respiratory distress in children l.
Skip this Video
Loading SlideShow in 5 Seconds..
Respiratory distress in children PowerPoint Presentation
Download Presentation
Respiratory distress in children

Loading in 2 Seconds...

play fullscreen
1 / 44

Respiratory distress in children - PowerPoint PPT Presentation

  • Uploaded on

Respiratory distress in children. Prepared by : Dr. MOHAMMAD Mizyed Supervised by: Dr. Nadwa Al- zohlouf -2008-. Respiratory distress in children. Respiratory distress is one of the most common chief complaints for which children seek medical care.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Respiratory distress in children' - belinda

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
respiratory distress in children

Respiratory distress in children

Prepared by:


Supervised by:

Dr. Nadwa Al-zohlouf


respiratory distress in children2
Respiratory distress in children
  • Respiratory distress is one of the most common chief complaints for which children seek medical care.
  • It account about 10% of pediatric emergency visits to E.R .
  • The evaluation of acute respiratory distress should include determination of severity and the need of emergent intervention as well as underling cause.
  • Respiratory distress defined as increased work of breathing.
  • distress develops as a result of:

- an attempt to improve minute ventilation

(tidal volume x RR) as in hypoxia.

-as a result of respiratory stimulation or depression.

-difficulty in mechanics of respiration ,typically from airway obstruction or muscle fatigue.

signs symptoms of distress
Nasal flaring

Hypoventilation, apnea








Head bobbing

Tripod positioning


 Level of consciousness

 Air movement



Signs & symptoms of distress
why are kids different
Obligate nose-breathers

Tongue relatively larger

Higher larynx (C3-C4 versus C6)

Narrow airway causes .

Increased metabolic demands

Less elasticity of alveoli.

Lower FRC.


Muscle fibers more vulnerable to fatigue

Chest wall

More compliant

Ribs more horizontal

Why are kids different?

SOrespiratory distress must be earyrecognised because they become fatigued and decompensated early than older patients

normal upper airway anatomy







Normal upper airway anatomy
typical causes of distress
Typical causes of distress
  • LIFE THREATINING CONDITIONS:1-Complete or severe upper airway obstruction as foreign body aspiration, angioedema and epiglottitis.

2-Tension pneumothorax .3-Cardiac tamponade.

4- Pulmonary embolism5-Traumatic conditions as flail chest

typical causes of distress9
Typical causes of distress
  • Respiratory Conditions:
  • Upper airway
    • Croup
    • Retropharyngeal abscess
    • Epiglottitis
    • Foreign body aspiration
  • Lower airway
    • Asthma
    • Bronchiolitis
    • Pneumonia
    • Pneumothorax
typical causes of distress10
Typical causes of distress
  • Cardiovascular:-congestive heart failure. -cyanotic heart disease. -pericarditis. -myocarditis.
  • Nervous system -depressed ventilation. -hypotonia. -loss of protective reflexes.
typical causes of distress11
Typical causes of distress
  • Gastrointestinal: -abdominal distension. -aspiration from GER.
  • Metabolic diseases: -acidosis. -hyperthyroidism. -hypothyroidism.
  • Hematological: -severe anemia. -methemoglobinemia. -acute chest syndrome.
  • Trauma.
  • initial rapid assessment should include:

-identification of children with respiratory distress.

-rapid assessment of respiratory status.

-identification of children who require immediate intervention (life-threatining).

-brief history while emergent treatment is initiated.

-trial to keep the child calm and comfortable.

  • detailed history should obtained after stabilization of the child
  • Trauma as in pneumthorax, flail chest or head injury
  • Change in voiceusually occurs with upper airway pathology as hoarsness in croup
  • Onset & duration of symotoms.
  • History of foreign body aspiration/ingestion.
  • Associated symptoms as fever ,cough, vomiting or chocking
  • Exposure to specific toxins , infections or allergens.
  • Previous episodes as in asthma
  • Underlying medical conditions as Hx of asthma or sickle cell disease
physical examination
  • General observations:
  • mental status: anxiety, restlessness and lethargy.
  • position of comfort: as “sniffing position” (neck flexion with mild head extension) in upperairway obstruction and “tripod position” (child is sitting up and leaning forward on outstretched hands) in epiglottitis.
  • nasal flaring.
  • chest wall movement.
  • abnormal sounds as stridor, hoarsness & wheezes .
physical examination15
  • Cyanosis
  • respiratory rate
  • respiratory pattern

-rapid, shallow breathing as in asthma and bronciolitis (air trapping)

-kussmal breathing as in matabolic acidosis (DKA)

-ataxic respiration as in CNS infection or injury

physical examination16
  • Palpation and percusion

-subcutaneous emphysema which can be seen in pneumothorax

-vibratory rhonchi.

-increased tactile fremitus as in consolidation or decreased as in upper airway obstruction.

- hyper-resonance or dullness

physical examination17


-wheezes which is typically heard with asthma and bronchiolitis .unilateral wheezes indicates foreign body in lower airway.

-cracklesas in pneumonia an pulmonary edema

-pleural rub as in pneumonia and pleural abscess.

-decreased breathing sounds as in atelectasis ,pneumonia and effusion.


-the clinical evaluation usually suggest the cause of respiratory distress.

-diagnostic test should confirm the diagnosis and direct treatment, it may include; a-imaging -CXR -CT scan -Fluroscopy b-ABGs c-RBS d-cultures e-urine toxicology screen ……etc

  • Depends upon the underlying cause of respiratory distress ,severity and response to initial therapy .
  • Initial therapy may include:






croup l aryngo t racheo b ronchitis
Croup (LaryngoTracheoBronchitis)
  • Most severe in kids 6 mo - 3 years old
  • Males
  • Winter months
  • Associated illnesses
    • Ear infection
    • Pneumonia
    • Organisms: parainfluenza types 1, 2 & 3, adenovirus, RSV, influenza
croup symptoms
Croup symptoms
  • URT symptoms X 1-3 days
  • Low grade fever
  • “Barking” cough, hoarseness
  • Inspiratorystridor
  • Worse at night
  • Prefer to sit up
  • Aggravated by agitation & crying
croup diagnosis
Croup diagnosis
  • Clinical diagnosis
  • Does not require neck X-ray
    • Consider X-ray in patients with atypical presentation or clinical course
  • “Steeple sign”

Steeple sign

croup treatment transport


Narrow air column


Steeple sign

Croup treatment & transport
  • Position of comfort, with parent
  • Dexamethasone 0.6 mg/kg IV/IM
  • Epinephrine neb.
  • Heliox
  • SQ Epi.
  • Cool mist
retropharyngeal abscess
Retropharyngeal abscess
  • Deep, potential, space of the neck
  • Children age 6 months to 6 years
  • Other deep neck abscesses more frequent in older children & adults
    • Parapharyngeal
    • Peritonsillar
  • Potential for airway compromise
  • Complications secondary to mass effect, rupture of the abscess, or spread of infection
retropharyngeal abscess sxs
Fever, chills, malaise

Decreased appetite


Sore throat

Difficulty or pain swallowing

Jaw stiffness

Neck stiffness

Muffled voice

“Lump” in the throat

Pain in the back & shoulders upon swallowing

Difficulty breathing is an ominous complaint that signifies impending airway obstruction

Retropharyngeal abscess - sxs


retropharyngeal abscess27
Retropharyngeal abscess
  • Polymicrobial infection typical
    • Gram-positive organisms and anaerobes predominating
    • Gram-negative bacteria possible
    • Oropharyngeal flora .
  • Most common cause is group A beta-hemolytic streptococci
retropharyngeal abscess rx
Retropharyngeal abscess - Rx
  • Position airway – comfort.
  • Avoid unnecessary manipulation
  • Monitor, CT of neck, possible Op.
  • Sedation & paralytics can relax airway muscles, leading to complete obstruction.
  • Endotracheal intubation is dangerous.
  • Abx: clindamycin, ampicillin/sulbactam


  • Acute, rapidly progressive cellulitis of the epiglottis and adjacent structures.
  • Before immunization - peak incidence at 2-4 years of age.
  • Danger of airway obstruction - medical emergency.
  • Prompt diagnosis and airway protection is required
epiglottitis signs sxs
Epiglottitis - signs & sxs
  • More acute presentation in young children than in adolescents or adults.
  • Symptoms for <24 hrs
    • High fever, severe sore throat, tachycardia, systemic toxicity, drooling, tripod position.
  • Moderate or severe respiratory distress with inspiratorystridor & retractions (stridor suggest near complete airway obstruction)
epiglottitis lateral neck film
Epiglottitis - lateral neck film

Thumb sign

(swollen epiglottis)

epiglottitis etiology
Epiglottitis - etiology
  • Group A Streptococcus
  • Other pathogens seen less frequently include:
    • Strep pneumoniae
    • Strep pyogenes
    • Staph aureus.
    • Haemophilus influenza type b was the most common cause before administration of HiB vaccine.
epiglottitis rx transport
Epiglottitis - Rx & transport
  • Position of comfort, with parent
  • Minimize manipulatio
  • Intubation under controlled circumstances
  • O2prn, blow-by if not tolerating mask
  • Avoid agitation (Do not try to start IV, obtain blood or examine airway!)
  • Consult anesthesia & ENT
  • IV for antibiotics, after airway secure
epiglottitis trouble
Epiglottitis - Trouble
  • If respiratory arrest  Bag ventilation  if inadequate, attempt to intubate if unable to intubate, perform needle or surgical cricothyroidotomy
  • IV antibiotics
    • ceftriaxone / cefotaxime
  • Racemic epinephrine & steroids are ineffective
foreign body fb aspiration
Foreign body (FB) aspiration
  • Toddler through preschool age common
    • No molar teeth for thorough chewing
    • Talking, laughing, and running while eating
    • Infants <3y account 73% of cases.
  • Nuts, raisins, sunflower seeds and pieces of meat .
fb aspiration
FB aspiration
  • Sudden episode of coughing / choking while eating with subsequent wheezing (sometimes unilateral), coughing, or stridor
  • Tragic cases occur with total or near-total occlusion of the airway
  • Frequent sites of FB lodgement:
    • Usually below vocal cords
    • Mainstem bronchi
    • Trachea
    • Lobar bronchi
fb aspiration38
FB aspiration
  • Extrathoracic FB:
    • Breath sounds are inspiratory
  • Intrathoracic FB
    • Noises are symmetric but more prominent in central airways
    • If FB is beyond the carina, the breath sounds are usually asymmetric
fb aspiration39
FB aspiration
  • Hyperinflation & air-trapping of the affected lobe(s) is typical
    • Best seen with X-ray taken at expiration
    • Difficult in little kids.
  • May see soft tissue opacity in proximal airway
clinical manifestation
Clinical manifestation
  • Three stages:
  • Initial event:

paroxysm of coughing, chocking & possibly airway obst.

  • Asymptomatic interval:

F.B become lodged ,reflexes fatigue & immediate irritating symptoms subside.

  • Complications:

.obstruction, erosion, or infection occurs which direct attention again to the presence of F.B

.symptoms of this stage include fever.cough,hemoptysis,pneumonia and atelectasis

fb aspiration transport issues
FB aspiration - transport issues
  • Position of comfort
  • Heimlich maneuver, back blows
  • F.B removal by:

-Magill forceps (if object above cords)

-Rigid bronchoscopy.

  • Cricothyrotomymay be

indicated to establish airway in upper airway obst.