9. YL Kegawatdaruratan Pediatric.pptx

8/20/2019 9. YL Kegawatdaruratan Pediatric.pptx

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PEDIATRIC

EMERGENCY Silvia TriratnaDivisi Pediatri Gawat Darurat

Bagian Ilmu Kesehatan Anak FK UNSRIPalembang


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• RSPIRAT!R" #RGN$"

• $IR$U%AT!R" #RGN$"

• NUR!G" #RGN$"• ND!$RIN #RGN$"

• TRAU#A

• P!IS!NING& INT!'I$ATI!N• (((((((


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• A )undamental *+n*e,t in,ediatri* emergen*- *are is

that *hildren are n+t sim,l-s*aled.d+wn adults and*ann+t be treated as su*h(


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Pediatri* *+nsiderati+n

• A *hild/s ,h-si+l+gi* res,+nse t+ a*riti*al illness +r in0ur- is di1erent)r+m an adult/s((

• $hildren are als+ devel+,ingmentall- and behavi+rall-(

• In)ants and -+ung *hildren *ann+ttell -+u what the ,r+blem is +r whereit hurts(


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PEMERIKSAAN

SULIT DILAKUKAN

KOMINIKASI SULIT

C NDRUNG

K TAKUTAN

PENILAIAN KEGAWATAN

SULIT DILAKUKAN


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CHILD IS NOT SMALL ADULT

The ke- di1eren*es t+ *+nsiderin *hildren are23( 4eight5( Anat+mi*al 6 si7e and sha,e8( Ph-si+l+gi*al 6

*ardi+vas*ular9 res,irat+r-9

immune )un*ti+n:( Ps-*h+l+gi*al 6 intelle*tualabilit- and em+ti+nal res,+nse


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In)ant is nasal breather

• N+se is res,+nsible )+r ;res,irat+r- distress +r )ailure

S+S+metimes9 +ral and nasalsu*ti+ning is all that is

needed??


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Tongue

• %arge in ,r+,+rti+n t+ rest +) +ral *avit-

• %+ss +) t+ne with slee,9 sedati+n9 $NSd-s)un*ti+n

• Fre@uent *ause +) u,,er airwa- +bstru*ti+n

P+siti+ning with +r with+ut+ral airwa- *an be en+ugh(


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Pediatric Cardiopulmonary Arrest

Almost all pediatric “codes” are of respiratory origin

Internal Data. B.C. Children’s Hospital, ancou!er. "#$#.

10%10

%

80%

100%

75%

%ur!i!al rate

HentiNapas

HentiKa!iopu"#ona"

75 $ 0 %

7 $ 11 %

9


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KEHI&ANGANCAIRAN

PRDARAANG

%UKA BAKAR

MA&DI'TRI()'ICAIRAN

S"!K SPTIK PN"(ANTUNG

ANAFI%AKSIS

DI'TRE'PERNAPA'AN

ASPIRASIAS#A

BP

DEPRE'IPERNAPA'AN

KANG TIK ↑

KRA$UNAN

GAGA% SIRKU%ASI GAGA% NAPAS

GAGA& KARDI*P)&M*NA&

HENTI +ANT)NG

Pen,e-a- Kega.atan Ka!iopu"#ona"

10

Pediatric&CP'((((((


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'PIRAT*RY EMERGEN


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The Need for Oxygen

0 – 1 minute: cardiac irritability 0 – 4 minutes: brain damage not likely 4 – 6 minutes: brain damage ossible 6 – 10 minutes: brain damage !ery likely " 10 minutes: irre!ersible brain damage


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Res,irat+r- mergen*ies

• In *hildren9 illness and in0ur-)re@uentl- result in res,irat+r-

*+m,r+mise9 a leading *ause +),ediatri* m+rbidit- and m+rtalit-C

• #anagement +) the airwa- and

breathing sh+uld be -+ur rst*+n*ern in all ,ediatri* ,atients


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Res,irat+r- mergen*ies

#esiratory distress is one of the mostcommon chief comlaints for $hichchildren seek medical care%

nearly 10 & of ediatric emergencydeartment !isits and '0 & ofhositali(ations


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#esiratory distress in children)articularly neonates and infants)must be romtly recogni(ed andaggressi!ely treated because theymay decomensate *uickly%

1+


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#esiratory arrest is the mostcommon cause of cardiac arrest inchildren and outcomes are oor foratients $ho de!elocardioulmonary arrest as the resultof resiratory deterioration

16

P di t i


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Pening/atan

penggunaan 'u-stat

*/sigenG"u/osa

Pu"ses

)ottled

Dingin

Pu2at

CRT

Respon3!oice,

pain4

Ge"isa

Irrita*l

e

Ke6ang

Ko#a

''PKu"itKa!ioas/u"

e

*ganA-!o#en

Gin6a"

+hirdspacing

uids

I"eus

Dysmotili ty

Bo-elslough

Anuria

liguri a

/rine

output 0

Gaga" 6antung

Resistensi /api"e

Ta/i/a!

i

(a!i/a!i

Asystol e

Pediatric&CP'((((((

Maniestasi /"inis

1,


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1-


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Pediatric considerations

The fre*uency of acute resiratoryfailure is higher in infants and youngchildren than in adults) for se!eralreasons%

19


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.actors that contribute to raidresiratory comromise in children

smaller air$ays)

increased metabolic demands)

decreased resiratory reser!es)

inade*uate comensatorymechanisms as comared to adults%

'0


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/xtrathoracic air$ay differences

The area extending from the nosethrough the nasoharynx)oroharynx) and larynx to thesubglottic region of the tracheaconstitutes the extrathoracic air$ay%

This area differs in ediatric !ersusadult atients

'1


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Neonates and infants are obligatenasal breathers until the age of '6months because of the roximity ofthe eiglottis to the nasoharynx%

Nasal congestion can lead toclinically significant distress in thisage grou%

''


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The air$ay is small this is one of therimary differences in infants andchildren younger than - years comared$ith older atients%

2nfants and young children ha!e a large

tongue that fills a small oroharynx% 2nfants and young children ha!e a

cehalic larynx% The larynx is oosite!ertebrae 34 in children !ersus 36,

in adults% '


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The eiglottis is larger and morehori(ontal to the haryngeal $all inchildren than in adults%

The cehalic larynx and large eiglottis

can make laryngoscoy challenging%

'4


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2nfants and young children ha!e a narro$subglottic area%

2n children) the subglottic area is coneshaed) $ith the narro$est area at thecricoid ring%

5 small amount of subglottic edema canlead to clinically significant narro$ing)increased airway resistance, andincreased work of breathing%

'+


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5dolescents and adults ha!e a cylindricalair$ay that is narro$est at the glotticoening%

'6


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2n slightly older children) adenoidal andtonsillar lymhoid tissue is rominent andcan contribute to air$ay obstruction%

ncorrected congenital anatomicabnormalities 7eg) cleft alate) 8ierre

#obin se*uence or ac*uiredabnormalities 7eg) subglottic stenosis)laryngomalaciatracheomalacia maycause insiratory obstruction

',


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2ntrathoracic air$ay differences

The intrathoracic air$ays and lunginclude the conducting air$ays andal!eoli) the interstitia) the leura) thelung lymhatics) and the ulmonarycirculation%

'-


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The intrathoracic air$ays and lunginclude the conducting air$ays andal!eoli) the interstitia) the leura) thelung lymhatics) and the ulmonarycirculation%

'9


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2nfants and young children ha!e fe$eral!eoli than do adults% The numberdramatically increases during childhood)

from aroximately '0 million at birth to00 million by - years of age%

The al!eolus is small% 5l!eolar si(eincreases from 1+01-0 to '+000 ;mduring childhood%

Therefore) infants and youngchildren ha!e a relati!ely small

area for gas exchange0


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3ollateral !entilation is not fullyde!eloed

therefore) atelectasis is more common

in children than in adults%


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The resiratory um includes

the ner!ous system $ith central control7ie) cerebrum) brainstem) sinal cord)

eriheral ner!es) resiratory muscles) and

chest $all%

Respiratory pump differences

'


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The resiratory center is immature ininfants and young children

leads to irregular resirations and anincreased risk of anea%

The ribs are hori(ontally oriented%=uring insiration) a decreased

!olume is dislaced)the caacity to increase tidal !olumeis limited comared $ith that in

older indi!iduals%



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The small surface area for theinteraction bet$een the diahragmand thorax limits dislacing !olume in

the !ertical direction%

The musculature is not fullyde!eloed% The slo$t$itch fatigue

resistant muscle fibers in the infantare underde!eloed%


4


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The soft comliant chest $all ro!ideslittle oosition to the deflatingtendency of the lungs%

This leads to a lo$er functionalresidual caacity in ediatric

atients than in adults) a !olumethat aroaches the ediatrical!eolus critical closing !olume%


+


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6


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3auses of acute resiratorycomromise in children

#esiratory tract

3ardio!ascular

Ner!ous system

>astointestinal

?etabolic and endocrine diseases

@ematology

8oisoning

2N./3T2ON) etc,


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#esiratory tract

-

=ecrease muscle tone

2nfection

5sthma

5nahylaxis

.oreign body 7uer air$ay) lo$er air$ay) esohagus5ir$ay anomalies 7eg) laryngomalacia) laryngosasm)

tracheoesohageal fistula) tracheal stenosis) tracheal ring

Aiologic or chemical $eaons 7eg) anthrax) ner!e agents) ricin

3hest $all abnormalities 7eg) flail chest) oen neumothorax

Thoracic ca!ity conditions 7eg) neumothorax) hemothorax) leuraleffusion) emyema) mediastinal mass

8ulmonary contusion

8ulmonary embolism


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Respiratory tract

9

INFECTION

!ulitis)

/iglottitis#etroharyngeal abscess) 8eritonsillar

abscess3rouAacterial tracheitisAronchiolitis)

8neumonia


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3ardio!ascular

40

Congenital heart disease

5cute decomensated heart failure

?yocarditis

8ericarditis


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Ner!ous system

41

• Depressed entilation !eg, ingestion, CN"

tra#$a, sei%#res, or CN" infection&

• @yotonia 7!ariety of etiologies causing oor

air$ay or resiratory tone and ineffecti!eresiratory effort

• 8ulmonary asiration due to loss of air$ay

rotecti!e reflexes


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'astrointestinal syste$

4'

"plinting fro$ abdo$inal pain!intraabdo$inal tra#$a&

5bdominal distention 7eg) small bo$elobstruction) bo$el erforation

>astroesohageal reflux $ith ulmonary

asiration


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?etabolic and endocrine diseases

4

(etabolic acidosis !eg, diabetic ketoacidosis, seere

dehydration, sepsis, to)ic ingestions&

@yerthyroidism

@yothyroidism

@yerammonemia

@ematologic=ecreased O' carrying caacity 7eg) acute se!ere anemia fromhemolysis) methemoglobinemia) carbon monoxide oisoning

5cute chest syndrome 7atients $ith sickle cell disease


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3auses of uer and lo$erair$ay roblems in children

44

*pper+iway

ower+irway

-oth

• Trauma• 3rou• Aacterial

Tracheitis• 5bscess

• /iglotitis• Neck 2mBury

• 5sthma• Aronchiolitis• 8neumonia• Aruising of

the Cung

• 3ollaseCung

•


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#esiratory roblems ha!e le!els of se!erity

#esiratory distress)

#esiratory failure) and #esiratory arrest%

4+


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#esiratory /mergencies

E #esiratory distress is a state $here achild is able to maintain ade*uateoxygenation of the blood) but only by

increasing his or her $ork of breathing%

E #esiratory failure occurs $hen a child

cannot comensate for inade*uateoxygenation and the circulatory andresiratory systems begin to collase%


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#esiratory /mergencies

E #esiratory arrest

are unresonsi!e and lim) $ith cyanosisaround the lis%

#esiratory rate and $ork of breathingmay be !ery slo$ or absent) or you maynote agonal resiration

Dinfre*uent) gasing breaths $ith nochest rise

Da attern that is seen in dying


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#esiratory arrest

3hildren are unresonsi!e andlim) $ith cyanosis around the lis%

#esiratory rate and $ork ofbreathing may be !ery slo$ orabsent) or you may note agonal

resirationDinfre*uent) gasingbreaths $ith no chest rise

4-


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#esiratory arrest is the mostcommon cause of cardiac arrest inchildren and outcomes are oor for

atients $ho de!elocardioulmonary arrest as the resultof resiratory deterioration

49


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3linical e!aluation of#esiratory /mergency

.ow do yo# initially assess apatient in respiratory distress/

+0

should be rapid and 0#ickly deter$ineif atient needs emergent inter!entions

and rule out life threatening conditions


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P E N A M P

I & A N

) P A

Y A N

A 9 A '

'IRK)&A'I K)&IT

;3

T = Tonus

I =Interactiveness C = Consolability L = Look/Gaze S = Speech/Cry

Suara nafasabnormal

Posisi abnormal Retraksi apas cupin!

hi"un!

#ottle" Pucat Sianosi

s

'EGITIGA PENI&AIAN PEDIATRIK P$%I&TRIC &SS$SS#$T TRI&GL$ = P&T'


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• A)ter *+m,leting the Triangle9begin a m+re *+m,lete

• pediatric primary sur!ey (

AIRWAY

BREATHING

CIRCULATION

DISABILITY


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Tachynea: Eorld @ealthOrgani(ation

+ge -reaths per $in#te

Cess than ' months "60 breathsmin

' to 1' months "+0 breathsmin

1 to + years "40 breathsmin

?ore than + years "'0 breathsmin

#eroduced $ith ermission from: Eorld @ealth Organi(ation% The management of acute resiratory infections inchildren% 2n: 8ractical guidelines for outatient care% Eorld @ealth Organi(ation) >ene!a) 199+% 3oyright F199+ Eorld@ealth Organi(ation%


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=iagnostic studies for e!aluationof acute resiratory distress

-edside testing1 8ulse oximetry

2N=235T2ON:

5ll atients $ith resiratory distress

+4


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-edside testing1 8ulse oximetry

Normal !alues desite hyoxia seen in atients $ith se!ereanemia) carboxyhemoglobin) or sickle cell disease

.alsely lo$ !alues obtained in atients $ith ulse oximeter

not correlating $ith ulse) oor eriheral erfusion) !enouscongestion) methemoglobinemia) certain nail olish colors)and in atients recei!ing !ital dyes 7eg) methylene blueduring surgical rocedures

++


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Test Indications Co$$ents

-edside testing

/ndtidal

3O'7/T3O'

measurement

3onfirmation of

succesful endotracheal

intubationNonin!asi!e monitoring

of !entilation inintubated atients

Nonin!asi!e monitoringfor sedation in children

?easurable in nonintubated and

intubated) atients


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=iagnostic studies for e!aluation

of acute resiratory distressTest Indications Co$$ents

-edside testing

/lectrocar

diogram

3linical susicion of

cardiac disease

7eg) cardiacmurmur) gallo)

differential ulsesor blood ressure

bet$een uer andlo$er extremities

Tyically combined $ith chestradiograh to assess heart si(e and

ulmonary !asculature in order todetermine need for echocardiograhy


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aboratory testing

5rterial blood

gas

=etermine 8aO' for

calculation of

hysiologic measuresof oxygenation 7eg) 5

a gradient) 8aO'.iO'ratio

3orrelate 3O' $ithendtidal 3O'

measurments?easure @ and

correlate $ith !enous@

/ndtidal 3O') ulse oximetry)and !enous blood gases may be

used as less in!asi!e methodsfor ongoing monitoring of

oxygenation) !entilation) andacidbase status if they

correlate $ith arterial blood gasmeasurements

d f l


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aboratory testing/lectrolytes

) blood urea

nitrogen)creatinine

8atients $ith

metabolic acidosis

5ssesses for the resence of

an anion ga and renaldysfunction

>lucose5ltered mental

status

5mmonia

5ltered mentalstatus and other

findings suggesti!e

of urea cycle

defects

d f l


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aboratory testing

3arboxyhemoglobin


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aboratory testing

=dimer

3linical findings

suggesti!e of

ulmonary embolus7eg) lo$ oxygenation)

leuritic chest ain)$edgeshaed

infiltrate on chestradiograh) and

redisosing conditionGeg) sickle cell

disease) thromboticconditionH

8ulmonary embolus is a rare

cause of resiratory distress in

children2maging otions in atients $ith

moderate to high clinicalrobability and ele!ated =

dimer include!entilationerfusion scan)

ultrasound of extremity !einsand dee !eins) 3T ulmonary

angiograhy) and ulmonaryangiograhy

=i ti t di f l ti


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I$aging

Cateral neckradiograh

3linical findings

suggesti!e ofeiglottitismretroharyngealabscess or ingested

foreign body

3rou can usually bediagnosed clinically

$ithout a radiograh

3hest

radiograh

5ll children $ith

significantresiratory distress

and those $ith focal

lung findings

=i ti t di f l ti


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I$aging.orced

exiratory or

bilateraldecubitus

chestradiograh


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I$aging

5bdominalradiograhs

7suine and

uright) orcrosstable

lateral


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3rou lateral neck radiograh

66Cateral neck radiograh sho$ing subglottic narro$ing and

distended hyoharynx consistent $ith acute laryngotracheitis%


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Aacterial tracheitis

6,

Cateral neck radiograh sho$ing intraluminal membranes and tracheal $allirregularity consistent $ith bacterial tracheitis%3ourtesy of #% 8aul >uillerman) ?=) =eartment of #adiology) Aaylor 3ollege of?edicine%


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#etroharyngealabscess

6-

Cateral neck radiograh demonstrating $idening of the retroharyngeal sace and re!ersal of thenormal cer!ical sine cur!ature% The retroharyngeal sace is considered $idened if it is greater than, mm at 3' or 14 mm at 36% The eiglottis and subglottic area in this radiograh are normal%

3ourtesy of Koe Alack) =eartment of =iagnostic 2maging) Texas 3hildrenJs @osital%


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>/N/#5C 5


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,0

52#E5L 5


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52#E5L 5


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5ir$ay and Areathing?anagement

8ositioning is the first ste in air$aymanagement%

2nfants : should be laced in the

Isniffing ositionI by a head tilt3hinlift or Ba$thrust maneu!er thatbrings the angle of the chin u 90

degrees from the bed

,'


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5ir$ay Obstruction

3rou 5 !iral infection of the air$ay belo$

the le!el of the !ocal cords

/iglottitis 2nfection of the soft tissue in the

area abo!e the !ocal cords

.oreign body air$ay obstructions


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3rou

is a common !iral infection that usuallyaffects children ' to 4 years old%

affects the larynx and trachea) although

this illness may also extend to thebronchi%

-+& of children to ha!e mild crou)

less than 1& $ith se!ere crou%

,4


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3rou

Tyical signs include a lo$grade fe!erof -M3 to 9M3)

a sealbark cough) and stridor)

articularly if the child is agitated% onset is gradual%

Areathing roblems $orsen at night) and

may aear se!ere and extremelyusetting to caregi!ers%

,+


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/iglottitis

5 bacterial infection that usually affectschildren 4 to 6 years old

usually resents $ith a higher fe!er rangingfrom 9M3 to 40M3%

=ifficulty s$allo$ing may cause the child todrool%


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Aacterial tracheitis

This bacterial infection causes thetrachea to s$ell)

resulting in artial air$ay obstruction%

@igh fe!er)

lo$itched stridor 7a snoring sound

a roducti!e cough are usually

resent

-0


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&'

Questions ?


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-


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-4

$+ngenital an+malies ass+*iated with strid+r


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gMa"o#ation Caa2teisti2s

N+se Nasal de)+rmities$h+anal atresia +r agenesis9 se,tum de)+rmities9 turbinateh-,ertr+,h-9 vestibular atresia +r sten+sis(

Phar-n

$rani+)a*ialan+malies

An+malies *ausing )a*ial retrusi+n are ass+*iated with u,,erairwa- +bstru*ti+n9 in*luding $r+u7+nHs9 Pierre R+bin9 and A,ertHsS-ndr+me(

T+ngue #a*r+gl+ssia and gl+ss+,t+sis

%ar-n

%ar-ng+mala*ia#+st *+mm+n *ause +) *hr+ni* strid+r in in)ants( Alm+st all,atients ,resent b- J weeks +) age( S-m,t+ms are m+re,r+n+un*ed a)ter u,,er res,irat+r- in)e*ti+ns(

%ar-ngeal webs; ,er*ent l+*ated in the gl+tti* area( $+m,lete webs *auseres,irat+r- distress at birth9 ,artial webs ,r+du*e strid+r9 weak*r- and di1erent degrees +) res,irat+r- distress(

%ar-ngeal *-sts%+*ated in su,ragl+tti* area ma- *ause res,irat+r- distress andstrid+r(

Subgl+tti*hemangi+ma

Presents as ,r+gressive l+ud strid+r with in*reased res,irat+r-distress( Ass+*iated with hemangi+mas in +ther ,arts +) theb+d-(

Subgl+tti* sten+sis#a- be *+ngenital but m+re +)ten a*@uired se*+ndar- t+intubati+n( Usuall- l+*ated 5. 8 mm bel+w the gl+ttis(

Tra*he

a

Tra*heal sten+sisUsuall- ,resent with strid+r +r b+th strid+r and whee7ing( I)sten+sis is signi*ant9 res,irat+r- distress +**urs(

Las*ular rings +rslings

: ,er*ent +) vas*ular rings are s-m,t+mati*(

Ass+*iated with +ther *+ngenital an+malies( #a- be se*+ndar-t+ a vas*ular rin +r * sts( 4+rsens with u er res irat+r


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=efinitions

-6

+c#te respiratory fail#re

• inability of the lung to meet themetabolic demands of the body%

• This can be from failure of tissue

oxygenation andor failure of 3O'homeostasis


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=efinitions

hyoxaemic resiratory failure:

8aO' ≤ +0 mm @g $hen

breathing room air

hyercanic resiratory failure:

8a3O'≥ +0 mm @g%


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Aasic resiratory hysiology

--

The maBor function of the lung is to get oxygen into thebody and carbon dioxide out


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!5$!5

body and carbon dioxide out


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90


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Oxygen in

=eends on

85O'

=iffusing caacity

8erfusion

entilationerfusion matching


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$arb+ndi+ide

4aterva,+ur

!-gen

Nitr+gen


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Oxygen in =eends on

85O

'

.2O' 853O' 5l!eolar ressure entilation

=iffusing caacityOksigen terusmenerus berdifusi dari udara dalam al!eoli ke dalam aliran darahdan karbon dioksida 73O' terus berdifusi dari darah ke dalam al!eoli% Dif#si

adalah ergerakan molekul dari area dengan konsentrasi tinggi ke areakonsentrasi rendah% =ifusi udara resirasi terBadi antara al!eolus denganmembrane kailer% 8erfusion:

8erfusi aru adalah gerakan darah mele$ati sirkulasi aru untuk dioksigenasi)dimana ada sirkulasi aru adalah darah deoksigenasi yang mengalir dalamarteri ulmonaris dari !entrikel kanan Bantung% entilationerfusion matching:

entilasi adalah roses keluar masuknya udara dari dan aruaru) Bumlahnyasekitar +00 ml


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3arbon dioxide out

Cargely deendent on al!eolar!entilation

5natomical deadsace constant buthysiological deadsace deends on!entilationerfusion matching


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3arbon dioxide out

#esiratory rate

Tidal !olume

entilationerfusion matching


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8athohysiology


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@yoxemia) defined as a decreasedle!el of oxygen in the blood

hyoxia) defined as a decreased le!el

of oxygen in the tissues%

%

9,

These ' conditions may be

closely related and may or maynot coexist) but they are notsynonymous


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3auses of @yoxemia

?ismatch bet$een al!eolar !entilation 7 andulmonary erfusion 7P

2ntraulmonary shunt

@yo!entilation

5bnormal diffusion of gases at the al!eolarcaillary interface

#eduction in insired oxygen concentration

2ncreased !enous desaturation $ith cardiacdysfunction lus one or more of the abo!e +factors

9-


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The most imortant abnormalities ingas exchange that lead to resiratoryfailure are

P mismatch)intraulmonary shunt) and

hyo!entilation

99

9 *:


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9I*:

;enti"ation.itout

peusion3!ea!spa2eenti"ationM

Di


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101

8erfusi Balan darah menuBu embuluh darah aru

=ifusi ergerakan oksigen dan karbon dioksida melintasi

membran kailer al!eoli

entilasi ertukaran udara dari rongga al!eoli dan

atmosfer


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;= ;=

3


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7


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7shunting

2ntraulmonary


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P mismatch:

Dead space entilation

5l!eoli that are normally !entilated butoorly erfused

+nato$ic dead space >as in the large conducting air$ays that does

not come in contact $ith the caillaries e%gharynx


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P mismatch:

Dead space entilation

8hysiologic dead sace

5l!eolar gas that does not e*uilibrate fully $ithcaillary blood


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Diff#sion abnor$ality:

Cess common

5bnormality of the al!eolar membrane or a

reduction in the number of caillariesresulting in a reduction in al!eolar surfacearea

3auses include: 5cute #esiratory =istress


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@yo!entilation

can be caused by disease at any of the anatomical sites

in!ol!ed in !entilation%

Arainstem inBury or disease mayresult in imaired functioning of theresiratory centre)

imaired functioning of theresiratory centre $hich suressedby deressant drugs

109


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Brainstem

S,inal*+rdNerve r++tAirwa-

Nerve

Neur+mus*ular 0un*ti+n

Res,irat+r-mus*le

%ung

Pleura

$hest

wall

es at .i2 !isease #a, 2ause enti"ato, !istu-an


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111

• The ner!e roots may be damaged by trauma or tumour• ner!e inBuries and neuroathies such as >uillain Aarre or

critical illness neuroathy may affect motor neuronssulying resiratory muscles

• Neuromuscular blockers or disease of the neuromuscular Bunction 7eg myasthenia gra!is may imair transmission of

ner!e imulses to resiratory muscles• Or the roblem may be in the muscle itself% #esiratory

muscle fatigue) disuse atrohy and malnutrition areimortant causes of resiratory muscle failure in the 23

• 5lternati!ely the roblem may be a roblem of increasedresistance to airflo$% .or examle due to obstruction of the

uer air$ay or bronchosasm• Or the roblem may be decreased comliance of the lung

itself) the leura or the chest $all%

#esiratory .ailure


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#esiratory .ailure


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#esiratory .ailure


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3linical

#esiratory comensation


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3linical

#esiratory comensation Tachynoea 5ccessory muscles

#ecesssion Nasal flaring


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3linical



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3linical



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3linical

5ltered mental state

=PaO2 3 PaCO2 acidosis> ? ?dilatation of cerebral resistance

esseles ICP? >

=isorientation @eadache

coma asterixis

ersonality changes


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3linical

#esiratorycomensation


121/127

Caboratory Testing

5rterial blood gas8aO'

8a3O'

8@

3hest imaging3hest xray

3T sacn

ltrasound

#esiratory .ailure


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Caboratory Testing

Other tests@emoglobin

/lectrolytes) blood urea nitrogen) creatinine

3reatinine hoshokinase) aldolase/R>) echocardiogram

/lectromyograhy 7/?>


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124/127

8 l i t


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Pa!5 kPaM

A b s a t u r a t i + n F =

M

O<

8ulse oximetry

< f


126/127


127/127

C *

I" CRITIC+ TO+C.IE5IN'

-OT. "*R5I5+ +ND+ F+5OR+-E

NE*ROO'ICO*TCO(E 7

Documents

9. YL Kegawatdaruratan Pediatric.pptx