Respiratory Diseases Summary MBBS
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Common Respiratory
ProblemsIn
Children
Common Respiratory
ProblemsIn
Children
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4 months old4 months old
One day history ofOne day history of
excessive cryingexcessive crying
Sent home with theSent home with the
diagnosis of windydiagnosis of windycolic with anticolic with anti--
spasmodicsspasmodics
Next day:Next day:
Grunting, respiratoryGrunting, respiratorydistress, fever.distress, fever.
Admitted ,oxygen, IVAdmitted ,oxygen, IV
ceftriaxone.ceftriaxone.
Case 1:
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Case (contd)Case (contd)
Second day:Second day:
Mother felt better butMother felt better but
continues to becontinues to be
tachypnoeic, chesttachypnoeic, chestindrawing, feverindrawing, fever
persisting.persisting.
Vancomycin addedVancomycin added
with oxygenwith oxygen
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Case (contd)Case (contd)
Third dayThird day Severe respiratorySevere respiratory
distressdistress
Pus drained through waterPus drained through water
seal drainageseal drainage Antibiotics contd.Antibiotics contd.
Discharged after 2 wk.Discharged after 2 wk.
Strepto.pneumoniae isolated
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16 month old boy with wheeze
Initial Vitals: HR 160
RR 60
BP 88/50
Temp 38
O2sat on RA 89%
Case 2
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You do your pediatric triage
Appearance Crying, distressed, looking
around, moving all 4 limbs
Breathing (work of) Laboured, chest caving in,
+++indrawing
Circulation ColourOK, N cap refill
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What would you like to do now?
Oxygen by mask applied, IV attempt started and
pt now on cardiac monitor
Airway No stridoraudible, no obvious secretions
Breathing +++ wheeze with little airentry bilat
(inspiratoryAND expiratory)
Circulation Warm extrem, PPP, cap refill 2 secs
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What would you like to do now?
Oxygen
Salbutamol nebulizer
IV Access established orders?
CXR done / pending
ABG report
Venous Gas pH 7.35
pCO2 38pO2 125
Normal ABG values are: pO2 of 80Normal ABG values are: pO2 of 80--100 mmHg; pCO2 of100 mmHg; pCO2 of
3535--45 mmHg; pH of 7.3545 mmHg; pH of 7.35--7.45; and SaO2 of 957.45; and SaO2 of 95--100%100%
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History:
Has had a cold foralmost 2 days now(mild fever, decreased energy / appetite with cough
and runny nose)
Started getting wheezy this morning
No history of exposure to allergens, inhalants
orFB aspiration
Family History of Asthma / no smokers / no pets
Otherwise healthy with no known allergies
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Continuous Salbutamol nebulizer
for15 mins has little effect
Still indrawing
RR 65
Still alert and looking around, crying
Additional treatment?
IV steroids Methylprednisolone 1 mg/kg IV / IM
Continue Salbutamol
Considerracemic Epinephrine (0.5 mls)
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Repeat Venous Gas about 30 mins later
pH 7.15
pCO2 55pO2 120
Eyes rolling back, little crying now
What do you want to do?
Drugs? Tube Size?
Ketamine 1-2 mg/kg IV
Atropine 0.01 mg/kg IV (min 0.1 mg)
Succinyl 1 mg/kg IV
4 4.5 tube
Normal ABG values are: pO2 of 80Normal ABG values are: pO2 of 80--100 mmHg; pCO2 of100 mmHg; pCO2 of
3535--45 mmHg; pH of 7.3545 mmHg; pH of 7.35--7.45; and SaO2 of 957.45; and SaO2 of 95--100%100%
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OtherOptions
IV Magnesium 25 mg/kg (max 2 gm)
IV Epinephrine
IV Salbutamol
Inhalational Anesthetics
Methylxanthines
Heli - Ox
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DifferentialDiagnosis ofWheezing
H + N Vocal cord dysfunction
Chest AsthmaBronchiolitis
Foreign BodyAspiration
CVS Congestive Heart FailureVascularRings
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Pediatric Asthma Guidelines
MILD Nocturnal cough
Exertional SOB
Increased Salbutamol use Good response to Salbutamol
O2 sat > 95%
PEF > 75% (predicted / personal best)
O2
Salbutamol
Considerpo Steroids
Symptoms
Pre - Treat
Treatment
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MODERATE Normal mental status
Abbreviated speech
SOB at rest
Partial relief with Salbutamol and required > than q 4h
O2 sat 92%-95%
PEF 50-75% (predicted / personal best)
O2 100%
Salbutamol
Systemic corticosteroids
Consideranticholinergic
Symptoms
Pre - Treat
Treatment
Pediatric Asthma Guidelines
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Asthma Guidelines
SEVERE Altered mental status Difficulty speaking
Laboured respirations
Persistant tachycardia
No prehospital relief with usual dose Salbutamol
O2 saturation
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Asthma Guidelines
Symptoms
Pre - Treat
Treatment
NEARDEATH Exhausted , Confused
Diaphoretic
Cyanotic, Decreased respiratory effort, APNEA
Falling heart rate
O2 saturation
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18 mo Girl with 24 hrHx of coughing with drooling
Hx: Has had an URTI forabout a week and was
getting mildly betteruntil yesterday. She
developed a feverand the cough got harsher.
Still drinking but not interested in solids
Vomited once last night
Started drooling this morning
CASE 3
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T39.1 degrees rectally, P170, R28, BP 100/66
Appearance alert, awake, not toxic, in no acute distress
Did not appearto preferupright ora forward leaning position
EENT Moist MM, slight erythema of oropharynx,
nasal crusting, N TMs, no rash / petechiae,
no drooling
Supple neck
Chest Clearwhen resting
Mild inspiratory stridorwith crying
Rest of the exam N
Physical Exam
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DDx?
Croup
Epiglottitis
Bacterialtracheitis
RetroPharygeal
abcess
Foreign Body
aspiration
Otherthings on DDx of
Inspiratory Stridor
Laryngeal Web
TEF
DiptheriaAirway thermal injury
Subglottic stenosis
Peritonsillarabcess
GERD
Esophageal FB
Laryngeal fracture
Laryngeal cyst
Lymphoma
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Soft tissue lateral
neckradiograph
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Lymph nodes between the posteriorpharyngeal wall
and the prevertebral fascia
gone by 3 4 yrs of life
drain portions of the nasopharynx and the posterior
nasal passages
may become infected and progress to breakdown
of the nodes and to suppuration
Retropharyngeal Abscess
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ETIOLOGY
Complication of bacterial pharyngitis
Less frequently
- extension of infection from vertebral osteomyelitis
Group A hemolytic streptococci, oral anaerobes,
and S. aureus
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Recent orcurrent history of an acute URTI
Abrupt onset:
High feverwith difficulty in swallowing
Refusal of feeding
Severe distress with throat pain
Hyperextension of the head
Noisy, often gurgling respirations
Drooling
Typically
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Soft Tissue Neck Film
Patient position MILD EXTENSION
Positive Film - Retropharyngeal soft tissue > the width
of the adjacent vertebral body
- may see airin the retropharynx
On Exam
Nasopharynx Bulging forward of the soft palate andnasal obstruction
Oropharynx Bulging of posteriorphyaryngeal wall
or
Not visualized
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Complications
Abscess rupture - aspiration of pus.
Lateral extension - present externally on the side of the neck
Dissection along fascial planes into the mediastinum
Death may occurwith aspiration, airway obstruction,erosion into majorblood vessels, ormediastinitis.
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Treatment
Ceftriaxone 75mg/kg/day/divided Q 12 hrly
Clindamycin 20-30 mg/kg/day divided Q8H
(if pre-fluctuant phase)
Decadron 0.6 mg/kg
Airway management
Surgical decompression
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17 month old male with a one-hourhistory
of noisy and abnormal breathing
Normal now but at the time, parents thought he was
quite distressed.
Now, he is able to speak and drink fluids without difficulty
CASE 4
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VS T36.8, P200 (crying), R28 (crying), O2 sat 99%
Alert with no signs ofrespiratory distress
Able to speak, had no cyanosis, no drooling,
no dyspnea
H+N No obvious swelling, bleeding, FB seen
Chest Mild wheezing with ? mild inspiratory stridor
What would you like to do now???
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Soft Tissue
Neck View
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CXR (PA)
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Next?
Expiratory
CXR
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Inspiratory View Expiratory View
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RightDecub
View
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Foreign Body Aspiration
More common with food than toys
Highest risk between 1 and 3 years old
(immature dentition no molars, poorfood control)
Common foods = peanuts, grapes, hard candies
Some foods swell with prolonged aspiration
(may even sprout)
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ClinicalManifestations
Typically
Acute respiratory distress (now resolved orongoing)
Witnessed choking period
Uncommonly
Cyanosis and resp arrest
Symptoms: cough, gag, stridor, wheeze, drool,
muffled voice
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Investigations
Xrays
Lateral neck
Chest inspiratory, expiratory, decubitus views
Expiratory views
Overinflation (partial obstruction with inspiratory flow)
Volume loss with mediastinal shift towards obstructed
side (partial obstruction with expiratory flow)
Atelectasis (complete obstruction)
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Decubitus views
Normal Smallervolumes and elevated diaphragm
on side down
Abnormal Hyperinflation ornormal volumes indecub position
If suspected Need a bronchoscope to rule out orremove Foreign Body
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CASE 5
2 yo Boy with BarkyCough for2 days
Runny nose, decreased appetiteNot himself
No PMHx / FHx of significance
Shots UTD
Othersibs with similarURTIs
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Temp 38.9
HR 140
O2 sat 98% (drops to 90% when he crys)
RR 40 (mild indrawing)
On Exam
Irritable, crying, good colour
H & N sl erythema of throat, no pus
N TMs, small cervical nodes
Chest Barky cough, inspiratory stridor
No wheeze noted
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Diagnosis?
Racemic Epinephrine 0.5 ml dose
? Dexamethasone now orlater
Re Assess in 30 minutes
No improvement with 1st dose of epinephrine
What would you like to do now?
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IV Ceftriaxone PLUS Cloxacillin
Consult Pediatric ICU / Pulmonary
forBronch / Intubation
Re Examine
Ongoing Inspiratory StridorCries when trachea is examined
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Bacterial tracheitis
An acute bacterial infection of the upperairway capable
of causing life-threatening airway obstruction
Staph aureus most commonly(parainfluenza, Moraxella catarrhalis, H. influenzae, anearobes)
Most pts less than 3 years old
Usually follows an URTI (esp laryngotracheitis)
Mucosal swelling at the level of the cricoid cartilage,
complicated by copious thick, purulent secretions
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Brassy cough
High fever
Toxicity" with respiratory distress
(may occurimmediately oraftera few days of
apparent improvement)
Failed response to CROUP TREATMENT
(mist, intravenous fluid, racemic epinephrine)
CLINICALMANIFESTATIONS
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Antibiotics (good Staph coverage)
Intubation ortracheostomy is usually necessary
? Decadron
Treatment
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Pediatric Pneumonia
Neonate Bacteria more frequentE. coli, Grp B strep, Listeria, Kleb
1 3 mo Chlamydia trachomatis (unique)
Commonly viral (RSV, etc.)B. Pertussis
1 24 mo S. pneumonia, Chlamydia pneum
Mycoplasma pneumonia
2 5 yrs RSV
Strep pneumonia, Mycoplasma, Chlam
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Severe Pneumonia:
Staph aureus
Strep pneumonia
Grp. A strepHIB
Mycoplasma pneumonia
Pseudomonas ifrecently hospitalized
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History:
Infants < 3 months Tachypnea, cough, retractions,
grunting, isolated feveror
hypothermia, vomiting, poor
feeding, irritability, orlethargy
As age increases, symptoms are more specific
Fever and chills, headacheCough or wheezing
Chest pain, abdominal distress,
neck pain and stiffness
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Physical Exam
Tachypnea is the best single indicator of pneumonia
Age in months Upperlimit of Normal RR
< 2 60
2-12 50
> 12 40
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Treatment
Neonates Ampicillin + Gentamycin / Cefotaxime
1 3 mo Erythromycin 10 mg/kg IV Q6H
1 24 mo Cefuroxime 50 mg/kg IV Q8H (not ICU)Ceftriaxone 50-75 mg/kg IV Q24H
and Cloxacillin 50 mg/kg IV Q6H (ICU)
3 mo 5 yrsCeftriaxone / ErythroClarithro / Azithro (outpt Tx)
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Respiratory Failure inRespiratory Failure inChildrenChildren
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Respiratory failure: where is theRespiratory failure: where is the
defect?defect?
Ventilation
DiffusionPerfusion
Abnormal oxygen
carrying capacityfailure of
cellular oxygen
uptake
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Types ofRespiratory FailureTypes ofRespiratory Failure
Type I failure, alsoType I failure, also
known asknown as
normocapnic ornormocapnic or
nonnon--ventilatoryventilatoryfailure, is indicatedfailure, is indicated
by hypoxemia (lowby hypoxemia (low
pO2 ) with a normalpO2 ) with a normal
or low pCO2.or low pCO2.
It is commonly due toIt is commonly due to
ventilation/perfusionventilation/perfusion
(V/Q) abnormalities.(V/Q) abnormalities.
Other causes include:Other causes include:impaired diffusionimpaired diffusion
across the alveolaracross the alveolar--
capillary membranecapillary membrane
(as occurs with(as occurs withpulmonary fibrosispulmonary fibrosis
and shunting)and shunting)
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Type II failure:Type II failure:
An elevated pCO2An elevated pCO2
is the hallmark ,is the hallmark ,
also known asalso known as
ventilatory orventilatory or
hypercapnichypercapnic
failure.failure.
It is generally theIt is generally the
result of alveolarresult of alveolar
hypoventilation,hypoventilation,
increased dead spaceincreased dead space
ventilation, orventilation, or
increasedC
O2increasedC
O2production. Otherproduction. Other
causes are factorscauses are factors
that impair the centralthat impair the central
ventilatory drive in theventilatory drive in thebrainstem, restrictbrainstem, restrict
ventilation, orventilation, or
increase CO2increase CO2
production.production.
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Causes of Type I FailureCauses of Type I Failure
V/Q abnormaltitiesV/Q abnormaltities Pneumonia,Pneumonia,
meconium aspiraton,meconium aspiraton,Pulmonary oedema.Pulmonary oedema.
Cyanotic heartCyanotic heartdiseasedisease
DiffusionDiffusionabnormalitiesabnormalities Interstitial fibrosisInterstitial fibrosis
Inadequate systemicInadequate systemicblood flowblood flow ShockShock
Inadequate oxygenInadequate oxygencarrying capacitycarrying capacity Severe anemia,Severe anemia,
methhemoglobinemiamethhemoglobinemia
Inadequate cellularInadequate cellularuptake:uptake: Cyanide poisioningCyanide poisioning
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Type II Failure: alveolarType II Failure: alveolar
hypoventialtionhypoventialtion
Neuromuscular:Neuromuscular:
CNS disease, GBCNS disease, GB
Syndrome.Syndrome.
Respiratory muscleRespiratory muscledisordersdisorders
Muscular dystrophyMuscular dystrophy
Chest wall / pleura:Chest wall / pleura:
Pliable chest,Pliable chest,
pneumothorax, pleuralpneumothorax, pleural
effusioneffusion
Airway disorders:Airway disorders:
Croup.Croup.
Pulmonary diseasePulmonary disease
Bronchiolitis,Bronchiolitis,pneumonia, asthmapneumonia, asthma
Increased CO2Increased CO2
production:production:
Sepsis, fever, burnSepsis, fever, burn
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In children, respiratory failure most often isIn children, respiratory failure most often is
due to diseases of the lungs.due to diseases of the lungs.
CNS disorders that lead to respiratoryCNS disorders that lead to respiratory
failure are:failure are:Control abnormalities that cause Type IIControl abnormalities that cause Type II
(hypercapnic) respiratory failure and(hypercapnic) respiratory failure and
usually present without signs andusually present without signs and
symptoms of respiratory distress (such assymptoms of respiratory distress (such as
dyspnea, retractions, or tachypneadyspnea, retractions, or tachypnea
A 16A 16 ld f l i i th ED ftld f l i i th ED ft
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A 16A 16--yearyear--old female arrives in the ED afterold female arrives in the ED after
the SLC result. No other history is availablethe SLC result. No other history is available
because the friends who brought him to thebecause the friends who brought him to theED left.ED left.
The vital signs are:The vital signs are:
Temperature (T) = 96Temperature (T) = 96F;F;
Pulse (P) = 90 beats/min;Pulse (P) = 90 beats/min;
Respiratory rate (R)Respiratory rate (R) = 6 breaths/min;= 6 breaths/min;
Blood pressure (BP) =120/80 mmHg; andBlood pressure (BP) =120/80 mmHg; and
Pulse oxygen saturation is 76% on room air.Pulse oxygen saturation is 76% on room air.
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Arterial blood gasArterial blood gas
(ABG) is: pH = 7.13;(ABG) is: pH = 7.13;
pO2 = 52; pCO2 = 81;pO2 = 52; pCO2 = 81;
HCO3 = 26; andHCO3 = 26; and
oxygen saturation =oxygen saturation =
75% on room air.75% on room air.
Glasgow coma scale: 4.Glasgow coma scale: 4.
Shallow respiration.Shallow respiration.
Pinpoint pupil.Pinpoint pupil.
Lungs and heart areLungs and heart are
normalnormal
Normal ABG values are: pO2 of 80Normal ABG values are: pO2 of 80--100 mmHg; pCO2 of100 mmHg; pCO2 of
3535--45 mmHg; pH of 7.3545 mmHg; pH of 7.35--7.45; and SaO2 of 957.45; and SaO2 of 95--100%100%
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ProblemProblem
This patient has hypercapnia and hypoxia.This patient has hypercapnia and hypoxia.
Of the physiologic events in respiration,Of the physiologic events in respiration,
diffusion, transport, and the tissue/cellulardiffusion, transport, and the tissue/cellular
uptake of oxygen are normal, butuptake of oxygen are normal, but
ventilation is impaired.ventilation is impaired.
Pin point pupil points to the poisoningPin point pupil points to the poisoning
probably narcotic drug.probably narcotic drug.
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An 8An 8--yearyear--old male muscularold male muscular
dystrophydystrophyEamination revealsEamination revealsrhinorrhea and excessiverhinorrhea and excessivesecretions in thesecretions in theoropharynx.oropharynx.
There are scatteredThere are scatteredrhonchi in the lungsrhonchi in the lungsbilaterally. There is nobilaterally. There is nocyanosis.cyanosis.
The neurologic exam isThe neurologic exam is
consistent with hisconsistent with hisdiagnosis of musculardiagnosis of musculardystrophy with muscledystrophy with muscleweaknessweakness
His vital signs are:His vital signs are:
T = 100.2T = 100.2F;F;
P = 120 beats/min;P = 120 beats/min;
R = 12 breaths/min; andR = 12 breaths/min; and
BP = 100/70 mmHg; andBP = 100/70 mmHg; and
Weight = 20 kg.Weight = 20 kg.
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The ABG is: pH = 7.17;The ABG is: pH = 7.17;
pO2 = 46; pCO2 = 78;pO2 = 46; pCO2 = 78;
HCO3 = 32; and O2HCO3 = 32; and O2
saturation = 71% onsaturation = 71% onroom air.room air.
This patient has TypeThis patient has Type
II hypercapnicII hypercapnic
respiratory failurerespiratory failure
secondary to failure ofsecondary to failure ofthe respiratorythe respiratory
muscles from amuscles from a
primary muscleprimary muscle
disorder.disorder.
Normal ABG values are: pO2 of 80Normal ABG values are: pO2 of 80--100 mmHg; pCO2 of100 mmHg; pCO2 of
3535--45 mmHg; pH of 7.3545 mmHg; pH of 7.35--7.45; and SaO2 of 957.45; and SaO2 of 95--100%100%
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A 4A 4--monthmonth--old female withold female with
breathing difficulties.breathing difficulties.
Her vital signs are:Her vital signs are:
T = 103.5T = 103.5 F;F;
P = 190 beats/min;P = 190 beats/min;
R = 64 breaths/min;R = 64 breaths/min;BP = 80/50 mmHg; andBP = 80/50 mmHg; and
Pulse oxygen saturationPulse oxygen saturation= 82% in room air= 82% in room air
Prematurity (30 weeks),Prematurity (30 weeks),respiratory distressrespiratory distresssyndrome requiring asyndrome requiring aventilator. She also had aventilator. She also had a
congenitalcongenitalgastrointestinal problemgastrointestinal problemrequiring surgery at 6requiring surgery at 6weeks of age and hasweeks of age and hascontinued to havecontinued to have
gastrointestinal problems.gastrointestinal problems.She hasShe hasbronchopulmonarybronchopulmonarydysplasiadysplasia
Small for her ageSmall for her age
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Small for her age.Small for her age.
Respiratory distress withRespiratory distress with
retractions, grunting,retractions, grunting,
flaring, head nodding.flaring, head nodding.Skin is pale, sweaty, andSkin is pale, sweaty, and
cyanotic with delayedcyanotic with delayed
capillary fill. There arecapillary fill. There are
rales in both lung fields.rales in both lung fields.The chest roentgenogramThe chest roentgenogram
shows diffuse bilateralshows diffuse bilateral
infiltrates.infiltrates.
The ABG on room airThe ABG on room air
is: pH = 7.61; pO2 =is: pH = 7.61; pO2 =
56; pCO2 = 24; HCO356; pCO2 = 24; HCO3
= 27; and oxygen= 27; and oxygensaturation is 78%.saturation is 78%.
Normal ABG values are: pO2 of 80Normal ABG values are: pO2 of 80--100 mmHg; pCO2 of100 mmHg; pCO2 of
3535--45 mmHg; pH of 7.3545 mmHg; pH of 7.35--7.45; and SaO2 of 957.45; and SaO2 of 95--100%100%
A 2A 2--monthmonth--old is brought to the ED withold is brought to the ED with
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A 2A 2 monthmonth old is brought to the ED withold is brought to the ED with
a chief complaint of not eating fora chief complaint of not eating for
several days.several days.Vital signs are:Vital signs are:
T = 36.8T = 36.8C (R);C (R);
P = 180 beats/min;P = 180 beats/min;
R = 58 breaths/minR = 58 breaths/min
BP = 55/30 mmHg;BP = 55/30 mmHg;
andandPulse oxygenPulse oxygen
saturation is 78% onsaturation is 78% on
room air.room air.
O/E tachypnea,O/E tachypnea,
retractions, andretractions, and
cyanosis. The lungscyanosis. The lungsare clear. The heart isare clear. The heart is
tachycardic with notachycardic with no
murmurs. The livermurmurs. The liver
edge is down 2 cm.edge is down 2 cm.The abdomen is nonThe abdomen is non--
tender. There is notender. There is no
edema and no rash.edema and no rash.
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ABG drawn on 100%ABG drawn on 100%
FiO2 showsFiO2 shows
essentially no changeessentially no changefrom the room airfrom the room air
blood gas: pH = 7.48;blood gas: pH = 7.48;
pO2 = 64; pCO2 = 35;pO2 = 64; pCO2 = 35;
HCO3 = 23; and O2HCO3 = 23; and O2saturation is 79%.saturation is 79%.
An initial ABGAn initial ABG
reveals: pH = 7.48;reveals: pH = 7.48;
pO2 = 62; pCO2 = 34;pO2 = 62; pCO2 = 34;and HCO3 = 23.and HCO3 = 23.
Normal ABG values are: pO2 of 80Normal ABG values are: pO2 of 80--100 mmHg; pCO2 of100 mmHg; pCO2 of
3535--45 mmHg; pH of 7.3545 mmHg; pH of 7.35--7.45; and SaO2 of 957.45; and SaO2 of 95--100%100%
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A 5A 5--yearyear--old male is seen for a cough ofold male is seen for a cough of
several days duration that is not improvingseveral days duration that is not improving
O/E: sitting up andO/E: sitting up and
leaning forward.leaning forward.
wheezing bilaterally.wheezing bilaterally.
Tachypnic withTachypnic withintercostal retractions.intercostal retractions.
Three continuousThree continuous
salbutamol aerosolssalbutamol aerosols
were given bywere given bynebuliser.nebuliser.
Vital signs are:Vital signs are:
T = 96.8T = 96.8F (O);F (O);
P = 170 beats/min;P = 170 beats/min;R = 44 breaths/min;R = 44 breaths/min;
andand
Pulse oximetry is 94%Pulse oximetry is 94%
on room air.on room air.
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His lungs are clear,His lungs are clear,
no wheeze or rales,no wheeze or rales,
and no retractions. Heand no retractions. He
has dry mucoushas dry mucousmembranes and palemembranes and pale
skin with tenting.skin with tenting.
Vital signs are now:Vital signs are now:
T = 96.8T = 96.8F (O);F (O);
P = 102 beats/min;P = 102 beats/min;
R = 16 breaths/min;R = 16 breaths/min;
BP = 65/40 mmHg;BP = 65/40 mmHg;
andand
Pulse oxygenPulse oxygensaturation = 86% onsaturation = 86% on
room air.room air.
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First ABG ; pH = 7.52;First ABG ; pH = 7.52;
pO2 = 58; pCO2 = 24;pO2 = 58; pCO2 = 24;
HCO3 = 14; andHCO3 = 14; and
oxygen saturation =oxygen saturation =88% on room air.88% on room air.
The second ABGThe second ABG
shows: pH = 7.12;shows: pH = 7.12;
pO2 = 68; pCO2 = 70;pO2 = 68; pCO2 = 70;
HCO3 = 14; andHCO3 = 14; andoxygen saturation isoxygen saturation is
90% on 100% FiO2.90% on 100% FiO2.
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of 35-45
mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
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Treatment: Acute Respiratory FailureTreatment: Acute Respiratory Failure
Hypoxemia is more dangerous than hypercarbia.Hypoxemia is more dangerous than hypercarbia.
Administration of supplemental oxygenAdministration of supplemental oxygenVentilatory supportVentilatory support
Extracorporial Membrane Oxygenation (ECMO)Extracorporial Membrane Oxygenation (ECMO)
Never use bicarbonates unless lung can exhaleNever use bicarbonates unless lung can exhale