Work Up: Respiratory Distress Pediatric Clerkship

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