Pediatric Clerkship

Work Up: Respiratory Distress

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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 hxHome 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/

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          Pediatric ClerkshipBy Traci Barnes
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