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/