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Approach To a Child with Respiratory Distress Dr Nor Azlina Bt Mohammad Rashid Aim To describe the respiratory system and common respiratory diseases and conditions in detail. To diagnose respiratory distress based on history, physical examination and investigation Formulate appropriate diagnosis Learning objectives Describe the respiratory system Depict signs of respiratory distress in a real patient List normal respiratory rate for different ages Define respiratory failure Describe obstructive and restrictive respiratory conditions Differentiate clinical presentation of obstructive airway conditions from restrictive lung conditions Learning objectives Describe upper respiratory tract problems in tabulated figure. Describe lower respiratory tract problems in tabulated figure Describe respiratory conditions presented with stridor. Differentiate clinical features of tracheolaryngobrochitis (croups) from acute epiglottitis. Describe conditions presented with wheezing in children and infants Emphasize on Childhood Asthma Describe congenital respiratory anomalies in infants briefly Lobar divisions of the lungs The anatomy of the respiratory system Respiratory function To provide adequate gas exchange between the circulating blood and the atmosphere Work of breathing- the work performed by the respiratory pump ; how much the volume of lung changes hence the respiratory muscles generate a given pressure Obstructive disorders Flow of gases through the airways is inhibited Extrathoracic- stridor Intrathoracic- wheezing, best heard during expiration Long deep breaths Hyperinflated and tympanitic to percussion Bronchoconstriction causes obstructive airway problems Restrictive disorders Alveoli are unable to expand fully Disease of the pulmonary parenchyma, pneumonia, fibrosis and consolidation Disease affecting pleura interfere pulmonary expansion Musculoskeletal , neuromuscular diseases Rapid shallow breathing , grunting, dull to percussion Restrictive pulmonary condition Clinical manifestation of respiratory failure Mechanical failure: increased ventilatory requirements and physical effort to fulfill these requirements—tachypnea, retractions, excessive use of accessory muscles Failure of respiratory control -apnea RESPIRATORY FAILURE Definition Alterations in the arterial PO2 and PCO2 Both parameters are regulated by the central nervous system Can result from failure of mechanical function f the lungs and chest wall or in the respiratory control Terminal respiratory unit task Divide your group, each group present a patient with common respiratory problems stated in the learning objectives . Present upper respiratory tract problems Present lower respiratory tract problems List common etiology including viral agents, bacteria, allergent and smoke inhalation. Describe and discuss preventive measures for your patient Relate to immunization programs Senario 1 Ahmad a 3 year old boy was playing with his small toy car with his elder brother. Suddenly he coughed and turned cyanosed. He appeared very apprehensive, held his throat and extend his neck. What is the mechanism of respiratory failure? What is your immediate action? Senario 2 Aminah, a 2 years old toddler girl was playing fireworks with her elder brothers and cousins at the balcony. Suddenly the firework exploded unexpectedly and produced excessive smoke. Aminah suddenly cough and her voice became muffled. What is the mechanism of Aminah’s respiratory distress? Senario 3 Samy, a 2 days old premature infant who was born at 30 weeks gestational age was noted to be cyanosed by a nurse. There was absence of chest movement. What is Samy’s clinical condition? What is your immediate action? What is the mechanism of his respiratory failure? Senario 4 Ah Kow, a 4 years old boy has been visiting the casualty many times this year with complaint of cough and difficulty to breath. His condition is releived by oxygen nebulized salbutamol . He has cough almost every night during sleep. Sometimes his mother heard wheezing sounds. What is the mechanism of Ah Kows respiratory condition? How do you confirm the diagnosis? What are the other histories that you would like to elicit? How do you categorize the severity of his problem? What is your plan of management? What are the relevant investigation? Senario 5 Aminah a 2 year old toddler has been having mild cough and rhinorrhea for the past 2 days. It was associated with low grade fever. Suddenly her mother noticed that she breath noisily with fast breathing. What is Aminah’s clinical condition? What are the relevant physical finding that you would like to look for? Outline the principle management. Senario 6 Kamala, a 9 month old Down syndrome infant is brought by her mother to the pediatric clinic. Her mother complaint that she has cough and shortness of breath for the past 2 days. It was associated with high grade fever. She refused to breastfeed. What physical signs do you want to look for? What do you aspect to find on the examination of the respiratory system? What is the clinical condition? What investigation do you want to perform? Outline the principle of management. What is the mechanism for Kamala’s respiratory problem. What is the most likely etiological agent? What is the possible complications?
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