why do paeds have a higher resp rate?
- greater metabolic rate
- higher O2 consumption
- Tidal volume of only 5-7ml/kg
- relatively few fatigue-resistance muslce fibres and tend to tire easily if work of breathing increased.
why are paeds at increased respiratory failure ridk?
decrease respiratory reserve + increase o2 demand
How long does it take for pulmonary physiology to mature to that of an adult?
8 years
what are the issues surrounding young infants being obligate nose breathers?
nasal secretions or malformations can eaily obstucty airflow and conteibute to resp distress
Why is chest wall compliance reduced in infants and young children?
Due to cartilaginous and flexible body structure of the chest wall
- intercostal muslces are also relatively soft
how do the ribs differ in infants than adults?
Lay more horizontal which limits the volume
what % of total oxygen consumption is taken up by normal breathing in paeds?
25 %
Why do paed respiratory muslces fatigue quicker?
less glycogen stores and fewer fatigue-resistance muscles
What is important to note about the abdominal covity when treating paeds?
Distension with gas more prone to vomiting on assisted ventilations
What is the difference between a paed and adult larynx?
Larynx is higher and more anterio in paed.
Sits at the level of 2nd - 3rd cervical vertebrae in paed…. 6-7th in adults
positioning is harder to visualise in paed airway
How c an tonsils be an issue in paed airway management?
tonsils in toddlers and young children may be enlarged, contributing to airway obstruction.
makes endotrachael tube more difficult
How can a soft cartilaginous trachae be an issue with paeds?
more subject to collapse and obstruction
What is the issue with paeds having a large tongue?
- obstructs airway
- difficult to visualise larynx
How is the epiglottis different in paeds?
Differently shaped
- adult is broader, axis parallel to trachea
- infant is omega shaped and angled away form axis of trachea
- more difficult to lift an infants epiglottis with curved laryngoscope blade
-
Detail head positioning for a child ages 1 - 14
and an infant (one month to 1 year)
1-14
Best left supine without towel or cushion
infant
managed with small towel under shoulders
why are infants less tolerant to demands of respiratory problems?
- smaller airways with high resistance to airflow
- Ventilation is the product of the respiratory
rate and tidal volume. Infants normally have less TV and lower
residual capacities, which provide minimal reserves of oxygen. - Children have relatively few fatigue resistant muscle fibres, and
tend to tire quickly with increases in the work of breathing
– Children can quickly go into respiratory failure
What are the signs of impending respiratory failure?
Increase work of breathing Tachypnea/tachycardia Nasal flaring Drooling Grunting Wheezing Stridor Head bobbing Use of accessory muscles/retraction of muscles Cyanosis despite O2 Irregular breathing/apnea Altered consciousness/agitation Inability to lie down Diaphoresis
What group of children have the highest risk of choking?
Under 4.
- smaller airways
- put shit in their mouth
- swallowing mechanisms are less developed
- infants cannot easily change their body position
- cant avoid or clear own obstruction
What are the parts of the Paed Assessment triangle?
Appearance
- tone
- interactiveness
- consolability
- look/gaze
- speech/cry
Breathing
- Abnormal breath sounds
- Abnormal positioning
- Retractions
- Nasal flaring
Circulation to the skin
- Pallor
- Mottling
- Cyanosis
What is the age range classification for a small infant?
Under 3 months
What is the age range classification for a Newborn?
24 hours
What is the age range classification for a large infant?
3 - 12 months
What is the age range classification for a small child?
1 - 4 years
What is the age range classification for a medium child?
5 - 11 years
