Auscultation of the lungs. Semiotics of the respiratory system diseases. The respiratory distress syndromes of and respiratory failure, general clinical symptoms

Respiratory System: Primary function is to obtain oxygen for use by body's cells & eliminate carbon dioxide that cells produce Includes respiratory airways leading into (& out of) lungs plus the lungs themselves Pathway of air: nasal cavities (or oral cavity) > pharynx > trachea > primary bronchi (right & left) > secondary bronchi > tertiary bronchi > bronchioles > alveoli (site of gas exchange) helpusobi 1

The external intercostals plus the diaphragm contract to bring about inspiration: Contraction of external intercostal muscles > elevation of ribs & sternum > increased front- to- back dimension of thoracic cavity > lowers air pressure in lungs > air moves into lungs Contrcnion of diaphragm: diaphragm moves downward > increases vertical dimension of thoracic cavity > lowers air pressure in lungs > air moves into lungs:

The mecanizm of breathing

Physiologicoanatomical peculiarities of the respiratory system The peculiarities of the nose at the neonate a) The nose consists particular by of cartilage, b) The nasal meatuses are narrow, c) There are not inferior nasal meatuses (until 4 years), d) Undeveloped submucosal membrane (until 8-9 years).

The peculiarities of sinuses in children a) The maxillary sinus is usually present at birth, b) The frontal sinuses begin to develop in early infancy, c) The ethmoid and sphenoid sinuses develop later in childhood.

The peculiarities of the pharynx at the neonate a) The pharynx is relatively small and narrow, b) The auditory tubes are small, wide, straight and horizontal

An average respiratory rate at rest of the child of different age is: newborn per minute, infant at 6 months per minute, at 1 year 30 per minute, 5 years 25 per minute, 10 years 20 per minute, years per minute.

Disorders of the respiratory rate Tachypnea is the increase of the respiratory rate. Bradypnea is the decrease of the respiratory rate. Dyspnea is the distress during breathing. Apnea is the cessation of breathing

Factors involved in increasing respiratory rate Chemoreceptors - located in aorta & carotid arteries (peripheral chemoreceptors) & in the medulla (central chemoreceptors) Chemoreceptors (stimulated more by increased CO2 levels than by decreased O2 levels) > stimulate Rhythmicity Area > Result = increased rate of respiration Heavy exercise ==> greatly increases respiratory rate Mechanism? 1.NOT increased CO2 2.Possible factors: –reflexes originating from body movements (proprioceptors) –increase in body temperature –epinephrine release (during exercise) 3.impulses from the cerebral cortex (may simultaneously stimulate rhythmicity area & motor neurons)

Rales Rales result from the passage of air through fluid or moisture. They are more pronounced when the child takes a deep breath. Even though the sound may seem continuous, it is actually composed of several discrete sounds, each originating from the rupture of a small bubble. The type of rales is determined by the size of the passageway and the type of exudate the air passes through. They are roughly divided into three categories: fine, medium, and coarse

Fine rales Fine rales (sometimes called crepitant rales) can be simulated by rubbing a few strands of hair between the thumb and index finger close to the ear or by slowly separating the thumb and index finger after they have been moistened with saliva. The result is a series of fine crackling sounds. Fine rales are most prominent at the end of inspiration and are not cleared by coughing. They occur in the smallest passageways, the alveoli and bronchioles

Medium rales Medium rales are not as delicate as fine rales and can be simulated by listening to the "fizz" from recently opened carbonated drinks or by rolling a dry cigar between the fingers. They are prominent earlier during inspiration and occur in the larger passages of the bronchioles and small bronchi.

Croup Syndromes 1 Acute laryngotracheitis. Laryngotracheobronchitis. 2.Spasmodic croup (more abrupt onset, milder course). Etiology. Viral coup syndrome is caused by a viral infection in the subglottic area of the larynx transmitted. Most cases involve children age 3 months to 3 years. Peak incidence of the disease is in late autumn, early winter. Clinical Findings Often occurring at nigh. Croupy (barky) cough. Inspiratory dyspnea. Hoarseness Coryza (catarrh). Fever. Intercostal, suprasternal, infrasternal retractions. Respiratory rate slightly increased

Croup Syndromes

Acute Epiglottitis Epiglottitis is an infection of the epiglottis and supraglottic structures.The child may also show intercostal retractions and perioral cyanosis and sounds stridorous

Acute Epiglottitis Do not attempt direct visualization of the epiglottis by depressing the tongue as this may cause reflex laryngospasm and obstruction, which may lead to respiratory arrest

Foreign body aspiration Foreign body aspiration is occurred of aspiration of small objects (seeds, nuts, toy parts, buttons, pebbles) into laryngotracheal are or main stem bronchus. Aspiration is frequent in children between 7 months and 4 years. Clinical Findings Signs and symptoms depend on degree of obstruction and nature of the foreign body. The parents describe in history of disease that child was swallowing or playing with a small object followed by sudden onset of cough, choking or gagging or wheezing. There may be a period of no symptoms following initial episode. Foreign body aspiration clinic depends on the level of obstruction. Laryngeal foreign bodies may completely obstruct airways and may elicit stridor, high pitched wheezing, cough or aphonia and cyanosis. Tracheal foreign bodies usually elicit cough, some stridor or wheezing and may produce "slap" sound Bronchial foreign bodies usually cause wheezing or coughing and are frequently misdiagnosed as asthma; may present with decreased vocal fremitis, impaired or hyperresonant percussion note, and diminishes breath sounds distal to foreign body.

Diagnostic tests Upper airway foreign bodies may be visualized on standard roentgenography. Bronchoscopy is usually required for definitive diagnosis of foreign bodies in the larynx and trachea. Treatment 1.Establish airway if child is in obvious distress. 2.Back blows, Heimlich maneuver. 3.Removed by means of direct laryngoscopy or bronchoscopy. 4.Prevention is most important aspect; age appropriate anticipatory guidance, including siblings.

Thank you for attention