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Critical Care Pediatrics

Importance of Early Recognition of System Failure

Outcomes in pediatric cardiopulmonary arrest are generally sepsis poorer than in adults.

Projected Impending Existing Failure

· Respiratory Failure

· Circulatory Failure

· CNS Failure

· Organ Failure

Respiratory Failure

Inadequate oxygenation and CO₂ excretion

Respiratory distress is not always present

Causes of Airway Obstruction

· Congenital Lesions

· Acquired Lesions

· Infections

· Epiglottitis

· Laryngotracheobronchitis (croup)

· Retropharyngeal Abscess

· Bacterial Tracheitis

Causes of Acquired Airway Obstruction

· Neurologic Dysfunction - loss of pharyngeal tone

· Trauma

· Foreign Body Aspiration

· Mass Lesion

Management of Airway Obstruction

· Positioning

· Head Tilt

· Chin Lift

- Lifts base of tongue off posterior pharyngeal wall

· Clear Secretions

· Bag-Valve-Mask

· Self-inflating bags

· Anesthesia bags

· Intubation

· Suction

· Oxygen

· Bag-Valve-Mask

· Laryngoscope

· Blades

- Straight

- Curved

- Endotracheal Tubes: 16 + age (yrs)

Causes of Lower Pulmonary Disease and Respiratory Failure

· Bronchiolitis

· Asthma

· Pneumonia

· Acute Respiratory Distress Syndrome

· Aspiration/Near Drowning

Respiratory Pump Dysfunction

· The chest wall is much more compliant in infants

· Paradoxical respirations or thoracoabdominal asynchrony occurs when airway resistance becomes increased

Chest Trauma

· Chest trauma is most commonly cause is by a blunt mechanism, such as a motor vehicle accident.

· Chest trauma is usually associated with other injuries.

· Chest trauma isore likely to injure both intrathoracic and abdominal organs.