Respiratory Distress and Failure Flashcard 2

B. Rationale: Hyperventilation reduces the survival rate to hospital discharge in post-cardiac arrest pediatric patients due to the side effects of increased intrathoracic pressure. However, in the case of increased intracranial pressure, uncal herniation is prevented by providing brief periods of hyperventilation. Hyperventilation decreases the arterial CO2 content, which causes cerebral blood vessels to constrict, leading to a reduction in intracranial pressure.

C. Rationale: In the respiratory management of pediatric patients with cyanotic heart disease, oxygen supplementation should be titrated to the child’s baseline SPO₂.

C. Rationale: Mild croup is characterized by an occasional barking cough and can treated with dexamethasone. Moderate to severe croup is characterized by a frequent barking cough, audible stridor at rest, retractions, agitation, respiratory distress, and decreased air entry by auscultation. Croup can be treated with humidified oxygen, nebulized epinephrine, and dexamethasone, and if the situation does not improve, heliox (helium-oxygen mixture) can be given with a 40% oxygen concentration.

B. Rationale: In the seriously ill child with a medical condition that progresses quickly, respiratory failure can result even without obvious respiratory distress. Poor outcomes are noted if respiratory failure progresses to cardiac arrest. Therefore, the PALS provider immediately treats a seriously ill child through the prompt recognition and effective management of respiratory distress to restore respiratory function and prevent cardiopulmonary failure that progresses to cardiac arrest.

C. Rationale: Early diagnosis is important as high altitude (acute mountain) sickness is easily treated in cases of mild to moderate symptoms. High altitude sickness is reversed by descending to a lower altitude environment to increase oxygen pressure. Supplementation with oxygen is encouraged and, in moderate to severe cases, may be necessary. Other treatments include beta-agonist inhalers to open the airways, a phosphodiesterase inhibitor, such as sildenafil, to increase blood flow to the lungs, and mechanical ventilation with severe respiratory distress.

D. Rationale: Respiratory failure is the inability to maintain adequate oxygenation, ventilation, or both to support the body’s metabolic demands. This condition is most apparent when the child shows a decreased level of consciousness. Other signs of respiratory failure include bradypnea or apnea, inadequate or even absent respiratory effort, and absent distal air movement.

D. Rationale: Cyanotic congenital heart disease needs surgical intervention to correct respiratory problems. Oxygen supplementation corrects acute mountain sickness or high-altitude sickness. Respiratory problems associated with bronchial asthma are treated with bronchodilators, steroids, selective leukotriene receptor antagonists, and oxygen supplementation. Respiratory problems associated with pneumonia are corrected with oxygen supplementation and antibiotics.

C. Rationale: The PALS provider must give each breath over 1 second at a rate of 20 to 30 breaths per minute. While giving each breath, the provider must observe chest rise. Once chest rise is observed, the rescuer ends breath delivery. Ending inhalation once visible chest rise is observed safeguards the patient from complications such as over-ventilation, volutrauma, or pneumothorax.

D. Rationale: Croup is caused by an upper airway infection that produces edema to the larynx and trachea. This edema causes an increase in airway resistance where patients may present with stridor and frequent “barking cough.

D. Rationale: Disordered control of breathing is usually due to neurologic disorders secondary to increased intracranial pressure, neuromuscular diseases, CNS infections, traumatic brain injuries, brain tumor, and hydrocephalus. Some conditions and even medical interventions can induce disordered control of breathing, such as deep sedation, drug overdose, metabolic conditions, and seizures.