विवरण
Dyspnea in children can result from a variety of underlying conditions, ranging from respiratory infections and asthma to congenital heart defects and foreign body aspiration. A thorough history and physical examination are essential, focusing on the onset, duration, and associated symptoms. Key diagnostic steps include assessing the child’s respiratory rate, oxygen saturation, and auscultation findings, followed by appropriate imaging or laboratory tests as needed to determine the cause. Early recognition and intervention are critical to manage potential life-threatening conditions effectively.
सारांश
- The presentation focuses on the clinical approach to dyspnea in children, emphasizing the importance of understanding lung function (oxygenation and ventilation) and recognizing signs of increased work of breathing, such as tachypnea, retractions (subcostal, intercostal, suprasternal), and abnormal sounds (stridor, wheezing, grunting). Respiratory distress signifies discomfort during breathing efforts, while respiratory failure indicates system failure with altered sensorium, cyanosis, or ineffective breathing.
- Proper technique for counting respiration rate is emphasized, counting for a full minute with eyes at chest level, only counting chest movement in one direction. Specific cutoff values for tachypnea are provided for different age groups: over 60 in children under 2 months, over 50 for 2-12 months, over 40 for 1-5 years, and over 30 for any age above that.
- Different types of chest retractions indicate different issues, such as subcostal for diaphragm issues, intercostal for decreased parenchymal compliance, and suprasternal for upper airway involvement. Various sounds are described in terms of their anatomical origin: stridor (extra-thoracic airway obstruction), wheezing (intra-thoracic airway obstruction), and grunting (lung parenchyma problem). Abnormal breathing patterns are also discussed, including prolonged expiration, slow breathing (acidotic), rapid shallow breathing (pleurisy), and apneustic breathing (CNS problems).
- The presentation shares clinical case studies illustrating different diagnoses: hyaline membrane disease, transient tachypnea of newborn, congenital diaphragmatic hernia, spontaneous pneumothorax, and bilateral choanal atresia. Key differentiators include history, presence/absence of retractions and grunting, and findings on chest X-ray. Alertness of the baby, pre-term status and diabetic mothers are useful diagnostic points.
- Further case studies covered acute laryngotracheobronchitis, diphtheria (emphasizing the importance of prompt anti-toxin administration even before lab confirmation), bronchiolitis, bronchial asthma, foreign body aspiration, and vascular ring. Differential diagnosis involves location of the sounds, family history of allergies, sudden onset and the use of chest X-ray for vascular ring and hyperinflated lungs to confirm the suspicion.
- Final cases explored ALN with left ventricular failure (emphasizing the importance of prompt diagnosis and treatment with diuretics) and organic acidemia (presenting with lethargy and metabolic acidosis). The lecture concludes with a three-step approach in approaching dyspnea cases in children.
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वरिष्ठ परामर्शदाता बाल रोग विशेषज्ञ, आकांक्षा चिल्ड्रेन हॉस्पिटल, अहमदाबाद
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