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SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43. Walsh E. Chavez RRT-NPS. Definition of SIDS. Sudden and unexpected death of an infant for which sufficient cause cannot be found by a death scene investigation, review of the history, and a postmortem

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sids aw disorders asthma plural disorders chapters 31 32 33 43

SIDs, AW disorders, Asthma, & Plural DisordersChapters: 31,32,33 & 43

Walsh

E. Chavez RRT-NPS

definition of sids
Definition of SIDS
  • Sudden and unexpected death of an infant for which sufficient cause cannot be found by a death scene investigation, review of the history, and a postmortem
  • 1week-1 year old (2-4 months < 6months)
  • ALTE (Apparent life-threatening event)
    • Color change
    • Hypotonia
    • 70% found in the morning…..
risk factors
Risk Factors
  • Lending for intervention
    • Prone positioning
    • Maternal smoking
    • Bottle-feeding vs Breast feeding????
normal control of heart rate and breathing
Normal Control of Heart Rate and Breathing
  • Breathing
    • Brainstem
  • Heart rate
    • Autonomic nervous system
slide5
SIDS
  • Etiology:
  • Brainstem: controls breathing(Prematurity?)
  • Central Apnea & periodic breathing
  • Tests for assessing risk factors
    • NO test that predicts risk for SIDS
    • Polysomnography/ pneumogram
    • Frequency of apnea
polysomnography
Polysomnography
  • Parameters: Pg. 547 Fig 31-3
    • EEG (Brain activity)
    • EOG (Bilateral Eye Movement)
    • EMG (Muscle tone) impendence belt

-EtcO2

-POX/ TCOM

-ECG

-Ph Probe graph Figure 31-2 (pg 546)

  • LaboratorySupervision: PediatricianWho Scores?
  • Setting: Pediatric Staged with Parent near
  • Personnel: knowledge of the child\'s behavior developmental stages
polysomnography cont
Polysomnography (cont.)
  • Normal sleep development:
    • REM and NON-REM
  • Apnea (3 categories)
    • Rapid base line
    • Central: (B’sD’s andColor change) 10-25%
    • Obstruction:hypopnea & apnea
    • OB lasting >10sec or 6-8 sec (UAW OB)
    • Complications: Desat/ > CO2;Day time Sleepiness, behavior changes, cor pulmonale
    • Treatment:
    • Removal of adenoidal & tonsils
    • NCPAP
    • NICU: Reflux, PofA, Hypoxia, anemia, IVH, Seditaives, seizures, incoordiation with feedings
home cardiorespiratory monitors apnea monitors
Home Cardiorespiratory Monitors= Apnea Monitors

Alert the caregiver to a cardiorespiratory abnormality

Diagnostic devices

Training

Social/parental implications

slide9

Chapter 32

Pediatric Airway Disorders and Parenchymal Lung Diseases

pediatric airway
Pediatric Airway

Upper airway (Pg. 555 fig. 32-1)

Above C3-4 Peds

non expandable Cricoid rings(Narrowest portion)

-obligate nose breathers 3-6 months

Poor coronation between rr& oropharngeal motor skills & large tongues

Developement up to 8 years of age

  • Lower airway:
  • Trachea > Subdivisions 17-16: adults23 generations…..RSV ?
  • Airway obstruction:
  • AP/ Lateral Neck-XRAY
  • Assessments: RDS, Auscultate UAW: Air movement muffled/stridor
upper airway disorders lesions inflammatory abnormal tissue tone
Upper Airway Disorderslesions, inflammatory, abnormal tissue, tone
  • Supralaryngeal obstruction
    • Choanal atresia
    • Pierre Robin syndrome
    • Deep neck infections
    • Tonsillar enlargement/Peritonsillar abscess
    • Obstructive apnea
upper airway disorders cont
Upper Airway Disorders (cont.)
  • Periglottic obstruction (around the glottis)
    • Epiglottis
    • Laryngotracheobronchitis (LTB-CROUP)
    • Table 32-1 Differential Diagnosis
    • Pg. 559
epiglottitis life threatening bacterial infection h influenza b
Epiglottitis Life Threatening =Bacterial infection (H influenza B)
  • Incidence and etiology
    • <6 years old
    • Noninfectious: aspiration of hot liquid, traumatic intubations, blind finger sweep
  • Signs and symptoms: ABRUPT
  • Fever, soar throat, dysphagia(drooling)
  • MUFFLED, retractions, RDS, upright sniffing position
  • Diagnosis: lateral NECk (Thumb sign) C&S, ABG
  • Treatment: (small?) ETT, RSI, ceftriaxone, Extubate leak?Bronchoscope, antibotcs
laryngotracheobronchitis ltb croup 6 months 6 years
LaryngotracheobronchitisLTB-CROUP(6 months-6 years)
  • Incidence and etiology:
  • Parainfluenza Virus 1
  • Over several days
  • Signs and symptoms:
  • Low grade fever, malasise, rhinorrhea, hoarse voice BARKY COUGH
  • Diagnosis:
  • Lateral neck-xray: Steeple sign (SUBglottic)
  • Treatment: Racemic Epi, hydration, temp ……………..control, humidification, Mist tents, O2,

>0.35Fio2= impending resp Failure

Intubations

lower airway disorders
Lower Airway Disorders
  • Obstruction of the trachea and major bronchi
    • Tracheomalacia
    • Congenital tracheal or bronchial stenosis
lower airway disorders pg563
Lower Airway Disorders pg563
  • Foreign body aspiration
    • Incidence:
      • Leading cause of accidental death
    • Signs and symptoms:
      • Degree of AW OB
      • Unilateral Wheezing/ reoccurring PNA
    • Diagnosis: AP CXR/neck and lateral
    • Laryngeal level
    • Hyperinflation/Ball valve effect
    • Bronchoscopy
    • Treatment:
    • Removal of object continue to monitor patient
lower airway disorders1
Lower Airway Disorders
  • Atelectasis
    • Etiology and pathophysiology:
      • Failure to reinflate
    • Signs and symptoms:
      • Dyspnea
      • (Severe) V/Q mismatch
      • RDS
    • Diagnosis: CXR, B/S, tracheal deviation
    • Treatment: Hyperinflation therapy, Bronchial hygiene therapy,
lower airway disorders2
Lower Airway Disorders
  • Bronchiectasis:
  • Irreversible dilation of the bronical tree
    • Etiology and pathology
      • CF/ frequent respiratory infections
      • Left lower lobes mostly involved
    • Signs and symptoms:
      • Chronic cough w/ copious amts of purulent sputum
    • Diagnosis: CXR and CT
    • Treatment: CPT, hydration, antibotics,
lower airway disorders3
Lower Airway Disorders
  • Acute bronchiolitis
    • Etiology: Viral Respiratory Tract infection related to RSV
    • Incidence:<1 year of age with BPD, CF, PPHN & CHD
    • Signs and symptoms: coryza, cough, RDS, wheezing (APNEA), dehydration
    • Diagnosis:Nasal Swab: +RSV
    • Treatment:O2, (MV), IV, Supportive care
    • Prognosis: GOOD
pneumonia
Pneumonia
  • Viral
    • 1st:Respiratory syncytial virus (RSV)
      • Coryza, NASAL CONGESTION, cough & fever
      • Supportive Care vs. Ribavirin
    • 2nd:Parainfluenza virus Types1(LTB), 2, and 3(children<5yr)
      • O2 and supportive care
    • Influenza virus:
      • Winter seasons
      • Vaccinations yearly
    • Adenovirus:
        • High rates of M & M.
        • Overwhelming sepsis
        • Supportive care
pneumonia1
Pneumonia
  • Bacterial
    • Incidence: Compromised immune function, recurrent aspiration, malnutrition, daycare, passive cigarette
    • Etiology: microorganisms colonize in the URT
    • Signs and symptoms: same as viral
    • Diagnosis: CXR, > total band count>1500, CRP, Blood Culture
    • Treatment: oral/ IV antibiotics
    • 7-14 days
        • Pox & ABG
slide25

Chapter 33

PG. 582-597

Asthma

Most common chronic childhood disease

pathogenesis
Pathogenesis
  • Definition:Chronic inflammatory disorder of the AWs
    • Mast cells, eosinophils, T lympocytes, IgE, Macrophages, neutrolphils, & epithelial cells
    • Wheezing &Breathlessness
pathogenesis of asthma
Pathogenesis of Asthma
  • Pathophysiology
    • Chronic airway inflammation
    • Bronchial hyperresponsiveness
    • Hypersecretion of mucus
  • Components of Asthma:
    • Inflammation -A remodeling
    • Bronchial constriction -Mucous plugging
    • AW edema -AW Hyperreponsiveness
    • RESULTS:
      • HYPERinflation, atelectasis, hypoxia, V/Q mismatch, Hypercarbia
risk factors for developing asthma
Risk Factors for Developing Asthma
  • Allergic response:
    • IgE
    • Reversible vs. irreversible
    • AW remoding=fibrosis
  • Environmental triggers
    • Intervention
    • Remediate & eliminate
      • Tobacco
      • Cockroaches/ Dust mites
      • Molds
national asthma education and prevention program
National Asthma Education and Prevention Program
  • Purpose:
  • to serve as a comprehensive tool to diagnosis and manage asthma
  • Goals: Box 33-1:
    • Prevent: Chronic asthma, recurrent
    • Maintain: NL ADLs, NL/near NL pulmonary function
        • Optimal pharmacology
        • Meet family & patient’s expectations
diagnosis
Diagnosis
  • Medical history:
    • Symptoms & triggers
  • Physical examination:
    • History a stronger factor
    • Prolongs expiratory phase
    • RDS, Hyperexpansion
  • Pulmonary function testing:
    • FVC, FEV1 <80% predicted, FEV1/FV(< 65% predicted), FEF25-75%
  • Bronchoprovocational challenges (methacholine 20% decrease=+test)
  • Exercise: running/biking
        • Less sensitive HR > 170
management
Management
  • Pharmacologic therapy
    • Long-term control medications
      • Taken daily
      • Antiinflammatoryagents/ corticosteroids
      • Long acting B2 agonist(LABAs)
        • Salmeterol & Formoterol 30-90 minutes
      • Methylxanthines
      • Leukotriene modifiers: inhibits
      • Cromolyn sodium (Stablizes mast cells)
      • Immnuomodulators: Binds to IgE
management1
Management
  • Quick-relief medications: (5-15 minutes)
    • Short acting B-agonist last 4-6 hours
    • “rescue”
    • Anticholenergics
  • Delivery systems
    • MDI (Spacers & holding chambers)
    • DPI
    • SVN
management cont
Management (cont.)
  • Control of triggers
    • Identification of allergens
    • Avoidance and control measures
    • Immunotherapy
      • controversial
management cont1
Management (cont.)
  • Peak flow monitoring
    • Peak flow meter
    • Peak flow diary
    • Personal best reading
    • Peak flow zone system
        • Pg. 593
patient and family education
Patient and Family Education

Asthma disease process

Medication skills

Identification and control of triggers

Self-monitoring techniques

managing asthma
Managing Asthma
  • Exacerbations in the ED
    • Assessment: PF of airflow, POX
    • Beta-2 agonists
    • Corticosteroids
managing asthma cont
Managing Asthma (cont.)
  • Hospitalization and respiratory failure

BOX 33-8 (Criteria for hospitalization)

    • Intubation
      • Elective
      • Respiratory Fatigue
    • Mechanical ventilation
      • Low Vt
        • PS ventilation Based on the degree of sedation
        • I:E ratio for adequate ventilation
        • Prone to pneumothorases, barotrauma, per > PIP, & hypotension
asthma
Asthma
  • Exercise-induced bronchospasm (EIB)
    • 5-10 minutes after activity
  • Asthma at school
    • Teachers
    • Self esteem
  • Asthma camps
    • AHA
      • SCAMP CAMP
slide39

Chapter 43

Pg. 706-714

Disorders of the Pleura

pleural effusion
Pleural Effusion
  • Clinical signs:
    • Decrease in B/S, Dullness to percussion compared to the contralateral
    • Tachypnea and pain
  • Diagnosis: CXR
  • Tx:Thoracentesis
  • Laboratory studies: Transudate vs. Exudate, empyema (-Tube)
  • Causes:BOX 43-2 & 43-3 (pg. 708)
  • Complications:
  • pneumothorax
  • Hemorrhage
  • Infections
pneumothorax
Pneumothorax
  • Clinical signs:
    • Chest pain & SOB
    • Decrease breathsounds on affected side with hyperresonnance
  • Diagnosis: CXR
  • Treatment:
    • Nitrogen washout
    • Needle aspiration
    • CT
thoracostomy drainage
Thoracostomy Drainage
  • Indications: Drainge of air/ fluid
  • Procedure for placement
    • Conscious sedation
    • Role of the respiratory therapist
    • Assist/ Place
    • Drainages system (3 bottles)
surgery in the pleural space
Surgery in the Pleural Space

Treatment of empyema

Thoracoscopy

Chemical pleurodesis

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