Diagnostic Approach of Dyspnea in Children

Nastiti Kaswandani

Dyspnea approach
symptom (subjective) VS sign (objective)

symptom: sensory experience (sensation), that only could be feel and judge by the patient  psychologic disturbances sign: respiratory distress, patient breath with difficulties, involvement of additional respiratory muscle  physiologic disturbances

Dyspnea approach
Acute VS Chronic (sudden onset) (long standing)
 acute:

often resolves with treatment of the underlying condition  chronic: usually result in progressive dysfunction, severe disability, and eventual death the lecture focus on acute dyspnea

Chest and Respiratory System .

disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .Dyspnea classification pathophysiology. anatomic.

anatomic. disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .Dyspnea classification pathophysiology.

Extra-thorax FLOW disorders  rhinitis with nasal obstruction. epiglottitis  thymus hypertrophy Obstruction of proximal / larger airways • clinical: inspiratory stridor • age : infant – below five . nasal polyp  cranio-facial malformation  OSAS  tonsil-adenoid hypertrophy  laringo-tracheo-malacia  larynx papilloma  diphtheria  croup.

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Thymus hyperplasia .

Vascular Rings Secondary Tracheomalacia (Extrinsic) Compression disorder  Collection of congenital vascular anomalies that encircle and compress the esophagus and trachea   Diagnostics seen on MRI and echocardiograph .

disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .Dyspnea classification pathophysiology. anatomic.

Intra-thorax FLOW disorders Obstruction of distal / smaller airways  asthma  bronchiolitis  vascular ring  solid foreign body aspiration  lymph node enlargement pressure • clinical: expiratory effort • age: infants. below five age – bronchiolitis .

Bronchiolitis .

anatomic disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .Dyspnea classification pathophysiology.

aspiration)  atelectasis  pulmonary edema  near drowning  sepsis clinical: inspiratory effort .Intra-thorax VOLUME disorders Lung Parenchyma Disorder  pneumonia (infection.

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Dyspnea classification pathophysiology. anatomic disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .

scoliosis) klinis : inspiratory effort . hematothorax) hernia diaphragmatica diaphragmatica eventration intra-thorax mass (non pulmonary) chest trauma (rib fracture. lung contusion) thorax deformity (pectus excavatum. heart failure (perfusion) pleural effusion (incl’ empyema. pneumomediastinum cardiomegaly.Intra-thorax VOLUME disorders Extra-pulmonary disorders         pneumothorax.

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Dyspnea classification pathophysiology. anatomic. disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .

acute abdomen  aerophagia. peptic ulcer  extreme obesity  peritonitis. appendicitis. MG)  gastritis. GBS. meteorismus  ascites  hepato-splenomegali  abdominal solid tumor clinical: inspiratory constraint .Extra-thorax VOLUME disorders Lung compliance disorders  neuromuscular disorders (CP.

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Dyspnea classification pathophysiology. anatomic disorders EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .

DHF. usually adolescent) poisoning: salycylate. encephalitis encephalopathy (typhoid. alcohol trauma capitis CNS disease sequelae clinical: deep rapid breathing . metabolic) psychologic (anxiety.Extra-thorax VOLUME disorders Respiratory center disorders  anemia        metabolic acidosis CNS infections: meningitis.

Clinical approach symptomatology pathophysiology pathology treatment dyspnea evaluation etiology treatment ~ etiology .

at activity. wheezing other signs & symptoms  80% of cases can be diagnosed .1 first step : ANAMNESIS  identity: age. sex. etc  dyspnea:       acute. cough.Dyspnea clinical approach . factors make worse / better response to therapy    underlying cardiopulmonary / neuromuscular disease associated symptoms: chest pain. chronic. day or night triggers. recurrent degree of dyspnea how long has been dyspneic timing of dyspnea: at rest.

2 next step : PHYSICAL EXAMINATION sternal.Dyspnea  clinical approach . sign of heart failure  other holistic examination  inspiratory : nasal flaring. intercostal. rales. epigastrium). subcostal. retraction (supra . stridor. abdominal muscle contraction respiratory examination: respiratory rate. chest indrawing (retraksi arkus kosta)  expiratory : prolonged expirium. wheezing. symmetry of breath sound & on percussion.

ultrasound.  Blood gas analysis  Pulmonary function test  Electrocardiography. bronchoscopy  . laryngoscopy. echocardiography  Rhinoscopy.Dyspnea clinical approach .3 further step : SUPPORTING EXAMINATION Routine blood examination  Pulse oximetry  Imaging diagnostic: CXR.

Dyspnea clinical approach . before we can identify the etiology. since most cases need it  other cases. does not need O2 (see next)  .4 last step : TREATMENT based on etiology  first aid: give O2.

Dyspnea classification maybe oxygen is not needed EXTRA thorax INTRA thorax INTRA thorax FLOW disorders Obstruction of proximal / larger airway Obstruction of distal / smaller airway Lung parenchyma disorders Extra-pulmonary disorders Lung compliance disorders Respiratory center disorders VOLUME disorders EXTRA thorax .

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