peds : respiratory distress

Definition of respiratory distress

It is the increase in the work of breathing to get more oxygen

tachypnea under 2 months upperlimt

60

upper limit to define tachypnea in 2-12 months

50

upper limit to define tachypnea in 1-5 years and above

40, 30

signs of respiratory distress

Intercostal and subcostal retractions

Working ala nasi

grunting

cyanosis

headbobing

tracheal tugging

any patient with resp distress should be ......

admitted

What are the respiratory causes of respiratory distress in children

Croup, anaphylaxis, asthma, bronchiolitis, pneumonia.

What are the cardiac causes of respiratory distress

Arrhythmia, heart failure, cardiac tamponade.

What are the neurological causes of respiratory distress

Neuromuscular diseases, raised intracranial pressure, poisoning.

What are the metabolic causes of respiratory distress

Metabolic acidosis (e.g., DKA, renal failure, inborn errors of metabolism).

What are the classifications of respiratory distress by ABC status

Normal ABC = no distress; Abnormal B = respiratory distress; Abnormal AB = respiratory failure; Abnormal ABC = cardiorespiratory failure.

What is the management approach to respiratory distress

Keep the child calm, provide oxygen as needed, suction nasal airway if required, monitor with pulse oximetry and ECG.

What is the diagnosis in a febrile child with inspiratory stridor, hoarse cry, no drooling, and up-to-date vaccines

Laryngotracheobronchitis (croup).

What are the typical radiologic signs of croup and epiglottitis

Croup → steeple sign; Epiglottitis → thumb sign.

What are the key features differentiating acute laryngotracheobronchitis from acute epiglottitis

Croup: gradual onset, low-grade fever, barking cough, normal WBC.Epiglottitis: abrupt onset, high fever, drooling, dysphagia, muffled voice, elevated WBC.

What is spasmodic croup

A recurrent, nocturnal croup-like condition of allergic or psychogenic origin, usually without fever.

What are the signs of foreign body aspiration

Sudden cough, stridor, wheeze, unilateral decreased air entry or hyperresonance; x-ray may show unilateral hyperexpansion or atelectasis.

What is the treatment of foreign body aspiration

Bronchoscopy for removal.

What are the features of acute severe asthma

Sudden worsening of wheezing, cough, dyspnea; hypoxemia; hyperinflated chest; poor air entry.

What are the stages of asthma severity by clinical features

Mild: normal speech, mild retractions, O2 sat >94%.

Moderate: speaks in phrases, intercostal retractions, O2 sat 91-94%.

Severe: speaks in words only, marked retractions, O2 sat <90%

Impending failure: drowsy, silent chest, unable to speak.

What are the main treatments of acute asthma exacerbation

Oxygen, inhaled salbutamol, inhaled anticholinergics (ipratropium), systemic corticosteroids, IV MgSO4, aminophylline, adrenaline if needed.

What is bronchiolitis and its most common cause

A viral chest infection in infants <2 years, most commonly due to RSV.

What are the indications for hospital admission in bronchiolitis

Oxygen saturation <92%, significant respiratory distress, prematurity, chronic lung/heart disease, age <3 months, feeding difficulty, or inability of parent to care.

What are the indications for PICU admission in bronchiolitis

Persistent hypoxemia, hypercapnia, apnea, acidosis, severe cyanosis, worsening distress, altered mental status.

What is the mainstay of treatment for bronchiolitis

Oxygen supplementation, hydration, supportive care; bronchodilators or corticosteroids generally not routine.

What is pneumonia

An acute infection of the lungs where alveoli fill with pus and fluid, impairing oxygen exchange.

What are the common causes of pneumonia by age group

Neonates: Group B strep, E. coli, Listeria. 1-3 months: RSV, influenza, chlamydia, pertussis.4 months-4 years: RSV, influenza, parainfluenza, adenovirus, H. influenzae, Strep. pneumoniae.≥5 years: Mycoplasma, Chlamydia.

What are the criteria for hospitalization in pediatric pneumonia

Respiratory distress, oxygen saturation <92%, comorbidities, infants <3 months.

What is the management of pediatric pneumonia

Antibiotics (amoxicillin-clavulanate, ceftriaxone ± macrolide; vancomycin for MRSA), antivirals for influenza; supportive care.

What are pleural diseases

Pleurisy, pleural effusion, pneumothorax, hydropneumothorax, empyema, hemothorax, chylothorax.

What are the symptoms and signs of pleural effusion

Dyspnea, chest pain; decreased breath sounds, stony dullness; confirmed with CXR, ultrasound, CT, thoracocentesis.

What is the treatment of empyema

Antibiotics, drainage by tube thoracostomy, fibrinolytics, VATS, decortication, or pleurodesis.

Which antibiotics penetrate pleural fluid effectively

Penicillins, cephalosporins, aztreonam, clindamycin, ciprofloxacin (not aminoglycosides).

What is hydrothorax and its causes

A transudative effusion due to cardiac, renal, hepatic disease, hypoalbuminemia, SVC obstruction, peritoneal dialysis, or shunt.

What are the lab features of hydrothorax

Few cells, low specific gravity (<1.015), pleural fluid/serum protein ratio <0.5, LDH ratio <0.6.

What is the treatment of hydrothorax

Management of the underlying cause.

What are the causes of pneumothorax

Spontaneous (bleb rupture), infections, congenital lung diseases, asthma/CF/bronchiolitis, connective tissue disease, trauma, iatrogenic causes, malignancy.

What is a key radiologic sign of epiglottitis

Thumb sign.

What is a key radiologic sign of croup

Steeple sign.

What is the tripod position and when is it seen

Leaning forward with chin out, drooling, seen in acute epiglottitis.

What is the goal of oxygen therapy in asthma or bronchiolitis

Maintain oxygen saturation above 94% (asthma) or above 90% (bronchiolitis).

What is the treatment of acute epiglottitis

IV antibiotics (penicillin/cephalosporin), airway protection (intubation if needed).

What is the difference in fever between croup and epiglottitis

Croup: low-grade; Epiglottitis: high-grade.

What is the WBC finding in croup vs. epiglottitis

Croup: normal; Epiglottitis: elevated.

What is the treatment of spasmodic croup

Supportive, humidification, reassurance; usually self-limiting.