Respiratory System Approach To a Child with Respiratory Distress by yurtgc548


									 Approach To a Child with
 Respiratory Distress

Dr Nor Azlina Bt Mohammad Rashid
 To describe the respiratory system and
  common respiratory diseases and conditions
  in detail.
 To diagnose respiratory distress based on
  history, physical examination and
 Formulate appropriate diagnosis
Learning objectives
 Describe the respiratory system
 Depict signs of respiratory distress in a real
 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
 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
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
 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
 Musculoskeletal , neuromuscular diseases
 Rapid shallow breathing , grunting, dull to
Restrictive pulmonary condition
Clinical manifestation of respiratory
 Mechanical failure: increased ventilatory
  requirements and physical effort to fulfill
  these requirements—tachypnea, retractions,
  excessive use of accessory muscles
 Failure of respiratory control -apnea
 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
Terminal respiratory unit
 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
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
 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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