Common cause of wheezing in kids
viral infections
what time of day is ore suggestive of asthma?
Coughing thats worse in middle of the nigh (midnight at 3AM)
What are some risk for developing asthma?
- RSV infection prior to 6 months
- Family history of atopy: allergic rhinits, eczema
What are some examples of common triggers for astha?
- virus
- allergies
- exercise
- cold air
- cigs
what are some common finding on a CXR in a kid with asthma or reactive airway disease (RAD)
- atelectasis
- hyperinflation of both lungs
- perihiblar thickening
compare capillary refill in an asthmatic kid vs healthy
- cap refil right at 2 sec is concerning, chiild isn’t heading in right direction
- > 2 sec MUCH more concerning
- healthy kids cap refill nearly instantly
what is the best way to obtain blood gasses in a peds pts?
- Capillary blood gas fairly common in kids (quicker and less distressing than arterial gas which are more accurate
- can’t use PaO2 from them
- useful only for pH and Co2
where should a peds pt with asthma exacerbation be admitted?
PICU - due to risk of decompensation
Options for maintenance IVF in kids
1/2 NS in >1 yo OR 1/4 NS in <1 yo
- NS is reserved for bolusing
- In peds usually K is added to IVF
when is it appropriate to intubate an asthmatic pts and prior treatments
Make every attempt to maintain respiratory status before intubating. Add: terbutaline drip, Mg, Theophylline, subc epi, heliox, or BiPAP IN ORDER TO NOT INTUBATE.
- Time to intubate is where between irritable and obtunded
why do you not want to intubate asthmatics?
they can’t exhale, so if you force in air they get fuller and fuller and risk pneumothorax or acute right heart collapse and die
which population of asmathics has highest mortality?
- adolescents because theyre too cool to carry around rescue inhalers
signs of respiratory distress in a respiratory pt
- inspiratory and expiratory wheezing
- nasal flaring and tachypnea
- subcostal, intercostal and suprasternal retractions
- stridor
- sniffing or tripod position
- decreased air movement
what would indicate concern for CF in a respiratory distress pt and how would you test for it?
- poor height and wt
- clubbing
- foul smelling stools
- recurrent pneumonia
- edema
- failure to thrive
Test with sweat chloride test
sudden stridor in a child makes you think of what?
- foreign body aspiration
