Common disorders of Pediatric Respiratory System: Allergies

• Allergies
• Allergic Rhinitis caused by environmental factors (ie dust mold pollen pet dander) is an over reaction of mast cells, T-Lymphocites, and eosinophils that causes inflammation in the tissue lining the nose throat and airways.
• Leads to sinusitis, cough, sore throat from post nasal drip, ear infections. Extreme cases may lead to bacterial infections such as Upper Respiratory infection or Pneumonia.
• Signs of allergies: 
• Red, watery eyes
• Swollen, pale mucosa in the nose with clear drainage
• Allergic shiners (a purple hue under the eyes)
• Nasal crease (a skin crease on the bridge of the nose from frequent itchy nose rubbing)
• Mouth breathing and a "nasal" voice (due to nasal congestion)
• Treat with
• Antihistamines: Zyrtec, Allegra, Benadryl (Diphenhydramine)
• Intranasal Corticosteroid: Flonase, Nasonex, Nasocort, Rhinocort

Lab Values and Meanings for Pediatrics

Ability to Ventilate and ability to transport the items being ventilated ie O2 or PCO2.

• Oxygen (O2)
• Healthy person should be >95%
• Compromised individuals (ie smokers, actively asthmatic...) should be above 90%.
• Always check your sensor for accuracy.
• does the patient look like they are at 60%....or are they pink with no distress.
• is the sensor properly placed..ie sensors should be perpendicular to each other
• is the patient causing artifact ie wiggling
• try testing it on yourself/comparing to another sensor. If it is not working correctly label appropriately and notify proper people.
• replace the sensor if needed.
• Carbon Dioxide (CO2) 
• CO2 usually builds up due to the patient not ventilating well and thus not excreting the CO2.
• an Acid
• Reflects the respiratory component of acid base balance
• If the patient is acidic (pH is low) and PCO2 is high then the child is no longer compensating for the  respiratory distress.  High PCO2 is called hypercapnia.
• Hemoglobin
• Hemoglobin is a protein-iron compound in the blood cells that carries oxygen from the lungs to all cells. Carbon monoxide can bind to hemoglobin taking oxygen's place.
• Low Hemoglobin means less oxygen picked up and taken to the body thus lower O2 levels.
• Hematocrit
• The percentage blood that is made of red blood cells.
• Less red blood cells = less hemoglobin which is in red blood cells = less O2....so watch for low O2 levels.

Basic difference between adult and kids + intubation

• Airway is smaller
• Tongue is larger within oral/pharyngeal cavity
• Vocal cords have a lower attachment
• <10yrs Larynx is funnel shapped and Airway is narrowest below vocal cords
• Intubation:
• Below 8 Don't Inflate. The anatomy acts like a cuff so that when intubating you may not need a cuff especially in kids less than 8 years old.
• Endotracheal size formula: (Age(yr)/4) + 4 for example age is 7 years old then (7/4) +4=7
• Premie use 2.5, Term 3.0, 6mn 3.5, 1 year 4.0
• Laryngoscope Blade size:  (straight blades for infants/toddlers) 
• 1 yr=1.5
• 6mn =1.0
• Term = 0-1
• Premie = 0
• Age 2-10 yr = 2
• Age 10 yr = 3
• If no trama then NG tube placed to prevent gastric distention.
• Assessment for problems: DOPE - Displacement, Obstruction, Pneumothorax, Equipment Failure.
• >10 yrs Larynx is cylinder shapped and Airway is narrowest at glottic inlet