PAEDIATRIC EMERGENCY

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RESPIRATORY FAILURE

By: Dr. Siti Ainul Farhana Binti Sahar

By: Dr Siti Ainul Farhana Binti Sahar

Respiratory failure  

 

develops when the rate of gas exchange between the atmosphere and blood is unable to match the body's metabolic demands ptn unable to provide sufficient oxygen to the blood and develops hypoxemia PaO2 < 60 mm Hg or 8 kPa PaCO2 > 50 mm Hg or 6 kPa

Causes of hypoxaemia       Alveolar ventilation (V) and pulmonary perfusion (Q) mismatch Intrapulmonary shunt Hypoventilation Abnormal diffusion of gases at the alveolarcapillary interface Reduction in inspired oxygen concentration Increased venous desaturation with cardiac dysfunction .

Type II Type I -hypoxia (Pao2 < 8kPa) -normal or low PaCO2 -caused by V/Q mismatch Respiratory failure -hypoxia (PaO2 <8 kPa) -with hypercapnia (CO2 > 6 kPa) -caused by alveolar hypoventilation with or without V/Q mismatch .

Extrathoracic airway Respiratory pump AETIOLOGY Central control Intrathoracic airway and lung .

Extrathoracic airway retropharyngeal abscess  bacterial tracheitis  croup  burns  foreign-body aspiration  hypertrophic tonsils and adenoid  laryngomalacia  .

 Respiratory pump Diaphragmatic hernia Flail chest Kyphoscoliosis Duchenne muscular dystrophy Guillain-Barré syndrom Myasthenia gravis .

Intrathoracic airway and lung          Acute respiratory distress syndrome (ARDS) Asthma Aspiration Bronchiolitis Bronchomalacia Pneumonia Pulmonary edema Pulmonary embolus Sepsis .

Central control CNS infection  Drug overdose  Sleep apnea  Strok  .

suggest pleuritis or foreign-body aspiration. pulmonary edema. rhinorrhea. distal weakness that progresses upward . confusion Hypercania ± headache. bulbar dysfunction suggests myasthenia gravis. peripheral vasodilation. restlessness agitation. or other symptoms of an URTI fever or signs of sepsis . tachycardia. apnea associated with a traumatic injury suggests a cervical spinal cord injury Hypoxia ± dyspnea.infections can lead to respiratory failure because of a systemic inflammatory response. drowsiness.Clinical features         cough.suggests Guillain-Barré syndrome. coma . or ARDS pain .

in central control abnormalities.highly negative pleural pressures are required to overcome airway obstruction Auscultation .in intrathoracic airway obstruction. Grunting . and decreased breath sounds (eg. crackles. and effort Bradypnea . pleural effusion). Tachypnea .Clinical features  Respiratory rate. wheezing.for stridor. . alveolar consolidation.expiratory sound made by infants as they exhale against a closed glottis Nasal flaring ± increased effort to breath Suprasternal and intercostal retractions . quality.

an aerosolized vasoconstrictor Systemic corticosteroids .Management for extrathoracic airway obstruction:     Inspired humidity to liquefy secretions Heliox (helium and oxygen gas mixture) .to decrease airway edema .25% .to decrease work of breathing Epinephrine 2.

 .serves as an interface between the patient and the ventilator. to provide passageway for air  oropharyngeal airway .can be used temporarily in the unconscious patient  endotracheal tube .for partial upper-airway obstruction.Airway management: nasopharyngeal airway .

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Correction of hypoxemia to assure adequate oxygen delivery to tissues. in patients with severe hypoxemia.  Supplemental oxygen is administered via nasal prongs or face mask. however.  .  generally achieved with a PaO2 of 60 mm Hg or an arterial oxygen saturation (SaO2) of greater than 90%. intubation and mechanical ventilation are often required.

5 mm of inner diameter (ID)  In infants aged 6-12 months: 3.5 or 4 mm ID  In children older than 1 year: tube size (ID in millimeters) = (age in years + 16)/4  Ventilate with high concentration of O2  .Tracheal intubation In neonates and infants younger than 6 months: 3 or 3.

5 size smaller and larger. a skilled set of hands) .Preparation for tracheal intubation      Monitors (heart rate. nurse. blood pressure. capnography for CO2 detection) Suction and catheters Oxygenation with a bag-valve mask Apparatus (laryngoscope. pulse oximetry. stylets. endotracheal tubes appropriate for the patient's age and endotracheal tubes 0. oral airways) People (respiratory therapist.

 .Lungs and respiratory pump support Continuous positive airway pressure (CPAP) -indicated if lung disease results in severe oxygenation abnormalities  Noninvasive positive-pressure ventilation (NPPV) -assisted ventilation provided with nasal prongs or a face mask instead of an endotracheal or tracheostomy tube.

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