Question: A low flow delivery system does what?

Answer: Delivers air through a nasal cannula or a simple mask that does not fit tightly against the childs face.

Question: Low flow systems provide how much inspired O2 concentration?Who uses them?

Answer: 22- 60%Used for stable children who require a low inspired O2 concentration, such a when a child is not in severe respiratory distress or shock

Question: Examples of low flow systems?

Answer: Nasal cannula and simple mask

Question: O2 flow rate for nasal cannula

Answer: 0.25 to 4 L/min

Question: Simple mask flow rate?

Answer: 6-10 L/min Inspired O2 concentration of 35- 60%

Question: Why cant the simple mask deliver inspired O2 concentration greater than 60%?

Answer: Because room air enters between the mask and face during inspiration

Question: high flow O2 delivery systems do what? Flow rate?When should they be used?Most common example of High flow O2 system?

Answer: Deliver O2 concentration 60% or greater (95%) . Flow rate is 10L.Used in emergency situations whenever the child has respiratory distress or shockNonrebreathing mask

Question: Nonrebreathing mask valves do what?

Answer: A valve in 1 or both exhalation ports to prevent room air from entering during inspirationValve between reservoir bag and mask to prevent flow of exhaled gas into reservoir

Question: How do you prevent bag collapse in nonrebreather?

Answer: Adjust O2 flow rate into mask. Greater than 10L

Question: During inspiration how much O2 is drawn by the child with a nonrebreather?

Answer: 100% from the reservoir bag and O2 inflow

Question: High Flow nasal cannula

Answer: O2 can be adjusted from 4 L in infants up to 40 L or more in adolescents. Deliver a combo of room air and oxygen.

Question: Gas flow for nebulizer? How long?

Answer: 5-6L/min8-10 min

Question: Does skin pigment affect accuracy or function of the pulse oximeter?

Answer: FALSE

Question: What must you confirm with a pulse ox?

Answer: Confirm validity of oximeter data by evaluating Childs appearance. Also compare HR displayed by pulse ox with HR displayed by the bedside monitor

Question: respiratory arrest

Answer: The absence of respirations (apnea) with detectable cardiac activity. Must provide rescue breathing to prevent cardiac arrest

Question: When should endotracheal intubation be considered?

Answer: If the child is unstable to maintain effective airway, oxygenation, or ventilation despite initial intervention.

Question: DOPE

Answer: DisplacementObstructionPneumothoraxEquipment failureCould cause deterioration of the pt

Question: If a pts condition deteriorates you first must do what?

Answer: Supply oxygenation and ventilation. Rapidly assess the child to figure out cause of crashing. Hand ventilate with bag

Question: What should you observe while pt is deteriorating on a vent? And what do you check?

Answer: Observe chest rise and symmetryAuscultate over both sides of anterior chestCheck monitors Check HRSuction ET tubeUse sedatives or analgesics

Question: If you cannot verify that the ET tube is in the airway what do you do?

Answer: Direct visualization of the tube passing through the glottis is advised.

Question: What happens if the childs condition is deteriorating and you suspect that the tube is no longer in the trachea?

Answer: You may need to remove it and ventilate with a bag mask device

Question: Common causes of upper airway obstruction

Answer: Foreign body aspirationAirway swellingMass compromising airway lumenThick secretionsCongenital airway abnormalityPoor control of upper airwayHospital acquiredTonsillar hypertrophy

Question: Why do infants and small children easily develop upper airway obstruction?

Answer: Small airways

Question: Why is it dangerous for an infant to have a decreased level of consciousness?

Answer: Infants tongue is large in proportion to the oropharyngeal cavity. If decreased level of consciousness the muscles may relax and allow the tongue to fall back and obstruct the oropharynx

Question: Why is a prominent occiput bad for infants?

Answer: if infant With decreased level of consciousness is supine, resting on the large occiput can cause flexion of the neck, resulting in upper airway obstruction

Question: Signs of upper airway obstruction?

Answer: Stridor, hoarsness, or a change in voice or cry during inspiration.Inspiratory retractions, use of accessory muscles and nasal flaring are often present

Question: Other signs of upper airway obstruction?

Answer: Increased RR and effortDrooling, snoring, gurglingPoor chest risePoor air entry on auscultation

Question: croup

Answer: an acute respiratory syndrome in children and infants characterized by obstruction of the larynx, hoarseness, and a barking cough. audible stridor

Question: in severe cases of upper airway obstruction, infants and children may benefit from specific airway adjuncts such as?

Answer: In children with decreased level of consciousness an OPA or nasopharyngeal airway may help relieve tongue obstruction

Question: A child with an gag reflex may tolerate what?

Answer: May tolerate a nasopharyngeal airway. Must be placed carefully due to bleeding.

Question: A child or infant with upper airway obstruction from redundant tissues or tissue edema may benefit from?

Answer: Noninvasive ventilation with positive airway pressure

Question: Appropriate interventions for child with barking cough, good air entry, sats 93% on ra, and retractions at rest.

Answer: Consider dexamethasoneAdminister oxygen and nebulized epi

Question: Mild allergic reaction interventions

Answer: Remove offending agent (stop iv antibiotics)Get helpask child or parent History of allergy or anaphylaxisLook for medical braceletOral dose of antihistamine

Question: What should you do before suctioning a child who has upper airway obstruction?

Answer: Determine the underlying cause of the obstruction

Question: FABO

Answer: foreign body airway obstruction

Question: If you suspect FABO that is mild what do you do?How would it be mild?How would it be severe?

Answer: Call for help and allow the child to try and clear obstruction by coughing. Mild if child is able to make sounds and cough forcefullySevere when child makes no sound, unable to speak or cough, has poor air exchange

Question: How old will a pt be for back slaps? How much must you give if choking?

Answer: 1 year and younger5 back slaps and 5 chest thrusts

Question: Infant interventions FABO

Answer: 1. confirm severe airway obstruction2. 1 year and younger5 back slaps and 5 chest thrusts3. Repeat step 2 until the victim becomes unresponsive

Question: Child FABO

Answer: 1 year to adolescent/puberty1 Ask are you choking2 Stand or kneel behind child . Give abdominal thrusts3 Repeat thrusts until object is expelled or victim becomes unresponsive

Question: Most appropriate treatment for severe anaphylaxis?

Answer: Administer IM epinephrine

Question: Lower airway obstruction is usually where?Clinical signs?

Answer: Airways below thorax, can occur in lower trachea, bronchi or bronchioles.Signs occur during expiratory phase of respiratory cycle. RR is elevated in infants, inspiratory retractions become more prominent

Question: Common causes of lower airway obstruction are?

Answer: Asthma and bronchiolitis

Question: In asthma what happens to Small airways?

Answer: Small airways are obstructed via smooth muscle bronchial constriction, mucus plugging, inflammation, and external collapse due to high intrathoracic pressures

Question: What are the components of the breathing assessment?

Answer: Respiratory EffortLung and airway soundsRRChest expansion and air movementO2 saturation

Question: Medicine for croup

Answer: Dexamethasone Nebulized Epi

Question: When calculating the tube size based on the childs age, to avoid injury to the subglottic area you should use an et tube that is?

Answer: Half size smaller than predicted for the child.

Question: In a child with severe respiratory distress or respiratory failure first do what?

Answer: First restore adequate oxygenation.

Question: Why isnt immediately correcting hypercarbia to the childs baseline level not required?

Answer: Because most children can tolerate hypercarbia without adverse effects.

Question: If a child with lower airway obstruction needs bag mask ventilation, provide ventilation at what rate? Why?

Answer: Provide ventilation at a slow rate allowing more time for expiration. This reduces air trapping in the chest at end expiration

Question: Providing to many breaths or breaths with to much volume may result in what complications?

Answer: Gastric distension ( air in stomach), results in increased risk of vomiting and aspirationRisk of pneumothorax ( air in pleura space of lungs)Severe air trapping (Decreases oxygenation, decreases venous return to the heart and cardiac outpt)

Question: pneumothorax

Answer: air in pleura space of lungs. Can cause decreased blood return to the heart and risk of lung collapse. And resultant complications are severe hypoxemia and obstructive shock

Question: The anticipated results of the nebulized treatment should include which of the following improvements in the patient?

Answer: Decreased Bronchoconstriction, decreased airway edema, decreased respiratory effort

Question: What illness can cause lung tissue disease?

Answer: Pneumonia

Question: Lung tissue disease involves what substance?

Answer: Parenchyma or tissue of the lung

Question: parenchyma

Answer: functional tissues of any organ, such as the tissues of the bronchioles, alveoli, ducts, and sacs, that perform respiration

Question: What happens to lungs with lung tissue disease?This requires increased what?

Answer: Childs lungs become stiff because of fluid accumulation in the alveoli or interstitium or both.Requires increased respiratory effort during inspiration and exhalation

Question: What increased WOB signs are common with lung tissue disease?sings of lung tissue disease

Answer: Retractions and accessory muscle use are common. Tachypnea is common and often quite markedIncreased respiratory effort, grunting, crackles, and decreased air movement, diminished breath sounds, tachycardia and hypoxemia despite O2 use

Question: Grunting produces?Grunting is a compensatory mechanism which?

Answer: Produces early glottic closure during expiration. Which maintains positive airway pressure and prevents collapse of alveoli and small airways

Question: Why is hypoxemia marked with lung tissue disease?

Answer: Hypoxemia is marked due to alveolar collapse or reduced O2 diffusion. Caused by pulmonary edema fluid and inflammatory debris in alveoli

Question: Causes of lung tissue disease

Answer: Pneumonia, and cardiogenic and noncardiogenic pulmonary edema. Caused by CHF or ARDS.

Question: Other potential casues of lung tissue disease

Answer: Pulmonary contusionallergic reactiontoxinsvasculitisinfiltrative disease

Question: Children with lung tissue disease can maintain ventilation ( CO2 elimination) with a small?

Answer: With a small number of functional alveoli, but they cannot maintain oxygenation as effectively. AS A RESULT HYPOXEMIA IS AN EARLY SIGN OF LUNG TISSUE DISEASE

Question: What disease is characterized by fluid accumulation in the alveoli/ interstitium

Answer: Lung tissue disease

Question: How can small airways be obstructed in acute lower airway obstruction?

Answer: Mucus PlugSmooth muscle bronchial constriction

Question: Infectious pneumonia results from?

Answer: Viral, bacterial or fungal inflammation of the alveoli.

Question: Name the interventions for managing acute infectious pneumonia.

Answer: Diagnostic assessmentAdminister antibiotic therapyTreat wheezing with albuterolNoninvasive positive pressure ventilationReduce metabolic demand by normalizing temperatureIntubate in severe cases

Question: Disordered Control of Breathing

Answer: This is inadequate respiratory effort and the parent may say that the child is breathing funny

Question: What is the net effect of disordered control of breathing?

Answer: Its often hypoventilation leading to hypoxemia and hypercarbia

Question: Causes of disordered control of breathing?

Answer: Neurologic disorders such as seizures, CNS infections, head injury, brain tumors, hydrocephalus and neuromuscular disease. Metabolic abnormalities and drug overdose

Question: Because disordered control of breathing is typically associated with conditions that impair what? These children often have a decreased?

Answer: Impair neurologic functionOften have decreased levels of consciousness

Question: Signs of disordered control breathing

Answer: 1-Variable/irregular respiratory rate (tachypnea alternating with brady)2-Variable respiratory effort3-Central apnea4-Shallow breathing5- normal or decreased air movement

Question: Which type of respiratory problem is most likely in a child with an altered level of consciousness and variable respiratory rate?

Answer: Disordered control of breathing

Question: What are the interventions for disordered control of breathing due to Increased intercranial pressure?

Answer: Ensure the head is midlineVerify open/patent airway, adequate oxygenation and adequate ventilation.Administer 20 mL/kg IV isotonic crystalloidAdminister pharmacologic therapyTreat agitation and pain aggressivelyAvoid hypotensionAvoid and aggressively treat fever

Question: If you suspect poisoning or drug overdose whats the best way to manage it?

Answer: By supporting the airways and ventilation. This manages respiratory distress or failure caused by poisonings or drug Od

Question: What are the specific interventions for disordered control of breathing due to poisoning or drug OD

Answer: Contacting a poison control centerSuctioning the airwayAdministering an antidote. Administer naloxone for opioid overdosePerforming diagnostic assessmentsPreparing for transfer

Question: After supporting the airway and adequately oxygenating and ventilating the child with a suspected opioid OD, what is the next most appropriate treatment?

Answer: Administer naloxone

Question: When evaluating a 6 month old you notice that he has an abnormal respiratory pattern that produces inadequate minute ventilation. What immediate interventions should be done?

Answer: Position the infant to open his airwayAttach pulse oxBegin bag mask ventilation with 100% O2

Question: When oxygenation and ventilation are established on the 6 month old, the secondary assessment should be conducted. What is included in it?

Answer: Sample historyPhysical examinationIdentification of reversible causes

Question: What would be indications for intubation for the 6 month old boy?

Answer: Failure to maintain patent airwayInadequate spontaneous respiratory effortSigns of ICP

Question: 6 month old 7kg ET tube size cuffed formula? uncuffed?

Answer: uncuffed (Size in kg)/4+4cuffed (Age in years)/2+3.5

Question: After a child is intubated how should tube placement be both confirmed and monitored

Answer: Waveform capnography

Question: What condition is characterized by signs of adequate carbon dioxide elimination and hypoxia?

Answer: Lung tissue disease

Question: What intervention can reduce metabolic demand in a child with pneumonia?

Answer: Treat the fever