what are the anatomical differences between adult and paed respiratory system?
Anterior and superior larynx larger tongue Horizontal ribs smaller airways larger floppier epiglottis tonsils and adenoids less fatigue-resistant muscle fibres less developed Diaphragmatic breathers small mandible and neck
At what age does a childs rep system reach maturity?
approx 8 years old
precautions of child with resp conditions?
Children are obligate nose breathers
- nasal secretions or malformations can easily obstruct air flow
Predominately diaphragmatic breathing until 6-8 years… anything that interferes with this (pneumonia, abdo pain) can cause resp distress
what age does a baby in gestation start to generate pulmonary surfactant
24 weeks
what age does a baby in gestation generate adequate pulmonary surfactant
35 weeks
What is the O2 consumption of a child compared to adult?
Infant = 6ml/kg/min adult = 3ml/kg/min
Explain the difference in lung mechanics during inspiration and expiration between an adult and a premature infant
Adult:
Insp - diaphragm contracts down, chest wall expands out
Exp - Diaphragm relaxes up, chest wall moves inward
Prem Infant:
Insp - Diaphragm contracts down, chest wall moves inward
Esp - diaphragm relaxes up, chest wall moves outward
What is the tidal volume of a child?
5-7mls/kg
What is minute alveolar ventilation more dependent on in infants?
Increased RR rather than TV
If a radius is halved, how much does resistance increase by? (exam Q)
16x
What are some signs of respiratory distress in infants?
- Nasal flaring
- drooling
- cyanosis despite 02, pallor
- grunting/wheezing
- irregular breathing/apnoea
- inability to lie down
- diaphoresis
- stridor
- flaring
- head bobbing
- decrease conscious state
- lethargy
- floppy
- WOB +- accessory muscles
- Tachyponea
- Tachycardia initially, moving to bradycardia as late sign
What is the threshold for CPR in a paed?
Infant <60
Child <40
What are the components of the Paediatric Assessment triangle?
Appearance (TICLS)
- tone
- interactiveness
- Consoliability
- Look/gaze
- Speech/Cry
Work of breathing
- abnormal breathing sounds
- abnormal positioning
- retractions
- nasal flaring
Circulation to the skin
- Pallor
- Mottling
- Cyanosis
What are the normal values and age and weight of a newborn?
HR = 110 - 170 BP = 60 SBP AGE = 24 hours Weight = 3.5 kg RR = 25 - 60
What are the normal values and age and weight of a small infant?
HR = 110 - 170 BP = 60 SBP AGE = <3 months Weight = 6 kg RR = 25 - 60
What are the normal values and age and weight of a large infant?
HR = 105 - 165 BP = 65 SBP AGE = 3 - 12 months Weight = 6kg - 3 months / 8kg - 6 months / 10kg - 12 months RR = 25 - 55
What are the normal values and age and weight of a small child?
HR = 85 - 150 BP = 70 SBP AGE = 1 - 4 years Weight = age x 2 + 8 RR = 20 - 40
What are the normal values and age and weight of a medium child?
HR = 70 - 135 BP = 80 SBP AGE = 5 - 11 years Weight = age x 3.3 RR = 16 - 34
What accessory muscles are used by infants in resp distress?
intercostals suprasternal supraclavicular substernal subcostal
What are the signs of hypoxia in infants?
- pallor
- bradycardia
- hypotension
- apnoea
- lethargy
What are the signs of hypoxia in children?
- restlessness
- cyanosis
- tachycardia (brady as late sign)
- tachypnoea
What is Respiratory Syncytial Virus (RSV)?
presents similar to influenza and is the principal cause of bronchiolitis
- disease spectrum ranging from Rhinitis and Otitis media to bronchiolitis and pneumonia
peaks at 2-5 months. everyone would have had it by 3
what is the most common cause of lower respiratory tract infection (LRTI)?
RSV - respiratory syncytial virus
What are the symptoms of the respiratory syncytial virus
- high fever with ill appearance
- thick nasal discharge
- worsening cough or cough that produces yellow, green or grey mucus
- signs of dehydration
- trouble breathing
