SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43 Walsh E. Chavez RRT-NPS.
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Transcript of SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43 Walsh E. Chavez RRT-NPS.
SIDs, AW disorders, SIDs, AW disorders, Asthma, & Plural Asthma, & Plural
DisordersDisordersChapters: 31,32,33 & Chapters: 31,32,33 &
4343
SIDs, AW disorders, SIDs, AW disorders, Asthma, & Plural Asthma, & Plural
DisordersDisordersChapters: 31,32,33 & Chapters: 31,32,33 &
4343
Walsh Walsh E. Chavez RRT-NPSE. Chavez RRT-NPS
Definition of SIDS• Sudden and unexpected death of
an infant for which sufficient cause cannot be found by a death scene investigation, review of the history, and a postmortem
• 1week-1 year old (2-4 months < 6months)
• ALTE (Apparent life-threatening event)– Color change– Hypotonia– 70% found in the morning…..
Risk Factors • Lending for intervention
– Prone positioning– Maternal smoking– Bottle-feeding vs Breast feeding????
Normal Control of Heart Rate and Breathing
• Breathing– Brainstem
• Heart rate– Autonomic nervous system
SIDS
• Etiology:• Brainstem: controls breathing (Prematurity?) • Central Apnea & periodic breathing • Tests for assessing risk factors
– NO test that predicts risk for SIDS– Polysomnography/ pneumogram– Frequency of apnea
Polysomnography• Parameters: Pg. 547 Fig 31-3
– EEG (Brain activity)– EOG (Bilateral Eye Movement)– EMG (Muscle tone) impendence belt-EtcO2-POX/ TCOM-ECG-Ph Probe graph Figure 31-2 (pg 546)
• Laboratory Supervision: Pediatrician Who Scores?
• Setting: Pediatric Staged with Parent near
• Personnel: knowledge of the child's behavior developmental stages
Polysomnography (cont.)
• Normal sleep development:– REM and NON-REM
• Apnea (3 categories)– Rapid base line– Central: (B’sD’s andColor change) 10-25%– Obstruction:hypopnea & apnea– OB lasting >10sec or 6-8 sec (UAW OB)– Complications: Desat/ > CO2;Day time
Sleepiness, behavior changes, cor pulmonale– Treatment: – Removal of adenoidal & tonsils– NCPAP– NICU: Reflux, PofA, Hypoxia, anemia, IVH,
Seditaives, seizures, incoordiation with feedings
Home Cardiorespiratory Monitors= Apnea
Monitors• Alert the caregiver to a
cardiorespiratory abnormality• Diagnostic devices• Training• Social/parental implications
Chapter 32Chapter 32
Pediatric Airway Pediatric Airway Disorders and Parenchymal Disorders and Parenchymal
Lung DiseasesLung Diseases
Pediatric AirwayUpper airway (Pg. 555 fig. 32-1)
Above C3-4 Peds
non expandable Cricoid rings (Narrowest portion)
-obligate nose breathers 3-6 monthsPoor coronation between rr& oropharngeal motor
skills & large tonguesDevelopement up to 8 years of age• Lower airway:• Trachea > Subdivisions 17-16: adults23
generations…..RSV ?• Airway obstruction:• AP/ Lateral Neck-XRAY• Assessments: RDS, Auscultate UAW: Air movement muffled/stridor
Upper Airway Disorderslesions, inflammatory, abnormal tissue, tone
• Supralaryngeal obstruction– Choanal atresia– Pierre Robin syndrome– Deep neck infections– Tonsillar enlargement/Peritonsillar
abscess– Obstructive apnea
Upper Airway Disorders (cont.)
• Periglottic obstruction (around the glottis)
– Epiglottis– Laryngotracheobronchitis (LTB-
CROUP)
– Table 32-1 Differential Diagnosis– Pg. 559
Epiglottitis Life Threatening =Bacterial infection (H influenza
B)• Incidence and etiology
– <6 years old– Noninfectious: aspiration of hot liquid,
traumatic intubations, blind finger sweep
• Signs and symptoms: ABRUPT • Fever, soar throat, dysphagia(drooling)• MUFFLED, retractions, RDS, upright sniffing
position• Diagnosis: lateral NECk (Thumb sign) C&S, ABG
• Treatment: (small?) ETT, RSI, ceftriaxone, Extubate leak?Bronchoscope, antibotcs
Epiglottitis (cont.)
LaryngotracheobronchitisLTB-CROUP
(6 months-6 years)
• Incidence and etiology: • Parainfluenza Virus 1• Over several days
• Signs and symptoms:• Low grade fever, malasise, rhinorrhea, hoarse
voice BARKY COUGH
• Diagnosis:• Lateral neck-xray: Steeple sign
(SUBglottic)
• Treatment: Racemic Epi, hydration, temp ……………..control, humidification, Mist tents, O2,
>0.35Fio2= impending resp FailureIntubations
Laryngotracheobronchitis (cont.)
Lower Airway Disorders
• Obstruction of the trachea and major bronchi– Tracheomalacia– Congenital tracheal or bronchial
stenosis
Lower Airway Disorders pg563
• Foreign body aspiration– Incidence:
• Leading cause of accidental death – Signs and symptoms:
• Degree of AW OB• Unilateral Wheezing/ reoccurring PNA
– Diagnosis: AP CXR/neck and lateral– Laryngeal level– Hyperinflation/Ball valve effect – Bronchoscopy– Treatment:– Removal of object continue to monitor patient
Foreign Body Aspiration
Lower Airway Disorders• Atelectasis
– Etiology and pathophysiology:• Failure to reinflate
– Signs and symptoms:• Dyspnea • (Severe) V/Q mismatch • RDS
– Diagnosis: CXR, B/S, tracheal deviation– Treatment: Hyperinflation therapy,
Bronchial hygiene therapy,
Lower Airway Disorders• Bronchiectasis: • Irreversible dilation of the bronical tree
– Etiology and pathology• CF/ frequent respiratory infections• Left lower lobes mostly involved
– Signs and symptoms:• Chronic cough w/ copious amts of
purulent sputum– Diagnosis: CXR and CT– Treatment: CPT, hydration,
antibotics,
Lower Airway Disorders• Acute bronchiolitis
– Etiology: Viral Respiratory Tract infection related to RSV
– Incidence:<1 year of age with BPD, CF, PPHN & CHD
– Signs and symptoms: coryza, cough, RDS, wheezing (APNEA), dehydration
– Diagnosis:Nasal Swab: +RSV– Treatment:O2, (MV), IV, Supportive care– Prognosis: GOOD
Pneumonia• Viral
– 1st:Respiratory syncytial virus (RSV)• Coryza, NASAL CONGESTION, cough & fever• Supportive Care vs. Ribavirin
– 2nd:Parainfluenza virus Types1(LTB), 2, and 3(children<5yr)• O2 and supportive care
– Influenza virus:• Winter seasons• Vaccinations yearly
– Adenovirus:– High rates of M & M.– Overwhelming sepsis– Supportive care
Pneumonia• Bacterial
– Incidence: Compromised immune function, recurrent aspiration, malnutrition, daycare, passive cigarette
– Etiology: microorganisms colonize in the URT
– Signs and symptoms: same as viral– Diagnosis: CXR, > total band
count>1500, CRP, Blood Culture– Treatment: oral/ IV antibiotics– 7-14 days
– Pox & ABG
Chapter 33Chapter 33PG. 582-597PG. 582-597
AsthmaAsthma
Most common chronic Most common chronic childhood disease childhood disease
Pathogenesis
• Definition:Chronic inflammatory disorder of the AWs– Mast cells, eosinophils, T lympocytes,
IgE, Macrophages, neutrolphils, & epithelial cells
– Wheezing &Breathlessness
Pathogenesis of Asthma
• Pathophysiology– Chronic airway inflammation– Bronchial hyperresponsiveness– Hypersecretion of mucus
• Components of Asthma:– Inflammation -A remodeling– Bronchial constriction -Mucous plugging– AW edema -AW Hyperreponsiveness– RESULTS:
• HYPERinflation, atelectasis, hypoxia, V/Q mismatch, Hypercarbia
Risk Factors for Developing Asthma
• Allergic response:– IgE– Reversible vs. irreversible– AW remoding=fibrosis
• Environmental triggers– Intervention– Remediate & eliminate
• Tobacco• Cockroaches/ Dust mites• Molds
National Asthma Education and Prevention
Program
• Purpose:• to serve as a comprehensive tool to
diagnosis and manage asthma• Goals: Box 33-1:
– Prevent: Chronic asthma, recurrent– Maintain: NL ADLs, NL/near NL pulmonary
function– Optimal pharmacology– Meet family & patient’s expectations
Diagnosis• Medical history:
– Symptoms & triggers
• Physical examination: – History a stronger factor– Prolongs expiratory phase– RDS, Hyperexpansion
• Pulmonary function testing:– FVC, FEV1 <80% predicted, FEV1/FV(< 65%
predicted), FEF25-75%• Bronchoprovocational challenges
(methacholine 20% decrease=+test)• Exercise: running/biking
– Less sensitive HR > 170
Management
• Pharmacologic therapy– Long-term control medications
• Taken daily• Antiinflammatoryagents/ corticosteroids• Long acting B2 agonist(LABAs)
– Salmeterol & Formoterol 30-90 minutes• Methylxanthines • Leukotriene modifiers: inhibits• Cromolyn sodium (Stablizes mast cells)• Immnuomodulators: Binds to IgE
Management– Quick-relief medications: (5-15
minutes)• Short acting B-agonist last 4-6 hours• “rescue”• Anticholenergics
– Delivery systems• MDI (Spacers & holding chambers)• DPI• SVN
Management (cont.)
• Control of triggers– Identification of allergens– Avoidance and control measures– Immunotherapy
• controversial
Management (cont.)
• Peak flow monitoring– Peak flow meter– Peak flow diary– Personal best reading– Peak flow zone system
– Pg. 593
Patient and Family Education
• Asthma disease process• Medication skills• Identification and control of
triggers• Self-monitoring techniques
Managing Asthma
• Exacerbations in the ED– Assessment: PF of airflow, POX– Beta-2 agonists– Corticosteroids
Managing Asthma (cont.)
• Hospitalization and respiratory failureBOX 33-8 (Criteria for hospitalization)
– Intubation• Elective• Respiratory Fatigue
– Mechanical ventilation• Low Vt
– PS ventilation Based on the degree of sedation– I:E ratio for adequate ventilation– Prone to pneumothorases, barotrauma, per > PIP, &
hypotension
Asthma
• Exercise-induced bronchospasm (EIB)– 5-10 minutes after activity
• Asthma at school– Teachers – Self esteem
• Asthma camps– AHA
• SCAMP CAMP
Chapter 43Chapter 43Pg. 706-714Pg. 706-714
Disorders of the PleuraDisorders of the Pleura
Pleural Effusion • Clinical signs:
– Decrease in B/S, Dullness to percussion compared to the contralateral
– Tachypnea and pain• Diagnosis: CXR• Tx:Thoracentesis• Laboratory studies: Transudate vs.
Exudate, empyema (-Tube)• Causes:BOX 43-2 & 43-3 (pg. 708)• Complications: • pneumothorax• Hemorrhage• Infections
PLEURAL EFFUSION
Pneumothorax• Clinical signs:
– Chest pain & SOB– Decrease breathsounds on affected
side with hyperresonnance• Diagnosis: CXR• Treatment:
– Nitrogen washout– Needle aspiration– CT
HydroPneumothorax (cont.)
Thoracostomy Drainage
• Indications: Drainge of air/ fluid• Procedure for placement
– Conscious sedation– Role of the respiratory therapist– Assist/ Place– Drainages system (3 bottles)
Thoracostomy Drainage (cont.)
Surgery in the Pleural Space
• Treatment of empyema• Thoracoscopy • Chemical pleurodesis