RESPIRATORY DISTRESS IN CHILDREN

RESPIRATORY DISTRESS IN CHILDRENDepartment of Child HealthFaculty of Medicine Universitas Gadjah MadaYogyakarta

1Upon completion of this lecture, you will be better able to:Define the most common types of respiratory emergencies in childrenList the steps in assessing a child who is experiencing respiratory distressDescribe the proper interventions for selected respiratory emergenciesLEARNING OBJECTIVES22 types of breathing emergencies*Respiratory distress*Respiratory arrestBoth conditions are life threateningResp. distress is a condition in which breathing becomes difficultResp. arrest occurs when breathing stopsBy recognizing resp.distress and taking immediate action prevent resp.arrest

BREATHING EMERGENCY3InfectionAirway obstructionTraumaCongenital conditionsAllergic conditionsNeurologic: GBSCAUSES OF RESPIRATORY EMERGENCIES

4Respiratory rateIncreased early, decreased late NOTE: A slow respiratory rate is an ominous sign in children

Respiratory observationsNasal flaring Retraction

Use of accessory muscles

Coughing

SIGNS AND SYMPTOMS OF RESPIRATORY DISTRESS5Abnormal Breath SoundsWheezing - hallmark sign of lower airway obstructionInspiratory Stridor - hallmark sign of upper airway obstructionDecreased, absent, unequal breath soundsExpiratory Grunting - LATE signColorPale, flushed & bluish skin colorCyanosis is a late signLevel of consciousnessSomnolence/lethargy is a late signIncrease heart rate

SIGNS & SYMPTOMS6Signs of Respiratory Distress

Cyanosis is alate sign ofrespiratorydistress7

Seesaw Respiration8Hypoxia signs & symptoms of respiratory failureDiagnosis : Blood gas analysis sometime not available ..?Early detection clinical manifestation of Potential Respiratory Failure

CLINICAL MANIFESTATION OF RESPIRATORY FAILURE9Distress respiration- Work of breathing* Tachypneu* Accessories muscle* Chest wall retractin* Nasal flare- Consciousness & respons to pain- Weakness of muscle tones- Cyanotic

CLINICAL MANIFESTATION

10CLINICAL MANIFESTATIONRespiratory effortAgain, observe how much energy the patient is putting into breathingSkinpallor and diaphoresis indicate fight or flightcyanosis indicates hypoxia (peripheral, then central)

Chest wallRetractions & accessory musclesSymmetrySigns of traumaDont forget to look posterior!

11Head bobbingGrunting : pulmonary oedema, pneumonia, HMD, atelectasisSeesaw respiration inefficientStridor : upper airway obstruction macroglossia, laryngomalacia, vocal cord paralyse, mass, infection, oedema, foreign bodiesRespiratory effort12Wheezy on expiration lower airway obstruction- Bronchial asthma, bronchiolitis, pulmonary oedema, foreign bodies

Entry of air breathing- Compliance of chest wall tidal volume 6 L/min)Low FiO2Variability in actual FiO2

Nasal Canula47Thank You48