Pediatric Respiratory Distress Lecture Notes

Introduction

• Speaker: Jesse Rankin, Pediatric ER Physician at St. David's Children's Hospital.
• Topic: Pediatric Respiratory Distress.
  • Differences from adult presentations.
  • Focus on common conditions: croup, anaphylaxis, bronchiolitis, and asthma.
  • Aim: Recognize symptoms and avoid complications.

Pediatric vs. Adult Airways

• Anatomical Differences:
  • Smaller nasopharynx and larger structures in a smaller space.
  • Infants are obligate nose breathers.
  • Large tongue, tonsils, and adenoids relative to oral cavity.
  • Long floppy epiglottis prone to swelling.
  • Superior and anterior larynx.
  • Floppy tracheal cartilage.
• Physiological Differences:
  • Increased metabolic rate and oxygen consumption.
  • Rapid decompensation potential.
  • Primarily respiratory events leading to cardiopulmonary arrest.

Recognizing Respiratory Distress

• Initial Assessment:
  • Quick sick/not sick judgment.
  • Observe alertness and responsiveness.
  • Somnolence indicates potential respiratory failure.
• Signs of Respiratory Distress:
  • Tachypnea: Varies with age (neonates ~50 breaths/min, etc.).
  • Retractions: Types indicate airway obstruction location.
    • Supraclavicular: Upper airway.
    • Intercostal/Subcostal: Lower airway.
  • Other Signs: Head bobbing, nasal flaring, tracheal tugging.
  • Auditory Cues: Stridor indicates upper airway narrowing, distinguish from sturter (nasopharynx obstruction).

Common Conditions

Croup

• Overview:
  • Most common cause of acute stridor.
  • Affects children 6 months to 3 years old.
  • Viral infection (often parainfluenza).
• Treatment:
  • Maintain a patent airway.
  • Keep child calm, avoid unnecessary procedures.
  • Use racemic epinephrine for stridor at rest.

Anaphylaxis

• Criteria for Diagnosis:
  • Skin/mucosal involvement with respiratory compromise or hypotension.
  • Known allergen exposure with two of the following: skin, respiratory, circulatory, or GI symptoms.
  • Low blood pressure after allergen exposure.
• Treatment:
  • Immediate administration of epinephrine.
  • Adjuncts: IV fluids, albuterol, antihistamines, and steroids.

Bronchiolitis

• Overview:
  • Common in infants under 2, often caused by RSV.
  • Viral infection of lower respiratory tract.
• Symptoms:
  • Cough, tachypnea, wheeze, fever.
  • Risk of apnea in neonates.
• Treatment:
  • Supportive care: hydration, suction, oxygen.
  • High-flow nasal cannula therapy.
  • Bronchodilators are generally not recommended.

Asthma

• Overview:
  • Common chronic childhood disease.
  • Involves airway constriction and inflammation.
• Symptoms:
  • Severe cases: inability to talk, mental status changes, silent chest.
• Treatment:
  • Continuous albuterol nebulization.
  • Early administration of steroids.
  • Consider injectable bronchodilators like epinephrine for severe obstruction.

Key Takeaways

• Pediatric respiratory distress often results in respiratory failure.
• Sleepy or drowsy children in distress are concerning.
• Early and aggressive treatment of anaphylaxis.
• Bronchiolitis can be challenging; watch for apnea.
• Liberal use of albuterol in asthma exacerbations and don’t forget injectable bronchodilators.