RT134 Pediatric Respiratory Care

Brain cells not fully developed until about age 5

Motor development is from head to trunk

Developing brain more sensitive to poisions, infections and injury

Rib cage is more elastic and flexible due to higher amounts of cartilage than bone.

Has more cartilage than bone (fractures less common than pulmonary contusions)

about age 8

16 - 17 generations

Relatively small number of broncholes
this produces smaller number of cross sections and makes them more susceptible to broncholitis and RSV.

Airway diameters pediatric patients can be 1/2 that of an adult.
in the presence of an edema, a pediatric airway can narrow the airway by 50% while in the adult, it only narrows by 10%.

Trachea

sweat chloride test

RR 30 – 50
HR 84 – 145
BP 70/44

RR 16 – 21
HR 60 – 120
BP 120/77

RR 19 -24
HR 65 – 130
BP 111/70

increased ICP and lethargy

Normal kids are hyper and active.

Retractions
Sighs
grunting
nasal flairing

oxygen hood
10-15 lpm
Fi02 .80-.90

Alternatively: nasal cannula

Can deliver greater than .50 FiO2 at high flows
Not reliably stable concentrations
Limits access to patient

(age + 16)/4 = et tube size then round up.

et tube inner diameter x 3 = depth

neutral with a towel placed under it

2-6 yrs old
Bacterial (Haemophillus influenzae, type B)
Acute onset
Complaint of sore throat
High fever
Muffled voice
Perfers sitting upright with chin forward

Retractions, Drooling, Appears acutely ill

CXR show thumb sign

enlarged epiglotis

Thickened aryepiglottic folds

Establishment of stable, artificial airway is first priority!

ETT under general anesthesia
Use 1 size smaller than predicted due to edema
In place 12-48 hours to allow inflammation to decrease
Extubate when fever diminished and 20 cwp leak around ETT

Antibiotic Therapy
2 day course of ceftriaxone
5 day course of chloramphenicol

3 months – 3 years
Gradual onset usually during “cold season”
Often preceded by low grade fever, malaise, rhinorrhea and hoarse voice
Barky, seal-like cough
Nasal flaring, nasal congestion, retractions
Stridor that worsens as child gets agitated

Laryngotracheobronchitits

Steeple sign

narrowing of the subglottic area

Treatment is largely supportive care

Cool mist

Oxygen as indicated by SpO2

Racemic Epinephrine - Vasoconstriction of upper airway

2.2% solution

O.5 – 1.0 ml diluted in 3.0 ml normal saline

Deliver by face mask

Steroid Therapy

Single dose dexamethasone 0.6 mg/kg

Oral Dexamethasone at 0.6 mg/kg

RSV

sputum samples

| immunofluorescence of respiratory secretions

Have history of prematurity

Have chronic lung disease– CF, BPD

Have history of congenital heart defects

Live in crowded environments

Attend day care facilities

Are exposed to second hand smoke

Less than 1 year
Cold (coryza)
Cough, respiratory distress
Wheezing, tachypnea

Older than 2 years of age
Profound nasal congestion, productive cough
Diffuse rales (velco)
Wheezing

Mostly supportive care with careful monitoring

Watch for dehydration
Low O2 concentration- .30 - .40 by hood or tent.
Bronchodilators? (Controversial)

Antiviral Medications
Ribavirin via SPAG generator

bilateral lower lobe alveolar infiltrates

Have history of prematurity

Have chronic lung disease– CF, BPD

Have history of congenital heart defects

Live in crowded environments

Attend day care facilities

Are exposed to second hand smoke

DEC - MAR