Transcript Choking and Foreign Body Airway Obstruction (FBAO)

Walaa qadora •
Haneen shaqora •
Nabawiya el daour •
Jafraa nasser •
Manar aoda •
Azesa awad •
Heba awad •
Nada saleh •
Today our group will talk about care of
respiratory system in children .
firstly :
I will produce a short introduction about
anatomy of respiratory system in child
And the differences between the child
respiratory system and adult respiratory
system
What are the
differences
between adult
respiratory system
and children
respiratory system
?
The diameter of an infant’s airway is approximately 4 mm, in
contrast to an adult’s airway diameter of 20 mm. An
inflammatory process in the airway causes swelling that narrows
the airway, and airway resistance increases.
Note that :
swelling of 1 mm reduces the infant’s airway diameter to 2 mm,
but the adult’s airway diameter is only narrowed to 18 mm. Air
must move more quickly in the infant’s narrowed airway to get
the same amount of air to the lungs. The friction of the quickly
moving air against the side of the airway increases airway
resistance. The infant must use more effort to breathe and
breathe faster to get
"Respiratory
infections are the first leading cause of infant
mortality in palestine; Conditions in the prenatal period
form major cause of deaths among children under five
years Based on Ministry of Health data for 2011, the
leading cause of infant mortality in the West Bank was
respiratory tract infections with 39.7%: 42.0% for male
children and 37.0% for female. This was followed by infant
mortality caused by premature and low birth weight with
16.2%: 17.0% for male children and 15.2% for female
children.
PEDIATRIC RESPIRATORY
ASSESSMENT
Nose: Key Points
• Exam nose & mouth after ears
• Observe shape & structural deviations
• Nares: (check patency, mucous membranes,
discharge, turbinates, bleeding)
• Septum: (check for deviation)
• Infants are obligate nose breathers
• Nasal flaring is associated with respiratory
distress
Nose and Throat
Sinusitis:
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Fever
Purulent rhinorrhea
Facial Pain – cheeks, forehead
Breath odor
Chronic cough – could be day and night
Mouth & Pharynx: Key Points
• Lips: color, symmetry, moisture, swelling,
sores, fissures
• Buccal mucosa, gingivae, tongue & palate for
moisture, color, intactness, bleeding, lesions.
• Tongue & frenulum - movement, size &
texture
• Teeth - caries, malocclusion and loose teeth.
• Uvula: symmetrical movement or bifid uvula
• Voice quality, Speech
• Breath - halitosis
Neck: Key Points
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√ position, lymph nodes, masses, fistulas, clefts
Suppleness & Range of Motion (ROM)
Check clavicle in newborn
Head control in infant
Trachea & thyroid in midline
Carotid arteries (bruits)
Torticollis
Webbing
Meningeal irritation
Chest Assessment
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All 4 quadrants
Front and back
Take the time to listen
Be sure about “lungs CTAB”
(clear to auscultation bilaterally)
Auscultation
-All 4 quadrants
-Front and back
-Take the time to listen
-Be sure about “lungs CTAB”
(clear to auscultation bilaterally)
Lungs & Respiratory: Key Points
• Quality of Respirations:
– Symmetry, Expansion, Effort, Dyspnea
• S & S Respiratory Distress:
– Color: cyanosis, pallor, circumoral cyanosis, mottling
– Tachypnea
– Retractions
• Nasal flaring
• Grunting (expiratory)
• Stridor - inspiratory: croup
• Adventitious sounds:
• Crackles / Rales
• Rhonchi - course breath sounds
• Wheeze – inspiratory vs. expiratory
Lungs & Respiratory: Key Points
• Clubbing
• Snoring (expiratory): upper airway obstruction,
allergy,
• Fremitus:
– Increased in pneumonia, atelectasis, mass
– Decreased in asthma, pneumothorax or FB
• Dullness to percussion: fluid or mass
Work of Breathing
*Increased or
Decreased
Respirations
*Stridor
*Wheezing
Chest Assessment
• Auscultation
• Wheezing
• Retractions
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Subcostal
Intercostal
Sub-sternal
Supra-clavicular
– Red Flags:
– grunting
– nasal flaring
stridor
All that Wheezes
isn’t always Asthma
Think:
*Infection
*Foreign body aspiration
*Anaphylaxis
•Insect bites/stings, medications, food
allergies
And all Asthma
doesn’t always Wheeze!
•Cough
•Fatigue
•Reduced exercise
tolerance
Coughs
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Allergies
Asthma
Infections – pneumonia, bronchitis, bronchiolitis
Sinusitis – Post-nasal drip
GERD
Cigarette smoking
Exposure to secondhand smoke,
Other pollutants
Cough - Characteristics
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Dry, non-productive
Mucousy – productive
Croupy
Acute – less than 2-3 weeks
Chronic – more than 2-3 weeks
Associating Symptoms
Chest Pain
• if severe, acute, unremitting – needs immediate
attention - very rare
• Non-cardiac – most common
– Musculoskeletal: costochondritis
– Pulmonary
– Gastrointestinal e.g. GERD
– Psychogenic
– Often no significant physical findings
• Must rule out Cardiac origin – refer to PCP or
pedicardiologist
When you have asthma ?
House dust mites
• Washing the bed pillow ,sheet
And cover every weak.
• Use special allergy mattress and
Bed cover
• if possible , get rid of carpets, extra
Pillow, and upholstered furniture.
• Limit stuffed animals in children
Room .
• Dust and vacuum often.
• Use dehumidifier in damp area.
Animal and molds
• Don’t have furry pets in your home
• Repair leaks and clean with fungiSide or bleach and water when visible
• Use dehumidifier in damp area
Outdoor trigger
tree , pollens, grass , air pollution , smoke , car exhaust
• Keep your door and window shut
• Avoid outdoor activity during high
pollens
• Shower and shampoo after being
Out side
Strong smells
• Stay out side the house or apartment when
these chemical and spray being used.
smoker
• Smoker in families with asthma
Should quite.
• Should never smoke indoor.
Infection
• Get your flu shot every year
• Sea your provider for proper treatment
• Ask your provider for asthma medecin prior to
flu season to prevent asthma attack
If your child have the virus every year
Common cold and sinusitis
• Don’t ignore a drippy nose
• Washed hand frequently
• Don’t share toothbrush or toothpaste when
you have cold
Weather change
• Avoid doing much out door when the weather
very hot or cold.
Exercise
-If your exercise is one of your trigger,Your provider can
give you medicine10 to 15 mint before exercising to
prevent asthma attack.
-Do warm –up exercise 6 to10 mint prior exercise.
-Make a plane to be active and do regular exercise.
Peak flow meter
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A peak flow meter is simple to use for tracking
asthma
Here's what to teach:
Stand up or sit up straight.
Make sure the indicator is at the bottom of the meter
(zero).
Take a deep breath in, filling the lungs completely.
Place the mouthpiece in the mouth and blast the air
out as
hard and as fast as possible in a single blow.
Remove the meter from the mouth and record the
number
that appears on the meter.
Repeat three times
Interpreting Peak Expiratory Flow
Rates
• Green: (80-100% of personal best) signals all
clear and asthma is under reasonably good
control
• Yellow (50-79% of personal best) signals caution;
asthma not well controlled; call dr. if child stays in
this zone
• Red (below 50% of personal best) signals a
medical alert. Severe airway narrowing is
occurring; short acting bronchodilator is indicated
Aerosol therapy
• Aerosol therapy is used for respiratory care in
the treatment of some disease such as
Asthma and Cystic Fibrosis .
• The purpose of Aerosol therapy is to deliver a
fine mist medications into the lungs whether
to relieve the spasm or to liquefy bronchial
secretions to be removed easily.
Aerosol therapy
• The most common medications prescribed for
CF. is Albuterol, a bronchodilator that helps
open the airways and relax the airways
muscles.
• Necessary equipment includes a compressor ,
which blows air into a nebulizer or cup
changing liquid medicine into a mist
Aerosol therapy
Home Teaching Inhaled Medications
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Teach how to use medication
Correct dosage
Prescribed time
Proper use of inhaler
Device for Inhalation Therapy
• Selective of device include:
1-Nebulizer
2-Metered dose inhaler MDI
3-Dry powder inhaler DPI
Metered-Dose Inhaler with spacer
• A spacer is a chamber that can be attached to a metereddose inhaler (MDI). The spacer chamber allows the
medication to be held in the chamber before it is inhaled so
the child can inhale the medicine in one or many breaths,
depending on ability.
• A spacer:
 Helps prevent getting a yeast infection in the mouth
(candidiasis)
 Increases the amount of medicine delivered directly to
airways
Reduces the amount of medicine swallowed, which
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minimizes side effects.
How to use a Metered _Dose Inhaler
with spacer
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Remove the cap from the inhaler.
Remove the cap from the spacer.
Shake the inhaler well for 4 seconds.
Insert the inhaler into the open end of the
chamber.
5. Insure that the inhaler fits properly.
6. Stand up and turn your head back slightly.
How to use a Metered _Dose Inhaler with spacer(cot..)
7. Before starting to inhale , breathe out
completely away from the spacer.
8. Place the mouthpiece between your teeth
and close your lips tightly around the
mouthpiece.
9. Press the inhaler once and breathe slowly and
deeply.
10. Hold your breath for 10 seconds.
How to use a Metered _Dose Inhaler with spacer(cot..
11. Remove the inhaler and breathe out slowly.
12. Repeat the steps from 3 to 10 after 30
seconds, if another dose is required.
Using nebulizer
• If using a face mask, the mask must fit probably and
tightly over the nose and mouth.
• If using a mouthpiece, it must be between the teeth and
lips close tightly around it.
• Waving the mouthpiece around the mouth will not get
the medicine in to lung .
• Rinse mouth after nebulizing budesonide.
• Give infant a drink of water.
continue
• Cup , mouthpiece and mask should be wash
daily with mild soup and water.
• Rise in a vinegar and water solution , and
dried. Never wash the tube.
• Change filter of the nebulizer as manufacture
recommendation
Know your sings and symptom
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Coughing , sneezing ,and itchy throat.
Tight chest and wheeze.
Shortness of breath.
Wake up at night.
Fast heart beat and breathing.
Headache.
Take action
• Work with your provider to make an action
plan.
• Learn your child wearing sings .
When you feel an attack coming:• Get away from trigger factor.
• Give the child quick – relief medicine.
• If he stile have shortness of breath and
wheezing , get emergency help
Cystic Fibrosis Care
• Keep airway clearance
• by doing Chest Physiotherapy at least twice a
day to increase sputum expectoration .
• CPT (chest physical therapy) works in
combination with postural drainage
• Postural drainage means placing patients in a
various positions using gravity to help move
mucus upwards toward the large airways.
Postural drainage
chest physical therapy
• then clapping firmly over chest and back on
part of the lung segment to shake the mucus
loose. Once loosened, the mucus will fall to
the large airways, then can be coughed out
Exercise of cystic fibrosis
• Exercise should be encouraged in children and
with cystic fibrosis as regular exercise will help
clear mucus from the lungs, build up
respiratory muscles, and improve ability to
breathe.
• Just remember to drink plenty of fluid to
prevent dehydration and boost calories to
prevent weight loss
Choking and Foreign Body
Airway Obstruction(FBAO)
What is Choking?
• Choking is the physiological response to
sudden airways obstruction.
Choking……
• A foreign object that is stuck at the back of the
throat may block the throat or cause muscular
spasm.
• Young children especially are prone to
choking. A child may choke on food, or may
put Small objects into their mouth and cause a
blockage of the airway
Foreign body airway obstruction
(FBAO)
• Foreign body airway obstruction (FBAO)
causes asphyxia and is a terrifying condition,
occurring very acutely, with the patient often
unable to explain what is happening to them.
If severe, it can result in rapid loss of
consciousness and death if first aid is not
undertaken quickly and successfully.
Immediate recognition and response are of
the utmost importance.
Assess severity
*Mild obstruction:
• Children are fully responsive, crying or verbally
respond to questions, may have loud cough
(and able to take a breath before coughing).[
Sever obstruction :
*Is indicated by:
• Person is unable to speak, cry, cough or
breathe.
• If the person doesn’t receive assistance, they
will eventually become unconscious.
Management
For infant:
1-Call for help.
2-Approach the infant and grab his jaw.
3-Support the infant face down on your forearm and keep his
head lower than the trunk by using your thigh to support your
forearm.
For infant(cont…)
4-Deliver 5 back blows between the shoulder blades.
(make sure you do not hit him in the head,then deliver 5 slow
and deep chest thrusts.
For infant(cont…)
5-If the infant becom unresponsive ,call for an
ambulance.
6-Check his mouth.
7- Provide 5 breaths(mouth-to-mouth-and-nose)
For infant(cont…)
8-Deliver 30 chest compressions and 2 mouthto-mouth-and-nose breath.
(Repeat 3 times)
9-Continue until help arrives.
Management
• For Children:
1-Partial obstruction:
Approach the child and encourage him to cough.
2-Complete obstruction:
-call for help and stay with the child.
3-Grab the childs jaw and position him over your bent knee.
4-Deliver 5 back blows between the shoulder blades and 5
abdominal thrusts.
5-If the child becoms unresponsive,call for an ambulance.
Management(cont..)
6-Chek his mouth.
7-provide 5 breaths(mouth-to-mouth)
8-Deliver 30 chest compression and 2 mouth-tomouth breaths
(Repeat 3 times)
9-continue until help arrives
prevention
Children, in particular mobile babies and toddlers •
who orally explore their environments, are at risk
from FBAO. Carers need to maintain vigilance for
objects such as coins, balloons, marbles. Risky foods
in childhood tend to be round in shape and include
sweets, nuts, grapes and improperly chewed other
food
Meconium Aspiration
• Meconium aspiration syndrome (MAS) occurs
when a neonate inhales thick, particulate
meconium.
• This is usually secondary to fetal hypoxia
which causes increased peristalsis, relaxation
of anal sphincters and reflex gasping.
Meconium aspiration syndrome (MAS)
• Significant aspiration of thick meconium, however,
can induce 4 major pulmonary effects:
1-airway obstruction
2- Surfactant dysfunction
3-chemical pneumonitis
4-Pulmonary hypertention.
Presentation
• Obvious presence of meconium or dark green
staining of the amniotic fluid.
• Green or blue staining of the skin at birth.
• Baby appears limp, with a low Apgar score.
• Breathing is rapid, laboured, or absent.
• Signs of postmaturity (eg peeling skin) are
present.
• Fetal monitor may show bradycardia.
*Management
-Suction
- Oxygen:
- depending on the degree of respiratory distress, respiratory
support should be provided with oxygen via a nasal cannula,
continuous positive pressure ventilation or conventional
mechanical ventilation.
- Antibiotics:
(eg gentamicin)
Management(cont…)
- Surfactant :
meconium flowing into the lung deactivates the activity of surfactant,
causes a rise in surface tension and presaging the onset of
respiratory distress.
- Inhaled nitric oxide :
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this is useful in the management of pulmonary hypertension
associated with meconium aspiration syndrome (MAS). It is thought
to act by relaxing smooth muscles in the pulmonary vessels causing
vasodilatation, as well as promoting bronchodilation.
- Steroids - inhaled or systemic - have been used to good effect
in some studies.[
Prevention
-More frequent diagnosis of abnormal fetal heart rate
patterns and the avoidance of post-mature delivery by
elective Caesarean section have both been shown to
reduce the incidence of meconium aspiration
syndrome (MAS).
- The use of uterine stimulants such as misoprostol is
associated with meconium staining of amniotic fluid
and amniotomy during labour may be a risk factor for
MAS.