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CC: Pediatric Critical Care – Questions And Answers
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CC: Pediatric Critical Care – Questions And AnswersPediatric critical care Right Ans - ventilation
oxygenation
perfusion
Kids are resilient, but the decompensate very quickly!!
Unique pediatric factors Right Ans - larger head
depend on nose to breathe
larger more flaccid tongues
cricoid cartilage narrowest part of the funnel shaped airway
larynx more superior and more anterior: why we to the shoulder roll and
head tilt because they can occlude their airways just sitting in a car seat!
larger occiput
epiglottis more cephalid, elongated, and flexible
loosely attached mucous membrane
reply on diaphragm more than we do
Immature immune systems
Immature lung development
Resilience/Ability to Compensate: children often compensate well in illness,
however, then they decompensate, it is usually rapid and very concerning
Psychosocial needs: it is important to consider the developmental needs of
children and the caregivers/families that love them
Respiratory failure Right Ans - inability of the resp system to meed bodys
demands for o2 or eliminate adequate CO2 --> acidosis
Pulmonary causes of resp failure Right Ans - impaired lung tissue integrity
-atelectasis, pneumonia, bronchiolitis (not well tolerate, smaller airways),
ARDS cause low V/P (low vent)
-acute lung injury, alveolar overdistention(baby being overbagged), ARDS, or
cyanotic heart disease can cause V/P mismatches (low perfusion)
Increased airway resistance
,-airway edema (asthma) causes reduced diameter or airways --> increased
resistance to airflow and WOB
-congenital upper airway anomalies (vascular slings, makes airway smaller)
or foreign body aspiration may restrict air flow by narrowing it
Non-pulmonary causes of resp failure Right Ans - respiratory muscle
compromised leads to resp muscle fatigue, hypoventilation, hypoxia, and
acidosis (lungs aren't sick, they just dont have the room to do their work)
-diaphragmatic hernia (pressure on lungs from abd content), paralysis,
abdominal distention, or poor diaphragmatic function
Alterations in the CNS can interfere with the control of breathing
-guillan-barre, head trauma, SCI, myasthenia gravis, botulism, central
hypoventilation syndrome (dont take adequate breathes, end up on trachs or
vents), depression secondary to narcotic/sedative/anesthetics :(
Disorders of the upper airway
-choanal atresia, micrognathia (small jaw), cystic hyproma, obstruction,
tracheoesophageal fistula (aspiration)
Cardio/hematologic disorders
-congenital heart disease, anemia (hmg low...decreased o2 capacity), shock,
sepsis
resp distress: ped manifestions Right Ans - *head bobbing: generates
pressures
*Retractions: related to airway obstruction or alveolar disease
Grunting: compensatory mechanism to increased end-expiratory pressure
increased functional residual capacity
Upper airway obstruction: stridor (inspiratory), paradoxical chest movement,
sternal/intercostal retractions
Lower airway obstruction(asthma): prolonged expiration, wheezing
Diminished breath sounds related to decreased air entry (may be unilateral
[pneumo, pneuomia) or bilateral)
, pertussis: preventable, vaccines
resp failure: inhaled gases Right Ans - inhaled nitric oxide:
- selective pulmonary vasodilator
- reduces pulm vascular resistance (reduces r heart effort)
-treats pulm arteriolar HTN
-usually delivered during mechanical ventilation, but not necessary
-measure NO2 and methemoglocin levels to assess for toxicity
resp failure: inhaled gases Right Ans - Helium-Oxygen (Heliox): pretty
common in peds
(helium is lighter than o2, helps o2 flow into obstructed airways)
-improves resp distress, WOB, and delivery of bronchodilators to obstructed
lower airways
-gas flow becomes less turbulent --> reduced flow velocity --> laminar flow
pattern
-may be delivered via face mask with reservoir or non rebreather, or through
mechanical ventilation
may decrease cough efficacy: CAREFUL
depending on the amt of o2 requirement: they might not be eligible to for
heliox. high o2 requirements = not eligible
resp failure: noninvasive ventilation Right Ans - NC
head hood: seeing it less
simple face mask
non rebreather
high flow NC
Bi pap
CPAP
recommend flow rates for high flow NC Right Ans - 12L/min for older
infants and toddlers; up to 30L/min for children; up to 40L/min for adults
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