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This document provides a clinical overview of Respiratory Distress in pediatric patients, covering everything from initial presentation to long-term follow-up.
1. Basics & Pathophysiology
Definition: The body's response to difficulty in achieving adequate oxygenation and ventilation, characterized by abnormal sounds (wheezing, stridor) and increased work of breathing (nasal flaring, retractions).
Epidemiology: Accounts for approximately 10% of pediatric ER visits and 5% of pediatric ambulance calls.
Mechanism: Involves failure in one of three components: mechanical structures (chest wall/muscles), gas exchange (lungs), or the regulatory system (brainstem).
2. Etiology (Causes)
Upper Airway: Croup, epiglottitis, foreign body aspiration (FBA), or anatomical abnormalities like tonsillar hypertrophy.
Lower Airway: Asthma, bronchiolitis, pneumonia, or cystic fibrosis.
Non-Respiratory: Sepsis, heart failure, metabolic acidosis, or neurological issues (seizures, ingestion).
3. Diagnosis & Physical Exam
History: Focus on onset (acute vs. chronic), presence of fever, choking episodes, and immunization status.
Physical Exam:
Vital Signs: Tachypnea (rapid breathing) and oxygen saturation are critical.
Observation: Assess mental status, "tripod" positioning, and chest wall symmetry.
Auscultation: Listen for grunting, stridor, wheezing, or rales.
Testing: Pulse oximetry and end-tidal $CO_2$. Imaging (X-rays) or labs (ABG/VBG) are used based on severity.
4. Treatment & Stabilization
Initial Steps: Maintain the airway (head-tilt/chin-lift), provide supplemental oxygen, and suction as needed.
Emergency Interventions: * Intubation for impending respiratory failure.
Heimlich maneuver for complete airway obstruction.
Needle decompression for tension pneumothorax.
Medications: Tailored to the cause (e.g., albuterol for asthma, epinephrine for anaphylaxis, antibiotics for pneumonia).
5. Disposition & Follow-Up
Admission Criteria: Required for patients needing supplemental oxygen, frequent nebulizer treatments, or those unable to tolerate oral fluids.
Critical Care: Necessary for patients requiring ventilatory support or exhibiting altered mental status.
Prognosis: Generally excellent if treated early; however, prolonged hypoxemia can lead to organ damage or death.
Pearls: Young children are at a higher risk for respiratory distress due to their unique anatomy and physiology.
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