Pediatric Respiratory Distress Lecture Notes

Introduction

• Presenter: Jesse Rankin, Pediatric ER Physician
• Focus: Pediatric Respiratory Distress
• Objective: Recognize presentations and manage conditions like croup, anaphylaxis, bronchiolitis, and asthma

Pediatric vs Adult Airway

• Anatomical Differences:

  • Smaller, yet what exists is larger in a smaller space
  • Nasopharynx: Smaller and easily occluded
  • Infants: Nose breathers, large tonsils, adenoids, tongue
  • Floppy epiglottis and more anterior, superior larynx
  • Tracheal cartilage: Floppy, makes airway collapse easier

• Physiological Differences:

  • Increased metabolic rate and oxygen consumption
  • Small lung volumes, potential for rapid decompensation
  • Respiratory failure often leads to cardiopulmonary arrest

Recognition of Respiratory Distress

• Observation Techniques:

  • Evaluate child's alertness and response
  • Signs of lethargy or listlessness
  • Somnolence indicates potential respiratory failure

• Signs of Distress:

  • Tachypnea: Varies with age
    • Neonate: ~50 breaths/min
    • <6 months: ~40 breaths/min
    • 1 year: ~30 breaths/min
  • Retractions:
    • Supraclavicular: Upper airway obstruction
    • Intercostal/Subcostal: Lower airway obstruction
  • Head Bobbing: Due to neck muscle contraction
  • Nasal Flaring: Decreases airway resistance
  • Tracheal Tugging: Seen in croup
  • Grunting: Indicative of lower respiratory tract disease

Differentiating Strider and Sturter

• Strider: High-pitched noise on inspiration, indicates upper airway narrowing
• Sturter: Low-pitched snoring noise, indicates nasopharyngeal obstruction

Upper vs Lower Airway Obstruction

• Upper Airway:

  • Signs: Nasal flaring, strider, tracheal tugging, sturter
  • Conditions: Croup, Epiglottitis, Anaphylaxis

• Lower Airway:

  • Signs: Wheezing, grunting, subcostal/intercostal retractions
  • Conditions: Asthma, Bronchiolitis, Pneumonia

Specific Conditions

Croup

• Most common cause of acute strider
• Affects children 6 months to 3 years
• Viral infection, prevalent in winter
• Treatment: Maintain airway, racemic epinephrine for strider at rest

Anaphylaxis

• Rapid onset allergic reaction, can be fatal
• Criteria involve skin, respiratory, circulatory reactions
• Treatment: Epinephrine, adjuncts like steroids and antihistamines

Bronchiolitis

• Common in infants <2 years
• Viral infection affecting bronchioles, often caused by RSV
• Treatment: Supportive care, high-flow nasal oxygen, bronchodilators

Asthma

• Chronic childhood disease with airway constriction and inflammation
• Severe Asthma Indicators: Inability to talk, silent chest
• Treatment: Albuterol, steroids, epinephrine for severe cases

Key Takeaways

• Respiratory distress in children can lead to rapid decompensation
• Early recognition and intervention are critical
• Prioritize epinephrine in anaphylaxis and severe asthma
• Be cautious with bronchiolitis; monitor for apnea in neonates
• Continuous albuterol useful in status asthmaticus