In this episode, we discuss respiratory distress with Dr. Melanie Rudnick

What is respiratory distress?
Respiratory distress is all-encompassing for symptoms related to breathing problems. In children, causes can be broken up into the general categories of upper airway, lower airway, cardiac, and metabolic.

What are the symptoms and signs?

• Vital signs: tachypnea (unless neurologic or muscular impairment), tachycardia, normal to low oxygen saturation
• Nasal flaring
• Retractions
• Cyanosis (rare)
• Infants: Head bobbing, belly breathing

History-taking: 

• General: 
  • Preceding symptoms (fever, hx of asthma, happened before)
  • Impacted ADLs 
  • PO and urine output 
  • Gestational age
  • Sick contacts
  • Body positions that make symptoms better/worse 
• Airway (laryngomalacia, FBA): 
  • Noises from airway: stridor? barking cough?
  • Acute onset - think foreign body aspiration or allergy to new food 
• Cardiac (see cardiac episode):
  • Sweating, fatigue with feeds, FTT
• Metabolic: 
  • Tachycardia, tachypnea, sweating
  • Significant FTT
  • Dysmorphic features 
  • Organomegaly

PE: 

• Lung: 
  • Expiratory = obstructive 
  • Rhonchi = general inflammation
  • Crackles = fluid overload (cardiac)
  • Wheezing = larger airway (asthma, FBA)

Concerns by age group: 

• Neonates:
  • Full term: Transient tachypnea of newborn, MAS, RDS of newborn 
  •  PPV at birth: pneumothorax 
• Infants: 
  • Infectious (bronchiolitis, GBS)
  • Cardiac/metabolic 
• Toddlers/school age: 
  • Infectious (croup, viral/bac pneumonia)
  • Age 5+: atypical pneumonia 
  • FBA 
  • Anaphylaxis 
• Adolescents: 
  • DKA 
  • Ask HEEADSSS questions: smoking and vaping hx 
    • Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence
  • COVID-19 pneumonia 

For questions or suggestions, please email us at [email protected]

Intro/Outro Music:
Inspirational  by Rafael Krux
Link: https://filmmusic.io/song/5454-inspirational-
License: http://creativecommons.org/licenses/by/4.0/

Disclaimer: The views, opinions and research expressed in this podcast are those of the authors and do not reflect the official policies or position of  Quinnipiac University or any other agency, organization, employer or company.  Assumptions made in the analysis are not reflective of the position of any entity, other than the author(s).  While every effort has been made to ensure that the information is accurate and up to date, it is not intended to serve as the standard of care and any comments, suggestions or correction of errors is welcome.  Privacy is of utmost importance.  All people, places, and scenarios mentioned in the podcast have been changed to protect patient confidentiality.  Any direct similarities to any real person or case is purely coincidental and unintentional. Any mention of drugs or medical products is done in the setting of clinical and educational discussion and does not represent the author(s) endorsement of those drugs or products. The content is for informational purposes only, please consult a healthcare professional regarding any medical concerns that you may have.  The information in this podcast is only intended for use by medical students, resident