Anatomical and physiological features of the pediatric airway?
large tongue relative to size of oropharynx
obligate nose breathers
smaller airway
... [Show More] diameter
cricoid cartilage narrowest area
larynx more anterior and cephalad
cartilaginous larynx
short neck and short trachea
What is normal respiratory rate for the 5 pediatric age groups?
infant (1-12 months) - 30-60
toddler (1-3 years) - 24-40
preschooler (3-5 years) - 22-34
school age (5-11 years) - 18-30
adolescent (11-18 years) - 12-16
What is the narrowest area of the pediatric airway?
the crichoid cartilage - provides anatomical seal for uncuffed or cuffless ETT in children younger than 8 years old
Anatomical and physiological features of pediatric breathing?
compensatory mechanisms less effective
higher metabolic rate
respiratory rate varies with age
thin chest wall
cartilaginous sternum and ribs
poorly developed intercostal muscles
diaphragm positioned flat
ribs horizontally oriented
fewer smaller alveoli
What age is the respiratory system considered fully developed?
8 years old
Most common chronic childhood illness?
asthma, affects 9.3% of children
Do pediatrics have a higher or lower metabolic rate?
higher - results in more rapid respiratory rate and less efficient use of oxygen and glucose. In addition, other symptoms, such as fever or anxiety, may further increase metabolic rate
A pulse ox reading of less than ____ at sea level is indicative of respiratory compromise?
92%, exceptions include children with uncorrected congenital heart defects
How to estimate ETT size for pediatrics age 1-10?
uncuffed - (age/4)+4, cuffed - (age/4)+3.5
CO2 monitors may not be effective if the child is less than ____?
2kg
The esophageal detector may be considered for confirmation of tracheal tube placement in children weighing ___?
more than 20kg. It is unreliable in children younger than 1 year
The appropriate depth of insertion of an ETT can be estimated by the following formula?
internal tube diameter x3.
Studies show that the use of the length based resuscitation tape to determine depth of the ETT is the most accurate method
An excess of either of these 2 substances causes a direct excitatory effect on the respiratory center, resulting in increased rate of ventilation?
increased PaCO2 or increased H+
Most common cause of respiratory distress and failure in the pediatric patient?
upper or lower airway obstructive disorders
Causes of upper airway respiratory distress and failure in pediatric patients (several)?
anaphylaxis
bacterial tracheitis
croup
epiglotitis
foreign body aspiration
retropharyngeal abscess
sleep apnea
smoke inhalation
subglottic stenosis
tracheomalacia
trauma
Tracheomalacia?
(from trachea and the Greek μαλακία, softening) is an upper airway condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded.
Subglottic stenosis?
(SGS) is a narrowing of the upper airway below the vocal cords (subglottis) and above the trachea. Subglottic stenosis will involve narrowing of the cricoid, the only complete cartilage ring in the airway.
Retropharyngeal abscess?
(RPA) is an abscess located in the upper airway tissues in the back of the throat behind the posterior pharyngeal wall (theretropharyngeal space). Because RPAs typically occur in deep tissue, they are difficult to diagnose by physical examination alone.
ARDS?
Lower airway condition in which fluid collects in the lungs' air sacs, depriving organs of oxygen.
Causes of lower airway respiratory distress and failure in pediatric patients?
ARDS
aspiration
asthma
atelectasis
bronchiolitis
bronchomalacia
foreign bodies
pertussis
pleural effusions
hemo/pneumothorax
pneumonia
pulmonary contusion
pulmonary edema
smoke inhalation
trauma
What is Pertussis?
also known as whooping cough, is a highly contagious lower respiratory disease. It is caused by the bacterium Bordetella pertussis.
Incubation period of pertussis including 3 stages?
7-10 days characterized by 3 stages:
catarrhal stage - insidious onset of nasal secretions, low grade fever, mild cough.
cough becomes more severe over 1-2 weeks.
paroxysmal stage - numerous rapid coughs secondary to thick mucus in trachobronchial tree, long inspiratory effort with high pitched whoop, cyanosis, vomiting and fatigue after each episode
this lasts for 1-6 weeks.
convalescent stage - gradual recovery over 2-3 weeks.
How is the epiglottis different on pediatrics vs adults?
the epiglottis is more U shaped, higher, and more anterior in the airway making it more prone to infection and trauma
How is the larynx different on a pediatric pt vs an adult
larynx is more positioned more anteriorly and cephalad (toward the head)
Difference in tidal volume of a pedi vs an adult?
pediatric tidal volume is approx 10ml/kg
adult tidal volume is approx 50ml/kg
result is low residual capacity for pediatrics
Metabolic rate of pediatrics vs adults?
metabolic rate is twice as high in the pediatric patient. This results in twice the O2 consumption. Hypoxia occurs more rapidly when the child is in respiratory distress.
What is croup?
Insidious inflammation that results in partial upper airway obstruction as the result of tracheal narrowing
Viral illness caused by parainfluenza A or RSV
Occurs most commonly in children 6-36 months, more in boys than girls [Show Less]