress in children? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| UNDERSTANDING EQUIPMENT | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Respiratory Distress Hemoptysis Acute Bronchitis and Upper Respiratory Tract Infections Community-Acquired Pneumonia, Aspiration Pneumonia, and Noninfectious Pulmonary Infiltrates Empyema and Lung Abscess Spontaneous and Iatrogenic Pneumothorax Acute Asthma in Adults Chronic Obstructive Pulmonary Disease Pulmonary disease have only 6 Symptoms… • Dyspnea • Cough • Sputum production • Hemoptysis • Wheeze • Chest pain What is Dyspnea? Chronic dyspnea is defined as dyspnea lasting more than one month. When is dyspnea an emergency? • When the patient is: – Hypoxic "Eupnea" describes normal, unlabored breathing. "Dyspnea" - difficulty breathing "Tachypnea" - Rapid breathing "Bradypnea" - Slow breathing "Apnea" - NO breathing TABLE 1 Differential Diagnosis of Dyspnea
The differential diagnosis of chronic dyspnea in adults is presented in Table 3.8 The underlying cause of dyspnea cannot be determined by the duration or severity.9 Approximately two thirds of cases of dyspnea are caused by a pulmonary or cardiac disorder.10 Asthma, congestive heart failure, COPD, pneumonia, cardiac ischemia, interstitial lung disease, and psychogenic conditions (e.g., generalized anxiety disorder, panic disorders, post-traumatic stress disorder) are the cause of dyspnea in 85 percent of patients with this principal symptom.9,11 In one study9 of patients with dyspnea that was unexplained by history, physical examination, chest radiography, and spirometry, the most common causes of chronic dyspnea were COPD, congestive heart failure, psychogenic causes, and deconditioning.
TABLE 1 Differential Diagnosis of Chronic Dyspnea
GAD = generalized anxiety disorder; PTSD = post-traumatic stress disorder.
Intermittent breathlessness; triggering factors; allergic rhinitis; nasal polyps; prolonged expiration; wheezing Asthma Significant tobacco consumption; barrel chest; prolonged expiration; wheezing Chronic obstructive pulmonary disease History of hypertension, coronary artery disease, or diabetes mellitus; orthopnea; paroxysmal nocturnal dyspnea; pedal edema; jugular vein distention; S3 gallop; bibasilar rales; wheezing Congestive heart failure History of generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder; intermittent symptoms; sighing breathing Anxiety disorder; hyperventilation Postprandial dyspnea Gastroesophageal reflux disease; aspiration; food allergy Hemoptysis Lung neoplasm; pneumonia; bronchiectasis; mitral stenosis; arteriovenous malformation Recurrent pneumonia Lung cancer; bronchiectasis; aspiration Drug exposure Beta blockers aggravating obstructive airway disease Amiodarone (Cordarone)/nitrofurantoin (Furadantin): pneumonitis Methotrexate (Rheumatrex): lung fibrosis Illicit drugs (e.g., heroin): talcosis History of immunosuppressive disease or therapy; acquired immunodeficiency syndrome Opportunistic infections: protozoal (Pneumocystis carinii pneumonia); bacterial (tuberculosis; Legionella); viral (cytomegalovirus); or fungal (Aspergillus) Exposure to inorganic dust, asbestos, or volatile chemicals Pneumoconiosis; silicosis; berylliosis; coal workers lung; asbestosis Organic exposure to dust (birds, mushrooms) Hypersensitivity pneumonitis (bird fancier's lung) Accentuated P2; right ventricular heave; murmurs Pulmonary hypertension Abnormal inspiratory or expiratory sounds heard best over the trachea Central airway obstruction; vocal cord paralysis; laryngeal tumor; tracheal stenosis Localized, decreased, or absent breath sounds Pleural effusion; atelectasis; pneumothorax | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
