Sids aw disorders asthma plural disorders chapters 31 32 33 43
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SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43 PowerPoint PPT Presentation


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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

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SIDs, AW disorders, Asthma, & Plural DisordersChapters: 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

  • 1week-1 year old (2-4 months < 6months)

  • ALTE (Apparent life-threatening event)

    • Color change

    • Hypotonia

    • 70% found in the morning…..


Risk Factors

  • Lending for intervention

    • Prone positioning

    • Maternal smoking

    • Bottle-feeding vs Breast feeding????


Normal Control of Heart Rate and Breathing

  • Breathing

    • Brainstem

  • Heart rate

    • Autonomic nervous system


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

  • Parameters: Pg. 547 Fig 31-3

    • EEG (Brain activity)

    • EOG (Bilateral Eye Movement)

    • EMG (Muscle tone) impendence belt

      -EtcO2

      -POX/ TCOM

      -ECG

      -Ph Probegraph 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.)

  • 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

Alert the caregiver to a cardiorespiratory abnormality

Diagnostic devices

Training

Social/parental implications


Chapter 32

Pediatric Airway Disorders and Parenchymal Lung Diseases


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 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.)

  • Periglottic obstruction (around the glottis)

    • Epiglottis

    • Laryngotracheobronchitis (LTB-CROUP)

    • Table 32-1 Differential Diagnosis

    • Pg. 559


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


Epiglottitis (cont.)


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


Laryngotracheobronchitis (cont.)


Lower Airway Disorders

  • Obstruction of the trachea and major bronchi

    • Tracheomalacia

    • Congenital tracheal or bronchial stenosis


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


Foreign Body Aspiration


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 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 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

  • 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


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


Chapter 33

PG. 582-597

Asthma

Most common chronic childhood disease


Pathogenesis

  • Definition:Chronic inflammatory disorder of the AWs

    • Mast cells, eosinophils, T lympocytes, IgE, Macrophages, neutrolphils, & epithelial cells

    • Wheezing &Breathlessness


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

  • 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

  • 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

  • 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

  • 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


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.)

  • Control of triggers

    • Identification of allergens

    • Avoidance and control measures

    • Immunotherapy

      • controversial


Management (cont.)

  • Peak flow monitoring

    • Peak flow meter

    • Peak flow diary

    • Personal best reading

    • Peak flow zone system

      • Pg. 593


Patient and Family Education

Asthma disease process

Medication skills

Identification and control of triggers

Self-monitoring techniques


Managing Asthma

  • Exacerbations in the ED

    • Assessment: PF of airflow, POX

    • Beta-2 agonists

    • Corticosteroids


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

  • Exercise-induced bronchospasm (EIB)

    • 5-10 minutes after activity

  • Asthma at school

    • Teachers

    • Self esteem

  • Asthma camps

    • AHA

      • SCAMP CAMP


Chapter 43

Pg. 706-714

Disorders of the Pleura


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


Pleural Effusion


Pneumothorax

  • Clinical signs:

    • Chest pain & SOB

    • Decrease breathsounds on affected side with hyperresonnance

  • Diagnosis: CXR

  • Treatment:

    • Nitrogen washout

    • Needle aspiration

    • CT


HydroPneumothorax (cont.)


Thoracostomy Drainage

  • Indications: Drainge of air/ fluid

  • Procedure for placement

    • Conscious sedation

    • Role of the respiratory therapist

    • Assist/ Place

    • Drainages system (3 bottles)


Thoracostomy Drainage (cont.)


Surgery in the Pleural Space

Treatment of empyema

Thoracoscopy

Chemical pleurodesis


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